Evidence of dental screening for oral foci of infection in oncology patients

Pre-treatment dental screening of, amongst others, head-and-neck-cancer and hematology patients aims to identify and eliminate oral foci of infection to prevent oral problems during or post-treatment. The efficacy of dental screening in these patients is yet not evidence based. In particular in high dose chemotherapy patients it is even not set whether pre-treatment dental screening is effective at all. Thus, what is considered an oral focus of infection needing treatment might differ between patients scheduled for conventional radiotherapy, intensity modulated radiotherapy (IMRT) or chemotherapy. The general aim of this thesis was to assess the efficacy of pre-treatment dental screening in aforementioned patients regarding oral or systemic complications during treatment and follow-up. The results of the various studies showed that pre-treatment dental screening and subsequent treatment of oral foci of infection is mandatory in head-and-neck-cancer patients subjected to conventional radiotherapy or IMRT according to an (as far as yet available) evidence-based protocol, e.g., the protocol applied in our prospective study. A significant finding of the radiotherapy studies was that all patients need to be evaluated for periodontal disease, as periodontal disease is a condition making subjects prone to develop bone healing problems post-radiotherapy. With regard to pre-chemotherapy dental screening in hematology patients subjected to high-dose chemotherapy, oral foci of infection should be defined as acute or chronic. Chronic, asymptomatic oral foci of infection can be left untreated, as leaving these foci untreated did not increase infectious complications during intensive chemotherapy. Thus there is no need to treat hematology patients with chronic oral foci before or during the courses of high-dose chemotherapy. This treatment can be postponed until after completion of the chemotherapy course which reduces the morbidity of the oncologic treatment