An Audit of the Provision Dental Care in Oncology Patient’s at Birmingham Children’s Hospital.

BY

ALISON HUTTON SpR. Paediatric Dentistry.MARTIN ENGLISH Consultant Oncologist.VICTORIA CLARK Consultant in Paediatric Dentistry.

SARAH MCKAIG. Consultant in Paediatric Dentistry.

SUMMARY.

Background. Main audit results. Recommendations. Actions. Further audit.

BACKGROUND (NICE). 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 BACKGROUND.

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 condition.

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 commenced.

NICE BACKGROUND.

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.

BACKGROUND (UKCCSG-PONF).

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 NHS dentist.

FURTHER ADVICE.

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.

AIM.

To establish the need for specialist paediatric dental input for paediatric oncology patients.

To aid in the planning of future service provision.

To raise awareness for the development of a clear protocol and specific dental care pathway.

OBJECTIVES.

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.

METHODOLOGY.

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 department.

RESULTS.

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 cancer types.

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.

yes91% (51)

no9% (5)

Attendance patterns.

86% (48)

9% (5)

2% (1) 2% (1) 2% (1)0

10

20

30

40

50

60

70

80

90

0-12mths 12-24mths trouble never unanswered

Percentage

Number of children examined by a dentist before starting cancer therapy.

No91% (51)

Yes9% (5)

Once cancer treatment had started 27% (15) were subsequently seen in the dental specialities department.

87% (13) of which were referred by the oncologist and 13% (2) referred by another dentist.

59% (33) of general dentists were recorded as being happy to continue seeing the child despite the medical diagnosis.

4% (2) were recorded as being uncomfortable with this.

Preferred location of access to dental care.

0

10

20

30

40

50

60

Percentage

locally 52%(29)

hospital 25%(14)

don't mind23% (13)

Number who had been given information on how too look after the oral cavity during cancer therapy

yes 89% (50)

no 9% (5)

unanswered 2%(1)

The number of patients who had the effects of cancer therapy, on the teeth and mouth discussed with them.

0

10

20

30

40

50

60

70

Percentage

yes 66% (37) no 32% (18) no answer 2% (1)

CONCLUSIONS

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 cancer.

The families were well informed regarding the effects cancer therapy may have on their mouth and teeth.

There are no clear dental care pathways.

RECOMMENDED CHANGES

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 necessary.

There should be special provision of emergency dental treatment for teeth with poor prognosis before the start of treatment.

ACTIONS. Presentation of results to both the dental and

oncology teams. 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 consultations.

Referral form produced and placed on the hospital p-drive to aid dental referrals.

Further audits.

FUTURE AUDITS

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 dental department.

Questions

?

REFERENCES

Cancer, N. C. C. f. (2005). Guidance on Cancer Services. Improving Outcomes in Children and Young People with Cancer., National Institute for Health and Clinical Excellence.

UKCCSG-PONF (February 2006). Mouth Care for children and young people with cancer. Evidence based guidelines.