Surviving oral and head and neck cancer: The new normal

We call them survivors for a reason. They inspire. They give us hope. They bestow upon future survivors the courage to face the darkest of times. They remind those of us who fight against cancer that our efforts are not in vain...that victories are sometimes won and lives saved. But for those who have faced death and conquered the disease, what now?Life after cancer is different. The truth is survivorship experiences vary as greatly as the individual battles with cancer itself; but for many, survivorship may include a lifetime of struggles. Regardless of the type of cancer faced, many of these challenges revolve around oral health. One of the most common side effects of chemotherapy and radiation treatment to the head or neck is severe dry mouth. For many, especially those who have survived oral and head and neck cancer, the impact of this condition is long-term and debilitating. Beyond just the discomfort, severe dry mouth can cause rampant dental decay, frequent oral infections and difficulty in chewing and swallowing. This, in itself, can lead to poor nutritional intake. For those survivors whose treatment included head or neck radiation, limited opening of the mouth, known as trismus, can make eating a difficult task and oral hygiene burdensome. Oral and head and neck cancer survivors also face unwanted oral health issues with the possibility of rapidly advancing periodontal disease (gum disease), burning mouth syndrome, and osteonecrosis, an occurrence of dead bone which becomes exposed through the gum tissue and is often painful and can lead to systemic infection.It's not just those with oral and head and neck cancer who face oral health issues related to cancer care. Those treated with intravenous bisphosphonate drugs for multiple myeloma and metastatic bone disease have a similar risk for the development of osteonecrosis of the jaw.Bisphosphonates are excellent drugs that have a definitive place in treatment regimens, but their effect on the bone remains for decades. Those survivors whose treatment has included intravenous bisphosphonates must be certain their dentist knows their medical history and is familiar with the risks associated with this class of medications. Survivors who continue to take maintenance medications often continue to experience issues with dry mouth. While dry mouth may not be as severe as during cancer therapy, the decreased salivary flow is often enough to increase the risk of rampant dental caries and intraoral infections.Some of the challenges faced by survivors go well beyond health issues. Social and psychological changes are not uncommon. For the oral and head and neck cancer survivor, eating in a restaurant may be so great a chore that what was once a pleasant outing is avoided because of sensitivity to foods or inability to properly swallowing. Frequent choking or eating slowly makes the survivor self-conscious in a public setting. For survivors with cancer that has left them scarred with physical changes, psychological and emotional scars often take much longer to heal. Whether it is the head and neck cancer survivors acceptance of a reconstructed face, adjustment to a new body image for the breast cancer survivor, or the prostate cancer survivor's struggle with urinary incontinence, the challenges of survivorship are very real and a means of support and coping must be realized and valued.As more healthcare providers prioritize the importance of providing services to cancer survivors, it is my hope that we will see more emphasis placed on meeting the physical, emotional and spiritual health of this special group of individuals. Survivorship issues transcend the perceived barriers between medicine and dentistry and mental health and social work. This is an appropriate cause for healthcare professionals from all walks and specialties to come together for the betterment of those who were once our patients and are now survivors!Dennis M. Abbott, DDS, is the founder and CEO of Dental Oncology Professionals, an oral medicine practice dedicated to care for the unique dental and oral health needs of individuals battling cancer.