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Oral Cancer accounts for approximately 3% of all malignancies and is a significant worldwide health problem. Mostly oral malignancies occur as squamous cell carcinomas despite remarkable advances in treatment modalities, the 5-year survival rate has not significantly improved over the past several decades and still hovers at about 50-60%.
Many of these develop from premalignant conditions of the oral cavity. A wide array of conditions have been implicated in the development of Oral Cancer, including leukoplakia, erythroplakia, palatal lesion of reverse cigar smoking, oral lichen planus, oral submucous fibrosis, discoid lupus erythematosus, and hereditary disorders such as dyskeratosis congenital and epidermolysis bullosa. Despite the general accessibility of the oral cavity during physical examination, many malignancies are not diagnosed until late stages of disease.
- Oral Submucous Fibrosis
- Lichen planus
Here the interdisciplinary teams work together to improve the lives of Cancer survivors, by improving physical, psychological and social well-being, upgrading quality of life in patients treated for Oral Cancer,
Various challenges faced by sufferers and should be taken care of during pre-treatment and post-treatment rehabilitation.
- Oral Mucositis, Loss of taste − Dysgeusia, Erythema, Xerostomia, Radiation Caries, Trismus, TMJ dysfunction, Muscle fibrosis, Osteo-Radionecrosis, Changes in oral flora − Candidal infections, Gingivitis
- Loss of anatomical structures including Teeth, Mandible, Maxilla, Tongue, Soft Palate, Alveolar Ridges, Sulci
- Altered oral anatomy such as loss of Lip competence, Altered Muscle insertions, Altered Muscle balance, Altered Tongue function Loss or Altered sensations: loss of proprioception, Trismus Scar tissue and bulky Flaps
- Mastication, Deglutition and speech. Inability to use dentures
- The detrimental physical and psychological effects caused by Oral Cancer and its treatment leading to poor quality of life
Current rehabilitative practice is centered on five principles:
- The process of rehabilitation begins at the time of initial diagnosis and treatment planning
- The dentition should be preserved if possible
- Rehabilitative treatment plans should be based on fundamental principles of Prosthodontics including a philosophy of Preventive Dentistry and Conservative Restorative Dentistry
- Surgery before prosthetic rehabilitation may be indicated to improve the existing anatomic configuration after ablative Cancer surgery, reconstructive surgery, and/or radiation therapy
- Multidisciplinary Cancer care is required to achieve the optimal function
- Speech and Swallowing: Speech and language therapy is beneficial in the rehabilitation of patients with head & neck Cancer. The use of an oral prosthesis improves both speech and swallowing in the patient completing treatment for HNC
- Olfaction and Gustation: Pharmacological help limits radiation therapy-induced Xerostomia and Gustatory Dysfunction
- Pain and psychological impact: Pain is a common complaint among patients with Cancer, especially patients with head & neck Cancer with the most significant impact on general well-being and psychosocial distress. Pharmacologic therapy, intervention for depression, and physical therapy helps patients. Coping methods are important in overcoming the psychologic impact of Cancer
- Prosthodontic Oral Rehabilitation of the Oral Cancer patient: The Prosthodontic needs of Oral Cancer patients include the rehabilitation of oral form and function that have been lost through treatment. Prosthodontic treatment options include; maintenance of a functional dental arch (shortened dental arch), fixed prostheses (bridgework), removable partial dentures (RPDs), Maxillary Obturators, implant-retained fixed or removable prostheses, and complete dentures. To accelerate oral rehabilitation, a treatment plan should be devised (with the patient’s support) as early as possible, and preferably before Cancer treatment. Patients should follow a Prosthodontic pathway similar to that outlined in Figure 1. This shows patients moving through a pre-Cancer treatment oral rehabilitation assessment, primary interventions at the time of surgery, and secondary interventions after Cancer treatment
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