The Case for Having Dentists on Your Cancer Care Team

Caring for your oral health before, during, and after cancer treatment—a growing focus at NYU College of Dentistry—can minimize complications. Consider Dentists as apart of your Cancer Care.

Cancer treatment often takes a team of health professionals—oncologists, nurses, surgeons, radiologists, pathologists, and social workers—to coordinate and provide comprehensive support for patients. At NYU, dentists are increasingly being considered an important part of the cancer care team.  

Original Article

When faced with a cancer diagnosis, many patients push other health care to the side to focus on addressing the disease. But people with cancer can experience unique issues related to their oral health. For instance, radiation to the head and neck can damage the salivary glands, hurting their ability to produce saliva, which can lead to tooth decay or cavities. Radiation and chemotherapy can also cause painful mouth sores. Patients with cancer that has spread to their bones, or who are undergoing treatment that can weaken their bones, may be prescribed high doses of antiresorptive medications such as bisphosphonates. These medications can cause a rare condition called osteonecrosis of the jaw, in which the jawbone is exposed through the gums.  

Other treatments—including chemotherapy and bone marrow transplants—lower the immune system, leaving patients susceptible to infection. Infections in the mouth during cancer treatment are especially dangerous, given the immune system’s inability to fight back.

“An abscessed tooth may mean having to stop chemotherapy to treat the infection,” says Denise Trochesset, clinical professor and chair of the Department of Oral and Maxillofacial Pathology, Radiology and Medicine at NYU College of Dentistry.  

“Fortunately, intervening early to eliminate infection can minimize complications during the course of therapy,” says Dalal Alhajji, clinical instructor in the Department of Oral and Maxillofacial Pathology, Radiology and Medicine at NYU College of Dentistry.

Bridging the gap between cancer care and dental care
Many cancer centers lack services and protocols related to oral health; Trochesset and Alhajji are part of a small but growing number of oral health professionals working to change this.

Dalal Alhajji, DMD, MSD

NYU Dentistry’s Dalal Alhajji, DMD, MSD

Denise Trochesset, DDS

NYU Dentistry’s Denise Trochesset, DDS

“We need to give dentists a primary role on the cancer care team,” says Alhajji, who completed a fellowship in dental oncology and now specializes in treating cancer patients.

Over the past few years, NYU College of Dentistry has strengthened its connections with cancer providers at NYU Langone’s Perlmutter Cancer Center, particularly those treating head and neck cancers and diseases requiring bone marrow transplants. A growing number of patients with certain cancers are referred to the College of Dentistry for an exam prior to starting treatment. They’re seen at the NYU Dentistry Oral Health Center for People with Disabilities, where Alhajji oversees their care.

“We might not think of cancer patients as having a disability, but they may be medically disabled, even if for just a short period of time,” explains Trochesset.

During an exam and cleaning, Alhajji and dental students check for any signs of infection or other issues that could complicate cancer care. After the initial exam, patients can either return to their regular dentist or continue their care at the Oral Health Center for People with Disabilities, where general dentists and specialists are under one roof.

Closing this gap in care is not only transformative for patients, but for dental students as well. Because all NYU dental students rotate through the Oral Health Center for People with Disabilities during their third and fourth years of training, they now gain experience with a patient population being treated for cancer. 

“Our dental students already learn about cancer in their oral medicine and pathology courses—but now, it’s no longer just something they read about in their textbooks, which is unique for a dental school,” says Trochesset.

What cancer patients can do to keep their mouths healthy
Keeping up your oral hygiene before, during, and after cancer treatment is critical, according to Alhajji and Trochesset. They recommend that people diagnosed with cancer take the following steps to protect their oral health:

  • Visit a dentist before you begin cancer treatment for an exam, X-rays, and cleaning. The dentist may check for infections in your mouth, which can complicate cancer care that lowers your immune system. If your dentist finds an infection, they can treat it—through filling a cavity, extracting a tooth, or performing a root canal—prior to your cancer treatment.  
  • If you’ll be receiving radiation for cancer of the head or neck, Trochesset recommends asking your dentist about creating a custom mouth guard to wear during radiation treatments. A mouth guard can protect areas of your mouth from unnecessary radiation, and may be particularly useful for those with metal fillings and crowns. You may also benefit from jaw exercises or a referral to a physical therapist. 
  • Keep up your oral hygiene during cancer treatment. Alhajji recommends that you continue brushing your teeth, although you may want to switch to a very soft toothbrush. You may also need to take a break from alcohol-based mouthwash if you develop mouth sores.
  • Stay hydrated, especially if you are experiencing dry mouth.

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When A Dentist Dies from Oral Cancer

oral cancer

Dr. Manu Dua, a dentist practicing in Calgary, Alberta, discovered a lesion on his tongue around his 33rd birthday. He showed a photo of it to his sister, Parul, who is a dentist practicing in New York. “Get it biopsied,” she pleaded. He replied, “A dentist can’t have oral cancer. I’m too young.” Less than 2 years later, Dr. Manu Dua, a dentist, died from oral cancer.  He was 34. What happens with a Dentist dies from Cancer?

Manu had no risk factors for oral cancer.  He was young and didn’t smoke. He only had an occasional drink. He was athletic and had a healthy diet.  No one would suspect that the lesion on his tongue was cancer, not even him, not even the oral surgeon who thought it was lichen planus and prescribed him a steroid. His symptoms worsened: trouble speaking, pain on eating, and difficulty sleeping. Then came the devastating biopsy result – Stage 2 squamous cell carcinoma of the tongue.

The cancer was treated by removing the left half of Manu’s tongue and the lymph nodes from the left side of his neck. His tongue was repaired using the radial artery from his left arm and skin from his right thigh. He had to learn to speak, chew and swallow again. He recovered quickly and returned to the dental office that he recently opened. Less than a year later, he noticed swelling on the left side of his neck after he had a restoration. The cancer was back. A malignant lymph node on the left side of his neck was left behind. The dentist’s oral cancer had spread throughout his body. It was the beginning of the pandemic and Manu had to return to the hospital for more cancer treatment.

Manu endured 33 rounds of chemotherapy and radiation around his 34thbirthday. He sold his practice and decided to focus on his health. He bought a Porsche and was ready to enjoy life. A few months later he had a chest CT. A large tumour was growing in his chest. The treatment didn’t work.

Manu deteriorated over the next few months. The young dentist known for his muscular build and fun personality could barely walk or talk. He could barely breathe due to the fluid build up in his lungs. It hurt to eat and sleep. As he struggled to survive, alone in a hospital room, he wrote a book about what he learned from living and suffering called, Life Interrupted, Dr Dua’s Survival Guide. (Available on Amazon and on BN.com). He wrote, “One of the most important things that I have learned during these turbulent and difficult times is to accept the loss of control, and continue to ride the wave day by day. What is imperative is inner peace, strength and truly believing that there will be a better life in this world or the next.”

Manu, a dentist was dying of oral cancer. His parents called Parul asking her to come and say goodbye, as he went into organ failure. Across the border during a pandemic, Parul frantically got documents and COVID tests to get clearance to visit Canada. She didn’t make it in time. On a WhatsApp call, Parul tearfully said goodbye to her younger brother. “You can let go now.”

This is a sad story, but the story doesn’t end here. A new story has started. It’s a story that involves all of us doing thorough oral cancer screenings, referring suspicious lesions for biopsies, talking to our patients about decreasing risk factors, and encouraging the HPV vaccine which decreases the risk of oropharyngeal cancers. Manu is not here to tell his story. But we are here, and we can write a new story where no one dies from oral cancer.

ABOUT THE AUTHORS

Dr. Parul Dua Makkar started in Dentistry with a DDS in 2003, then worked in private practice in Calgary. In 2006, she moved to New York and did one-year general practice residency at Staten Island University Hospital. Makkar currently has a private practice in Long Island, New York, where she lives with her husband and two sons.

Email: parul_dua@yahoo.com. Instagram: @pdmfamilydental.com

Dr. Sanjukta Mohanta is a general dentist practicing in a publicly funded dental clinic in Brampton, Ontario. She graduated from the University of Toronto Faculty of Dentistry in 1999. She volunteers with the Canadian Dental Association, the Ontario Dental Association, the Halton-Peel Dental Association and Gift from the Heart.

Email: sanjuktamohanta@hotmail.com, Instagram: @drsanjmohanta.

Life Interrupted: Dr. Dua’s Survival Guide, written by Dr. Manu Dua, can be purchased on Amazon. Proceeds go to the Oral Cancer Foundation.

 

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When A Dentist Dies from Oral Cancer

oral cancer

Dr. Manu Dua, a dentist practicing in Calgary, Alberta, discovered a lesion on his tongue around his 33rd birthday. He showed a photo of it to his sister, Parul, who is a dentist practicing in New York. “Get it biopsied,” she pleaded. He replied, “A dentist can’t have oral cancer. I’m too young.” Less than 2 years later, Dr. Manu Dua, a dentist, died from oral cancer.  He was 34. What happens with a Dentist dies from Cancer?

Manu had no risk factors for oral cancer.  He was young and didn’t smoke. He only had an occasional drink. He was athletic and had a healthy diet.  No one would suspect that the lesion on his tongue was cancer, not even him, not even the oral surgeon who thought it was lichen planus and prescribed him a steroid. His symptoms worsened: trouble speaking, pain on eating, and difficulty sleeping. Then came the devastating biopsy result – Stage 2 squamous cell carcinoma of the tongue.

The cancer was treated by removing the left half of Manu’s tongue and the lymph nodes from the left side of his neck. His tongue was repaired using the radial artery from his left arm and skin from his right thigh. He had to learn to speak, chew and swallow again. He recovered quickly and returned to the dental office that he recently opened. Less than a year later, he noticed swelling on the left side of his neck after he had a restoration. The cancer was back. A malignant lymph node on the left side of his neck was left behind. The dentist’s oral cancer had spread throughout his body. It was the beginning of the pandemic and Manu had to return to the hospital for more cancer treatment.

Manu endured 33 rounds of chemotherapy and radiation around his 34thbirthday. He sold his practice and decided to focus on his health. He bought a Porsche and was ready to enjoy life. A few months later he had a chest CT. A large tumour was growing in his chest. The treatment didn’t work.

Manu deteriorated over the next few months. The young dentist known for his muscular build and fun personality could barely walk or talk. He could barely breathe due to the fluid build up in his lungs. It hurt to eat and sleep. As he struggled to survive, alone in a hospital room, he wrote a book about what he learned from living and suffering called, Life Interrupted, Dr Dua’s Survival Guide. (Available on Amazon and on BN.com). He wrote, “One of the most important things that I have learned during these turbulent and difficult times is to accept the loss of control, and continue to ride the wave day by day. What is imperative is inner peace, strength and truly believing that there will be a better life in this world or the next.”

Manu, a dentist was dying of oral cancer. His parents called Parul asking her to come and say goodbye, as he went into organ failure. Across the border during a pandemic, Parul frantically got documents and COVID tests to get clearance to visit Canada. She didn’t make it in time. On a WhatsApp call, Parul tearfully said goodbye to her younger brother. “You can let go now.”

This is a sad story, but the story doesn’t end here. A new story has started. It’s a story that involves all of us doing thorough oral cancer screenings, referring suspicious lesions for biopsies, talking to our patients about decreasing risk factors, and encouraging the HPV vaccine which decreases the risk of oropharyngeal cancers. Manu is not here to tell his story. But we are here, and we can write a new story where no one dies from oral cancer.

ABOUT THE AUTHORS

Dr. Parul Dua Makkar started in Dentistry with a DDS in 2003, then worked in private practice in Calgary. In 2006, she moved to New York and did one-year general practice residency at Staten Island University Hospital. Makkar currently has a private practice in Long Island, New York, where she lives with her husband and two sons.

Email: parul_dua@yahoo.com. Instagram: @pdmfamilydental.com

Dr. Sanjukta Mohanta is a general dentist practicing in a publicly funded dental clinic in Brampton, Ontario. She graduated from the University of Toronto Faculty of Dentistry in 1999. She volunteers with the Canadian Dental Association, the Ontario Dental Association, the Halton-Peel Dental Association and Gift from the Heart.

Email: sanjuktamohanta@hotmail.com, Instagram: @drsanjmohanta.

Life Interrupted: Dr. Dua’s Survival Guide, written by Dr. Manu Dua, can be purchased on Amazon. Proceeds go to the Oral Cancer Foundation.

 

Connect with us!

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