Head-and-neck cancers (HNCs) contribute significantly to the cancer burden in India,[1–3] among which oral squamous cell carcinoma (OSCC) solely accounts for 90% of HNCs.[4,5] The treatment modalities for such patients include surgery, radiation therapy, and chemotherapy, alone or in combination. This can lead to oral complications[4,6] or large post-surgical defects in case of surgical resection accompanied by defective speech, and swallowing; thereby affecting the quality of life of these patients.[6] Thus, the management of patients with OSCC does not end with the elimination of the disease but continues with the dental care required to address oral complications such as mucositis, altered taste sensation, trismus, dental hypersensitivity, osteoradionecrosis,[7] radiation caries, and diminished functional efficiency due to an intraoral defect or extracted teeth resulting in partial or complete edentulism. During the outbreak of the coronavirus 2019 (COVID-19) pandemic, dentists were unable to provide services to these patients to limit the spread of the disease.[8–10] Restrictions were imposed, and only emergency treatment was provided. Recently, another viral infection, monkeypox, has been declared a global public health emergency; however, restrictions have not been imposed yet. To reduce the negative effects of the COVID-19 pandemic and other health crises on the dental management of HNC patients, teledental services in line with telemedicine seem to be the only feasible option. Telemedicine services have already been successfully established in India, but teledentistry has not evolved parallel to telemedicine and lags far behind. Sound oral health plays a significant role in the overall wellbeing of a person and in improving the quality of life of patients with cancer. It can, therefore, be said that teledentistry is as significant as telemedicine in public health management. Naturally, virtual visits and teledental services will never completely replace face-to-face interactions. However, in times of emergency, they can provide an effective means of delivering palliative dental care to these patients, which is necessary not only to address the dental but also the psychological issues faced by patients with HNC. According to Biswas et al.,[11] the involvement of various specialties is crucial for the comprehensive care of patients with cancer. A study conducted by Khurana et al.[12] revealed that among the patients presenting to the palliative care clinics during the COVID-19 pandemic, a major percentage (37%) had head-and-neck diagnoses. National level interventions by the government and private dental organizations, in collaboration with the telecommunication sector, can provide oral health management to patients with cancer in crisis. The digital health policy of India also focuses on the use of telemedicine services. However, there are no such well-defined protocols or guidelines for teledentistry. Currently, the teledental service industry is almost non-existent in India and is not a part of the oral health policy. The Ministry of Health and Family Welfare MoHFW, India, has already introduced “e-DantSeva” a national oral health program with an aim to improve the oral health status of the Indian population. The Center for Development of Advanced Computing in Mohali in collaboration with MoHFW has developed the eSanjeevani Out Patient Department (OPD) which ensures safe and structured medical as well as dental video-based clinical consultations. However, awareness among patients is required about such dental services. A separate digital dental service may be initiated specifically to cater to the dental needs of patients with HNC. Moreover, the literature suggests that patients with HNC are at high risk for COVID-19 and other related infections and severe adverse outcomes due to their immunosuppressed state and corresponding treatment.[13–15] This risk is even higher in the geriatric population.[16] According to Thiagarajan et al.,[17] 24% of the patients with HNC are aged over 70 years. Therefore, protecting geriatric patients with HNC becomes even more crucial. Providing dental treatment to such patients even after the pandemic-related restrictions are lifted would be difficult as the insecurity of getting infected by the virus may remain due to asymptomatic carriers in society. Furthermore, the dental-care environment is a high-risk area due to aerosol generation and exposure to saliva. We cannot provide a specific protocol of therapy, but we suggest that these patients be guided thoroughly on the dental and psychological issues caused by these oral complications along with dietary advice. The goal should be to minimize the disruptions caused by the COVID-19 pandemic or any other crisis and to prevent exaggeration of their existing condition. In patients with post-surgical oral defects, dietary advice should be given to counteract the difficulty they face in mastication and swallowing. They should be advised to consume softer foods that are easy to chew and swallow, and finely chopped fresh fruits and vegetables, and to avoid foods that are hard to chew and can irritate the tissue, and foods that are spicy, and can cause mouth sores and irritation. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
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Jan 6, 2023
David H Wang + 3
Open Access