The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 4: miscellaneous cancers.

This article discusses relevant information for the dental sector regarding metastatic cancers beyond breast and prostate cancer. Typically, tumour sites such as lung, renal, colorectal, gastrointestinal, thyroid, hepatic and pancreatic cancers are increasingly being referred for bone-targeting agents upon evidence of bone metastases.The current article explores the presenting dental status of these tumour groups on the background of survival outcomes. In addition, the article provides insight towards the complexity in achieving 'dental fitness' and whether 'dental stability' could be an alternative to consider via palliative dentistry in certain cases.

The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 3: prostate cancer.

Introduction Metastatic prostate cancer (MPC) patients due to receive bone-targeting agents (BTAs) are expected to undertake a dental assessment before commencing. The aim of this study was to determine the dental status of this tumour group and understand the challenges the dental practitioner faces in attempting to achieve 'dental fitness'.Materials and methods Data were retrospectively collected from a dedicated pre-BTA dental assessment clinic and analysed for MPC. Statistical analysis and observational data were used to compare patient and tumour demographics.Results A total of 111 patients were included in this cohort, with the majority of patients presenting with only bone metastases (BM) and no additional metastatic sites. On average, MPC patients presented with 19.3 teeth and were below the threshold for functional dentition. The 75-84-year-old age group had the worst horizontal bone loss score and subsequently lose six teeth over a decade (p = 0.001). In addition, all MPC tumour sub-categories showed favourable survival rates.Conclusion MPC patients have a high dental burden on presentation, likely associated with their age. Favourable survival prospects and the cumulation of BTAs and dental disease would suggest a heightened risk of medication-related osteonecrosis of the jaw in this group compared to many other tumour sites.

The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 1: an overview.

Introduction Dental pre-assessment before bone-targeting agents (BTA) in oncology patients is a well-recognised practice; yet, guidance on this has typically been unable to differentiate between the intricacies of varying oncology groups. This study assesses the presenting dental status of oncology patients with bone metastases (BM) due to commence BTA, to determine whether differences exist with varying tumour groups.Materials and methods Data were retrospectively collected from a dedicated pre-BTA dental assessment clinic. Statistical analysis and observational data were used to compare patient and tumour demographics as well as to their peers via the Adult Dental Health Survey.Results A total of 492 patients with a solid tumour diagnosis and BM requiring BTA were included in this retrospective study. Demographics such as sex, age, smoking status and tumour site were all significant for the number of teeth present (p = 0.000). Furthermore, survival data post-BTA identified prostate, breast and thyroid groups surviving over 12 months following dental assessment (p <0.000). In contrast, the remaining groups such as lung, colorectal and gastrointestinal had poorer outcomes (p <0.000).Conclusion Pre-BTA dental assessment should consider and incorporate additional patient and tumour demographics to allow for a tailored and personalised dental treatment plan. Application of this principle would look to optimise oral function while considering tumour prognosis to avoid over- or under-prescribing pre-BTA dental treatment.

The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 2: breast cancer.

Introduction Patients with bony metastatic breast cancer (MBC) due to receive bone-targeting agents (BTA) are expected to undertake a dental assessment before commencing. The aim of this study was to determine the dental status of this tumour group and understand the challenges the dental practitioner faces in attempting to achieve 'dental fitness'.Materials and methods Data were retrospectively collected from a dedicated pre-BTA dental assessment clinic and analysed for MBC. Statistical analysis and observational data were used to compare patient and tumour demographics.Results A total of 229 patients were included in this cohort. On average, this cohort loses one tooth per decade (p = 0.003). Classifying the tumour sub-types provided observational differences in dental status with patients with triple negative MBC having the best dentition at presentation. These observations were more clinically profound when overlaid with survival following post-BTA dental assessment as patients with triple negative MBC had the lowest median survival (eight months, p = 0.002). In contrast, patients with luminal A breast cancer had a very complex presenting dentition with a median survival of 20 months.Conclusion A clear difference exists in the outcomes of MBC patients and therefore a pre-BTA dental assessment should consider and integrate both patient and tumour demographics into dental treatment planning.

The impact of the cessation of primary dental care services on oral cancer diagnosis at a single institution in the UK's epicentre during the COVID-19 pandemic.

Aims: COVID-19 put an unprecedented strain on healthcare services that was complicated by the widespread cessation of all face-to-face primary care dental activity from 23 March 2020 for 7 weeks. This led to a focus on telephone triage and remote prescribing that potentially impeded urgent referrals for suspected oral cancer. Guy's and St Thomas' NHS Foundation Trust (GSTFT) screens and diagnoses potential head and neck cancer patients via a 2-week wait (2 WW) clinic and provides access to patients with urgent oral health needs through an Acute Dental Care (ADC) service. The current service evaluation aims to assess and report on the impact of COVID-19 and the cessation of primary care dentistry on oral cancer diagnosis at GSTFT during a period of time where patients had extremely limited access to healthcare. Materials and Methods: Data regarding oral cancer diagnoses were collected retrospectively from secure logbooks and clinical records from the point at which routine dental practice was nationally halted (23 March 2020) to the date at which services were permitted to resume (08 June 2020). Individual patient pathways prior to diagnosis and through to treatment were recorded. Results: Sixteen new diagnoses of oral cancer were made during the described timeframe. Findings suggest that the paralysis of routine dental services resulted in delayed referral of suspicious lesions and highlights the limitations of a predominately telephone-based assessment service in primary care. Conclusion: The importance of the role of the primary care practitioner in the early identification of oral cancer has been emphasised.

Provision of dental services at a single institution in the UK's epicentre during the COVID-19 pandemic.

Coronavirus disease 2019 (COVID-19) has had a significant impact on dentistry in the UK due to the perceived risks associated with infection control. These concerns have led to a complete paralysis of routine dental care with provisions for emergency dental care only, which have been scarce. Considering the latter, this article presents a service evaluation of a hospital-based acute dental care service, which was rapidly adapted and enhanced to continue managing dental emergencies during the COVID-19 pandemic. The analysis is based upon the dental diagnoses, management and geography of travel of over 1,500 attending patients in a five-week period during the rise and peak of COVID-19 in the UK. In addition, we assess our dental workforce's COVID-19 sickness reporting for those providing urgent dental care within this enhanced service. The article aims to provide additional and valuable frontline clinical information, experience and outcomes, including our categorisation of personal protective equipment used for varying face-to-face dental management during COVID-19.

Patient-reported experience and outcome measures in oral surgery: a dental hospital experience.

Introduction Patient-reported experience and outcome measures (PREMs and PROMs) are useful tools in assessing the quality of a service and the care it provides. We present our findings from the collection and analysis of PREMs and PROMs at the Royal London Dental Hospital Oral Surgery Department and discuss implications for future practice.Methods PREMs questionnaires exploring peri-operative aspects of care were distributed to patients having dental extractions under local anaesthetic. Patients were later invited to complete a PROMs questionnaire to gather information about their post-operative experience.Results One hundred and fifty-five PREMs questionnaires were completed. Over 98% of patients reported that they felt involved in their treatment, their pain and anxiety was well managed, they received information in a suitable language, and they felt able to ask questions. Eighty-seven (56%) patients subsequently completed the PROMs questionnaire. Twelve (14%) reported that they required assistance following treatment and two (2%) required further surgery. Sixty-three (72%) patients reported that they achieved normal function/appearance within two weeks.Conclusion The majority of patients reported a positive experience throughout their patient journey. We conclude that PREMs and PROMs may be used for benchmarking and managing service provision. There is scope for developing comprehensive measures for use in dental settings.