An Audit of the Provision Dental Care in Oncology Patient's ...
An Audit of the Provision
Dental Care in Oncology
Patient’s at Birmingham
ALISON HUTTON SpR. Paediatric Dentistry.
MARTIN ENGLISH Consultant Oncologist.
VICTORIA CLARK Consultant in Paediatric
SARAH MCKAIG. Consultant in Paediatric
Main audit results.
The document, guidance on cancer
services ‘Improving outcomes in children
and young people with Cancer.’
published August 2005 by NICE.
Cancer therapy can result in acute oral
problems such as mucositis and other
viral, bacterial and fungal oral infections.
Cancer treatment can cause structural
anomalies of the developing dentition.
NICE stated oncology patients often
have inadequate dental input during their
illness and are later often lost to dental
follow up despite the seriousness of their
This may predispose children to oral
health care problems in the future.
NICE proposed that special provision for
emergency dental treatment should be
available before any chemotherapy is
Information on the effects of cancer
therapy should be given to all cancer
patients and their families.
A named professional should be
identified and co-ordinate oral health
care throughout cancer therapy.
During the transition to adult services
there should be clear protocols and
referral routes for oral care.
UKCCSG-PONF (United kingdom
Children’s Cancer Study Group,
Paediatric Oncology Nurses Forum.)
produced evidence based guidelines on
mouth care for children and young
people with cancer. February 2006.
All children should be registered with an
State children should have a dental examination
on diagnosis and every 3-4 months
subsequently throughout cancer treatment.
Any invasive dental treatment required should
be carried out by a specialist paediatric dentist.
There should be clear communication between
the cancer centre and routine dental provider.
Appropriate training in oral assessment should
be available within the cancer centre, ideally in
collaboration with a member of the dental team.
To establish the need for specialist
paediatric dental input for paediatric
To aid in the planning of future service
To raise awareness for the development
of a clear protocol and specific dental
Assess the number of patient’s currently
registered with a dentist.
Discover when their last visit to the dentist
was and if they have regular visits.
Establish if they were screened before
cancer treatment commenced.
Ascertain if patients have received
specialist paediatric dental input.
Investigate the access to dental care.
Data were collected in the form of a
questionnaire from the
parents/guardians of children attending
the oncology clinic.
The form was piloted by those attending
Dr English’s oncology clinic and later
distributed within the whole oncology
56 questionnaires were completed by
parents/guardians of children aged 0-16 years
over a 4 month period.
Of these 80% (45) had acute lymphoblastic
leukaemia, 5% (3) chronic myeloid leukaemia
and the remaining 15% (8) a mix of other
89% (50) were having chemotherapy, 9% (5)
had chemotherapy and radiation therapy and
2% (1) were being observed.
The number of patients registered
with a general dentist.
Number of children examined by a
dentist before starting cancer therapy.
Once cancer treatment had started 27%
(15) were subsequently seen in the dental
87% (13) of which were referred by the
oncologist and 13% (2) referred by
59% (33) of general dentists were
recorded as being happy to continue
seeing the child despite the medical
4% (2) were recorded as being
uncomfortable with this.
Preferred location of access to
Number who had been given
information on how too look after the
oral cavity during cancer therapy
yes 89% (50)
no 9% (5)
The number of patients who had the
effects of cancer therapy, on the teeth
and mouth discussed with them.
yes 66% (37) no 32% (18) no answer 2% (1)
Regular access to general dental services
was satisfactory within this group of patients.
Children were not screened for disease or
potential causes of infection on diagnosis of
The families were well informed regarding the
effects cancer therapy may have on their
mouth and teeth.
There are no clear dental care pathways.
There should be clear protocols and
referral routes for follow up.
Children are seen by a dentist before
commencing cancer therapy to screen
for dental disease and during if
There should be special provision of
emergency dental treatment for teeth
with poor prognosis before the start of
Presentation of results to both the dental and
Mouth Care seminar by the dental team to the
oncology team. Eliers assessment, 8 point
assessment. (swallow, tongue, gingivae, voice,
lips, teeth, saliva, mucous membrane.)
Availability of a dental hygienist for advice and
Referral form produced and placed on the
hospital p-drive to aid dental referrals.
Following recent changes to the general
dental services patient’s are technically
no longer registered with a general
dentist. A dentist has a contract with the
PCT to provide so much NHS care.
Repeat the audit to find out if this has
had an impact on these patient’s.
Audit the number of referrals to the
Cancer, N. C. C. f. (2005). Guidance on
Cancer Services. Improving Outcomes in
Children and Young People with
Cancer., National Institute for Health and
UKCCSG-PONF (February 2006). Mouth
Care for children and young people with
cancer. Evidence based guidelines.