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Dental Rehabilitation after Head and Neck Cancer Treatment, London

Effects of Head and Neck Cancer Treatment

Head and Neck cancer is a life threatening condition requiring decisive and timely treatment if it is to be eliminated. Surgical removal of a cancer in or near the mouth always results in a tissue defect. Without reconstruction these tissue defects, (if located in the maxilla upper jaw), often adversely affect appearance severely and compromise social activities such as ability to eat and to speak in an intelligible fashion.

While obturators are usually made to fill defects allowing communication between the mouth and nose, these are rarely effective if the defect is large. In these circumstances speech is often difficult to understand and food and drink tend to escape up into the nose, dripping from the nostril and escaping backwards causing coughing.

After head and neck cancer treatment without reconstruction the resulting problems cause disability in eating a normal diet and in social interaction. Many patients become reclusive, refusing to eat in company or with family. There is convincing evidence that these patients have dramatically reduced quality of life.

Solutions to the effects of Head and Neck Cancer Treatment, London

Modern vascularised composite flap reconstruction is available at a limited number of highly specialist centres including Head and Neck Cancer Centre at London Bridge. This state of the art treatment allows reconstruction of defects caused by cancer surgery either at the time of cancer surgery or at any time later which means that missing bone and soft tissue can be replaced restoring appearance and closing communication between the mouth and nose.

Speech, chewing, smiling and appearance are restored best using dental implant supported fixed prostheses.

Dental implants allow placement of fixed artificial teeth that function in exactly the way natural teeth do. This is in contrast to dentures and to obturators where function is always compromised.

In the case of patients being treated for head and neck cancer that affects structures in or near the mouth, reconstruction combined with dental implant supported prostheses can be highly effective in producing a functional result with minimum effect on eating ability, speech, smiling and chewing while restoring appearance in a way that can not be achieved by any other method.

In order to produce these results consistently it is essential that patients are treated by a multidisciplinary team working as one to achieve both disease elimination and aesthetic reconstruction, thereby preserving not only life but also quality of life.

At the London Bridge Hospital we combine surgeons, oncologists, prosthodontists and related specialists, all highly experienced leaders in their own fields committed to collaborating together from each patient’s first visit to achieve optimum clinical functional and aesthetic results. This combined highly specialised experience embodied in the multidisciplinary team has few equals anywhere and is the key to our success.

Depending on the nature of the disease present patients may have surgical reconstruction combined with placement of implants and even placement of an interim prosthesis in some cases at the time of surgery. However when surgical resection is complex or when the exact extent of resection has to be determined at surgery the best results may be achieved with delayed placement of implants. Interim prostheses can be provided where appropriate.

While the aim is usually to provide patients with fixed implant supported prostheses (artificial teeth acting like natural teeth that cannot be removed for cleaning by the patient), for patients who are experienced denture wearers before cancer treatment, sometimes an implant supported removable denture may provide a satisfactory solution.

In order to achieve optimal final results certain procedures such as sulcus creation (a sulcus being the part of the mouth where the jaws and cheeks meet) and soft tissue contouring may be required. These are planned as necessary from the beginning of treatment based on our extensive experience.

For patients in need of radiotherapy early dental involvement is critical to subsequent health and wellbeing. It is essential that teeth in poor condition in the direct field of radiotherapy are treated appropriately or removed if the risk of osteoradionecrosis is present.

A longer term problem for patients receiving radiotherapy is the dry mouth induced by radiation to the salivary glands. This not only makes eating uncomfortable but poses a major risk to the remaining teeth via a condition called radiation caries. This can be avoided in some cases by sophisticated radiotherapy planning but where irradiation to the salivary glands is inevitable, a dry mouth is usually unavoidable. We have vast experience in offering patients careful preventive programmes including saliva substitution which offer treatments for dry mouth problems, preserving the remaining teeth and improving function and quality of life.