One door closes, another opens
For nine years, Texas A&M College of Dentistry faculty have overseen care for oral cancer patients at Sammons Dental Clinic within Baylor University Medical Center. That commitment to patients continues despite two major changes that occurred this spring: COVID-19 and the pre-planned permanent shuttering of the clinic in May.
The College of Dentistry has kept its commitment to existing oncology patients despite the clinic closing and the dental school’s move to emergency-only protocol, says Dr. Amerian Sones, who has treated patients at the clinic since 2012. Oral cancer patients meet Texas Dental Association and American Dental Association guidelines as must-see urgent care patients, so treatment went uninterrupted.
“Unfortunately, cancer doesn’t recognize that there is a pandemic occurring and patients continually need care,” says Sones, director of the Office of Continuing Education at the dental school and AEGD prosthodontic faculty member. “It was a time of uncertainty as I continued to see patients during this shelter-in-place without the benefits of N95 masks and face shields. It was really a difficult and trying time. I was very creative in my personal PPE.”
The school is now working toward opening its own dental oncology department, Sones says. Faculty members Dr. Robert Triplett, Dr. Andrew Read-Fuller and Dr. Likith Reddy are pitching in as they organize and hammer out all financial and clinical aspects.
Services will start with pre-treatment support—including determining the need for pre-radiation extractions and dental care—immediate surgical obturator prostheses for patients after cancer surgery, and post-surgical care, she says. A continuum of care provided at the previous clinic will remain intact for patients and their referring physicians.
The school’s role will expand as it involves more faculty, students and dental alumni, including additional restorative dentists. Dental students will be offered a dental oncology selective rotation, and graduate students will learn how their area of expertise overlaps into head and neck oncology, Sones says.
“The future holds many possibilities with student education to include clinical research, fellowship programs and residency programs,” she says.
The clinic will also collaborate with the dental school’s wide range of in-house experts. That includes Dr. Jacqueline Plemons, director of stomatology, as well as Dr. Yi-Sheng Lisa Cheng, head of the diagnostic sciences department, which will play a role in biopsies and final diagnoses of intraoral tumors, Sones says. Rounding out the all-encompassing approach will be Dr. Hongjiao Ouyang, associate professor in endodontics, whose expertise has the potential to propel the college onto the national stage in cancer research.
“Maxillofacial prosthodontics requires a multidisciplinary approach among dental specialists and is truly an interprofessional collaboration of the ENT, radiation oncology and oncology physicians and speech pathologists,” Sones says. “I have had a chance to work with these amazing professionals since 2012, and we appreciate and understand the important role we all play as we care for our head and neck cancer patients.”
Sones was trained in maxillofacial prosthodontics at UCLA in the early ’80s, and her program director and mentor (whose book on maxillofacial prosthodontics is the “go-to” textbook) prepared her for this special opportunity to guide the school in establishing a one-of-a-kind center serving the patients of Texas, she says.
As the program develops and more providers join in, patient load will increase, along with expanded services and hours, she says. Because head and neck health care falls into the realm of both dental and medical health, many patients’ medical insurance plans will cover dental and maxillofacial prosthodontic treatment and procedures, along with their dental insurance. Ways to fund the uninsured are also being explored, as are avenues for raising funds for the clinic.
“Head and neck cancer is so devastating because it affects how we present ourselves to the world—our face and smile, our ability to speak, drink, enjoy our favorite foods, display our emotions, and present to our friends and family,” Sones says. “Restoring these important personal characteristics is why intraoral and extraoral rehabilitation is so important and appreciated by patients.”
Head and neck cancers account for about 4% of all cancers, affecting more than twice as many men as women, as well as those over age 50, according to the Centers for Disease Control and Prevention. In the past, tobacco and alcohol were causative factors, and they still play a role. However, in recent years, the human papillomavirus has been found to be a cause of many oropharyngeal cancers in young adults. In July, the Food and Drug Administration included oropharyngeal HPV positive cancers as an indication for the Gardasil HPV vaccination, which has been shown to prevent specific types.
In “Parent Perceptions of Dental Care Providers’ Role in Human Papillomavirus Prevention and Vaccine Advocacy” in the August issue of The Journal of the American Dental Association, a survey found that most parents felt comfortable with dental professionals discussing HPV and its vaccination with their patients ages 9 to 17.