Once patients have recovered and their healing is complete, I plan the fabrication of definitive or more long-term prostheses. I also provide various extraoral prostheses including ears, noses, eyes (ocular as well as orbital) and combination midfacial prostheses. I pioneered the use of osseointegrated implants in cancer patients and have used implants to support intraoral and extraoral prostheses in select patients.
As a dental oncologist, I am concerned with the effects of oral/dental disease on various cancer treatment approaches, especially bone marrow/stem cell transplant and head and neck radiation. Very often mundane dental problems can adversely affect the course of cancer therapy. A dental infection can become life-threatening in a patient whose immune system is severely compromised by high-dose chemotherapy. A thorough pre-treatment dental/oral assessment can minimize such complications. Conversely, cancer therapies often affect the oral cavity. Head and neck radiation therapy may promote post¬treatment dental disease and cause osteoradionecrosis (ORN) if dental surgery is required in irradiated bone.
Patients treated at Memorial Sloan-Kettering have among the lowest rates of ORN in the US because we extract unhealthy teeth before treatment, prescribe high-potency fluoride for patients to apply themselves, and see patients for frequent dental follow-ups. We were one of the first institutions to report on the incidence and management of bisphosphonate-related osteonecrosis of the jaws (ONJ), and have adopted a similar pre-treatment strategy in patients treated with this class of drug for metastases to bone.
In addition to my extensive clinical experience I have been active in clinical research and education. I am a Fellow of the American Academy of Maxillofacial Prosthetics and Chairman of its Research Committee and Educational Standards Committee. Over the years, I have written many papers on how various dental interventions affect the quality of life of cancer patients and I speak nationally and internationally on maxillofacial prosthetics and dental oncology.
