Integrating Preoperative Oral Care Into Cancer Treatment Plans

Preoperative oral care by a dentist decreased postoperative complications in patients undergoing surgery for cancer. Dental care was associated with reductions in both postoperative pneumonia and all-cause mortality.¹ The findings suggest oncology nurse navigators should consider integrating oral care by a dentist into preoperative care as a way to improve clinical outcomes and to reduce postoperative mortality.

Preoperative dental care could reduce postoperative complications in cancer patients. For example, aspiration of oral and pharyngeal secretions and bacteria can cause postoperative pneumonia, which is sometimes fatal. The adverse effect, however, occurs more frequently in patients undergoing surgery for esophageal cancer.²

In one study of digestive tract surgery in elderly patients (aged 60 to 98 years), postoperative oral care resulted in fewer abnormal pulmonary sounds, including dry or moist rales, and reduced bacterial load across several sites compared with a control group that did not undergo postoperative dental care.³

Although the oral care in this study included procedures executed by the patient, occurred postoperatively, and the patients did not have cancer, these results suggest oral care is an important part of optimizing clinical outcomes, particularly improved pulmonary function.³

Results from a retrospective analysis of patients with esophageal cancer who underwent esophagectomy found the absence of perioperative dental care was associated with increased incidence of postoperative pneumonia. In this study, perioperative dental care involved oral care from a dentist or dental hygienist prior to the procedure and instructions for patient-administered postoperative oral care. Researchers used propensity score matching to control for covariates that could affect receiving perioperative oral care.⁴

In another study, researchers assessed the bacterial profile contained in preoperative oral plaque in patients who underwent esophagectomy for thoracic esophageal cancer. The bacterial profile of the sputum was also analyzed in patients who went on to develop postoperative pneumonia.⁵

Although the study population was small (N = 39), the results demonstrated that the presence of pathogenic bacteria in preoperative plaque was more common in those patients who later developed pneumonia. Furthermore, the pathogenic bacterial profile of the preoperative plaque aligned with that of the postoperative sputum in those patients who developed pneumonia. “Pathogens in preoperative dental plaque are risk factors for postoperative pneumonia following thoracotomy in patients with thoracic esophageal cancer,” concluded the researchers.⁵Preoperative oral care could debride plaques that harbor pneumonia-causing bacteria.

Taken together, these results suggest perioperative oral care could reduce the risk of developing postoperative pneumonia in part by decreasing the bacterial load. This reduction could decrease aspiration of pneumonia-causing bacteria, with the resulting decrease in pneumonia correlating with improved survival.