Features of Orthodontic Therapy for Cancer Patients: An Integrated Analysis

Karvelous Gaver^*
*Correspondence: Karvelous Gaver, Department of Dental Medicine, University of Medicine and Pharmacy, Iasi, Romania, Email:

Introduction

Orthodontic therapy for cancer patients presents unique challenges and considerations due to the complex interplay between cancer treatment and oral health. Integrating orthodontic care into the comprehensive management of cancer patients requires a nuanced understanding of the specific needs and risks associated with cancer therapies. This essay provides an integrated analysis of the features of orthodontic therapy for cancer patients, emphasizing pre-treatment planning, intra-treatment management, and post-treatment care. The initial phase of orthodontic therapy for cancer patients involves a thorough assessment of the patient’s medical and dental history. This includes understanding the type and stage of cancer, the specific treatments planned (such as surgery, chemotherapy, or radiation therapy), and the timing of these treatments. Collaboration with the oncology team is crucial to tailor the orthodontic plan to the patient’s overall treatment schedule and health status.

Description

Cancer treatments can significantly impact oral health. For instance, chemotherapy and radiation therapy can lead to immunosuppression, making patients more susceptible to infections, mucositis, and osteoradionecrosis. Therefore, a risk assessment must evaluate the patient’s current oral health, focusing on potential issues like caries, periodontal disease, and existing dental restorations. This step is essential to mitigate any complications that could arise during cancer treatment [1]. Timing is critical when planning orthodontic interventions. Ideally, any elective dental procedures, including the placement of braces, should be completed before the initiation of cancer therapy. This timing helps minimize the risk of complications during periods of immunosuppression. In cases where orthodontic treatment is already in progress, adjustments may be necessary to accommodate the patient’s treatment schedule and overall health.

Maintaining optimal oral hygiene is paramount for cancer patients undergoing orthodontic treatment. Cancer therapies can exacerbate oral health problems, so patients should be educated about rigorous oral hygiene practices. This includes regular brushing with a soft-bristled toothbrush, using fluoride toothpaste, and frequent rinsing with a non-alcoholic, antimicrobial mouthwash. Orthodontists may recommend specialized tools such as interdental brushes or water flossers to help patients clean around braces effectively. Mucositis and dry mouth (xerostomia) are common side effects of cancer treatments [2], particularly chemotherapy and radiation therapy targeting the head and neck region. These conditions can be exacerbated by the presence of orthodontic appliances. To manage mucositis, patients might be prescribed topical analgesics, coating agents, or anti-inflammatory medications. For dry mouth, recommendations might include the use of saliva substitutes, increased hydration, and the avoidance of irritants like tobacco and alcohol.

Orthodontic appliances may need modifications to accommodate the unique needs of cancer patients. For example, brackets and wires should be selected and adjusted to minimize irritation and trauma to the oral mucosa. In some cases, removable aligners might be a preferable option, as they allow for easier maintenance of oral hygiene and can be temporarily removed during periods of severe mucositis. Even after the completion of cancer therapy, patients remain at risk for late effects that can impact orthodontic treatment. These include issues such as altered growth and development of the jaws (especially in pediatric patients), reduced salivary flow, and increased susceptibility to dental caries and periodontal disease [3]. Continuous monitoring and regular dental check-ups are essential to identify and manage these late effects promptly.

Post-cancer treatment may necessitate dental rehabilitation, especially if the patient has experienced significant dental deterioration or loss of teeth. Orthodontic therapy can play a crucial role in the comprehensive rehabilitation plan, which might include restorative procedures such as fillings, crowns, bridges, or implants. Coordinating with prosthodontists and other dental specialists ensures a cohesive approach to restoring the patient’s oral function and aesthetics. Cancer diagnosis and treatment can have profound psychological impacts, including anxiety, depression, and altered body image. The presence of orthodontic appliances can exacerbate these feelings, particularly in younger patients. Providing psychological support and counseling as part of the orthodontic care plan can help address these issues. Orthodontists should be attuned to the emotional well-being of their patients and work closely with mental health professionals when necessary [4].

Ultimately, the goal of integrating orthodontic therapy into the care of cancer patients is to enhance their overall quality of life. By addressing dental and orthodontic issues comprehensively and compassionately, orthodontists can contribute to the patient’s physical health, self-esteem, and social well-being. Successful orthodontic therapy for cancer patients relies on a multidisciplinary approach involving close collaboration between orthodontists, oncologists, general dentists, and other healthcare providers. This coordinated care approach ensures that all aspects of the patient’s health are considered, and treatment plans are adjusted as necessary to accommodate changes in the patient’s medical status.

Effective communication and thorough documentation are essential components of multidisciplinary care. Detailed records of the patient’s orthodontic treatment plan, modifications, and progress should be maintained and shared with the oncology team. Regular case conferences or meetings can facilitate ongoing dialogue between all parties involved, ensuring that the patient receives the best possible care. Technological advancements in orthodontics, such as digital imaging and 3D printing, can significantly enhance the treatment experience for cancer patients. Digital orthodontics allows for more precise treatment planning and the creation of customized appliances that can reduce discomfort and improve outcomes [5]. These technologies also enable better monitoring of treatment progress and adjustments, which is particularly beneficial for patients with complex medical histories. Teleorthodontics has emerged as a valuable tool, especially for patients who may have limited mobility or who are immunocompromised. Virtual consultations and follow-ups can minimize the need for frequent in-person visits, reducing the risk of exposure to infections. Teleorthodontics also allows for timely intervention and guidance, ensuring that patients continue to receive optimal care even when they cannot visit the clinic regularly. Ongoing research and case studies are crucial for developing evidence-based practices in the orthodontic treatment of cancer patients. Clinical studies that evaluate the outcomes of different orthodontic interventions, modifications, and timing in cancer patients can provide valuable insights and inform best practices. Sharing these findings within the dental and medical communities can help improve the standard of care for this unique patient population.

Innovative treatment modalities, such as the use of biomaterials that promote tissue healing and reduce inflammation, are being explored in orthodontic therapy for cancer patients. These advancements hold promise for enhancing the safety and efficacy of orthodontic treatments, reducing complications, and improving patient outcomes. Continued investment in research and development is essential to bring these innovations to clinical practice.

Conclusion

Orthodontic therapy for cancer patients is a complex but vital component of comprehensive cancer care. By understanding and addressing the unique challenges these patients face, orthodontists can provide effective and compassionate care that supports both oral health and overall well-being. Pre-treatment planning, intra-treatment management, and post-treatment care must be meticulously coordinated with the oncology team to ensure the best possible outcomes. Advances in technology and ongoing research are paving the way for improved practices and innovations that will further enhance the quality of life for cancer patients undergoing orthodontic treatment. Through a multidisciplinary approach and a commitment to patient-centered care, orthodontic therapy can play a crucial role in the holistic treatment of cancer patients.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Alvarez, Elysia M., Lisa M. Force, Rixing Xu and Kelly Compton, et al. "The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019." Lancet Oncol 23 (2022): 27-52.

Google Scholar, Crossref, Indexed at

2. Trama, A., D. Stark, I. Bozovic-Spasojevic and N. Gaspar, et al. "Cancer burden in adolescents and young adults in Europe." ESMO Open 8 (2023): 100744.

Google Scholar, Crossref, Indexed at

3. Wu, Ying, Yujiao Deng, Bajin Wei and Dong Xiang, et al. "Global, regional, and national childhood cancer burden, 1990–2019: an analysis based on the global burden of disease study 2019." J Adv Res 40 (2022): 233-247.

Google Scholar, Crossref, Indexed at

4. Wen, Yi Feng, Meng Xuan Chen, Guosheng Yin, Ruitao Lin, Yu Jie Zhong, Qian Qian Dong, and Hai Ming Wong. "The global, regional, and national burden of cancer among adolescents and young adults in 204 countries and territories, 1990–2019: a population-based study." J Hematol Oncol 14 (2021): 89.

Google Scholar, Crossref, Indexed at

5. Gatta, Gemma, Laura Botta, Silvia Rossi and Tiiu Aareleid, et al. "Childhood cancer survival in Europe 1999–2007: results of EUROCARE-5—a population-based study." Lancet Oncol 15 (2014): 35-47.

Google Scholar, Crossref, Indexed at