Prosthetics installed after oral surgery

Date Published | Jun. 1, 2008

BY HEIDI ULRICHSEN

After patients with oral cancer have surgery to remove growths in their mouths, they are sometimes left with severe defects that could detract from their quality of life.

Enter Dr. Deborah Saunders, a dentist who heads up the dental oncology program at Sudbury Regional Hospital’s Regional Cancer Program.

Working with dental implants and dentures, she constructs prostheses that allow these patients to function normally.

For example, if the roof of a patient’s mouth has been removed due to cancer, and there is no longer a separation between the mouth and nose, Saunders will design a denture with a bulb on the top that artificially creates this separation.

“I usually go into the operating room on the day that their cancer is being removed. I make a temporary prosthetic that I screw into the palate bone,” she said.

“That at least leaves them so they’re not totally open. I leave that in for about three weeks, and they come in and see me. I take out all the stinky packing out of there, and I move them into something more permanent.”

When cancer surgery leaves a part of the patient’s face missing, such as the nose, Saunders works with a prosthetist to have an artificial nose made.

The dental oncology program in Sudbury opened in 1990 along with the cancer centre. Saunders has been working there since 2001.

The program, serving the area governed by the North East LHIN, is only one of two such programs in the province. The other one is located at Princess Margaret Hospital in Toronto.

Oral cancer patients in some regions of the province and country without these services have to wait for weeks or months after their surgery before they see a private practice prosthedontist or prosthetist and have a device constructed, she said.

“You can imagine their quality of life until they actually get there. It’s horrific,” said Saunders. “You don’t know why a cancer centre would have a dental facility until you see all of this, and then you think ‘Why doesn’t every cancer centre have a facility like this?’”

Saunders, along with another part-time dentist, a hygienist and an assistant, is also the first point of referral for patients whose doctor or dentist suspect oral cancer.

The clinic has a device called a VELscope, which uses fluorescent light to further hone in on suspicious oral lesions. If Saunders thinks the lesion is cancerous, she does a biopsy and sends it in for testing.

Another large part of the practice is providing oral care services for chemotherapy and head and neck radiation therapy patients.

She ensures patients’ teeth and gums are clean and healthy by doing a dental cleaning before treatment, fitting them with flouride trays for home use and checking their mouths frequently throughout treatment.

While undergoing chemotherapy, patients’ immune systems are compromised and they become more prone to oral infections, said Saunders.

“With the mouth having the largest amount of bacteria in the body, in a person who is unhealthy, those bacteria counts can be quite high and put patients at risk for infections,” she said.

“One of the leading causes of people dying of infection while undergoing chemotherapeutic treatments for leukemia is from an oral source, so we do take it quite seriously.”

One of the side effects experienced by head and neck radiation therapy patients is a drying out of the saliva glands. Saliva contains natural fluoride, so when it is reduced, teeth are more prone to decay, said Saunders.

These patients also have tender gums, and they easily tear if they eat food that is too abrasive, she said.

Saunders continues to see head and neck radiation patients for years after their treatment is complete because the side effects of radiation are permanent. With chemotherapy, side effects only last as long as the drugs are in the patient’s body, she said.

The services provided by the dental oncology clinic are partly fee-for-service and partly OHIP-funded, Saunders said.

“The only services that OHIP pays for as far as dental services is the consultation and any extractions and biopsies that need to be done,” she said.

“If some patient comes in here and needs x-rays, they aren’t covered under OHIP. If they need a cleaning before chemotherapy or radiation, that’s not covered under OHIP. Any fillings or dentures aren’t covered under OHIP.”

At times, knowing the tight financial situation of her patients, Saunders will write off the bills for dental cleanings or other services.

The prosthetic devices installed after oral cancer surgery are covered by the province’s assistive devices program.

Dental implants are not funded by the assistive devices program. However, the company which supplies implant technology, Nobel Biocare, has been very generous in providing discounts to the dental oncology program, and patients are often able to get dental work done at cost, said Saunders.

Saunders said her job keeps her extremely busy, but she loves her work because she is making a difference in people’s lives.

“I love the patients, especially geriatric patients. They have so much to teach us. I really find it rewarding treating those patients. That’s all of it in a nutshell.”

www.neorcc.on.ca

Signs and symptoms of oral cancer:
• A sore on the lip or in the mouth that does not heal.
• A lump on the lip or in the mouth.
• A white or red patch on the gums, tongue or lining of
the mouth.
• Unusual bleeding, pain or numbness in the mouth.
• A sore throat that does not go away, or a feeling that
something is caught in the throat.
• Difficulty or pain with chewing or swallowing.
• Swelling of the jaw that causes dentures to fit poorly
or become uncomfortable.
• A change in the voice and/or pain in the ear.