Meeting complex health needs with tailored oral care

Emma Slade-Jones introduces the newly published guidance on medical conditions that may impact dental appointments, helping dental professionals manage complex cases with confidence.

Questions frequently arise regarding dental patients undergoing cancer treatment, antibiotic prophylaxis, managing anticoagulants, pacemakers and even cold sores, among many other conditions. While there is often no definitive answer, care should always take an individualised, holistic approach.

Guidelines can be complex, and knowing where to find concise, reliable information is essential. With this in mind, the BSDHT (British Society of Dental Hygiene and Therapy) guidance sheet, ‘Medical conditions that may impact dental appointments’, consolidates essential considerations into one accessible resource, supporting clinicians in making informed decisions.

It also highlights the importance of clear communication with medical teams. Clinicians should familiarise themselves with appropriate referral procedures, maintain templates for common requests, and ensure correspondence is accurately documented and uploaded into patients’ dental records.

Cancer care considerations

When modifying treatment plans for patients undergoing or recovering from cancer therapy, there is no universal approach. Factors such as the patient’s specific cancer treatment, therapy stage, type of dental treatment (invasive, elective or emergency) and overall health must all be considered. Clinicians should liaise closely with oncology or medical teams to ensure informed decisions prioritise the patient’s best interests.

Despite best efforts, oral health advice from medical teams can sometimes conflict with dental recommendations. For instance, when my mother underwent breast cancer treatment, she was advised to drink squash frequently for dry mouth and use chlorhexidine mouth rinse twice daily. As a dental hygienist, I found this surprising and provided alternative guidance. While multidisciplinary advice has improved, this underscores the importance of expert input from dental and medical professionals working collaboratively.

Clear guidance from oncology teams about appropriate timings for dental treatment can bridge gaps between secondary and primary care. Dental teams should prioritise assessment appointments post-diagnosis and before cancer treatment commences. Training staff to encourage patients who might otherwise cancel routine appointments to attend these assessments ensures valuable opportunities are not missed.

Systemic health impacts

Oral health is closely linked with systemic health and conditions such as stroke, which can severely impact a patient’s ability to maintain oral hygiene due to difficulties with speech, eating, swallowing and manual dexterity.

In my own experience, my grandfather-in-law suffered a stroke and, despite having oral hygiene listed in his care plan, toothbrushing is often not prioritised during his daily care visits. This underlines the importance of ongoing education and support for patients, caregivers and wider support teams to prioritise oral hygiene in comprehensive health management.

Medication management

For patients requiring invasive procedures who are taking anticoagulants, such as warfarin, apixaban, or rivaroxaban, clinicians must carefully assess the risks. INR (international normalised ratio) levels should be checked specifically for patients on warfarin, while treatment planning for those on apixaban or rivaroxaban should follow current guidelines and evidence-based risk assessments.

The Scottish Dental Clinical Effectiveness Programme (SDCEP) provides a helpful quick reference guide on anticoagulants.

Meanwhile, the ongoing debate around antibiotic prophylaxis necessitates careful decision-making in borderline cases. Guidance from the patient’s medical team, coupled with the type of planned dental treatment, should inform decisions. Evidence-based guidelines, such as those from the National Institute for Health and Care Excellence (NICE) or SDCEP, support clinically justified choices.

Key considerations include:

Patient’s medical history (eg immunosuppression, previous endocarditis)
Treatment invasiveness (eg extractions, subgingival PMPR)
Shared decision-making (ensuring clear documentation of discussions and rationales to ensure clarity and continuity of care).

A common misconception

Cold sores represent a grey area in dental practice. Dental hygienists and dental therapists may feel pressured by patients or colleagues to proceed with treatment, given rigorous infection control procedures.

However, guidelines recommend deferring elective treatment until lesions fully heal to prevent discomfort and reduce the risk of viral spread. Clinicians should exercise professional judgement to determine when it is appropriate to resume treatment. While cancellations can be inconvenient, safety-focused decision-making is paramount.

Patient awareness and proactive care

We have included a waiting room/clinic poster in the guidance to inform patients that certain medical conditions and medications may affect their dental treatment. Raising awareness beforehand helps anticipate and manage potential complications; for example, advising patients not to attend with an active cold sore, or ensuring INR levels are checked before an appointment.

Even if treatment is deferred, clinicians can use these opportunities to provide oral hygiene advice or simply check in on patients’ overall well-being, something patients often appreciate, especially when facing challenging health situations.

This document has been a collaborative effort, and I greatly appreciate the teamwork involved in its creation. Special thanks to fellow dental care professional, Joss Harding, for her significant contributions to promoting best practice for patients undergoing cancer treatment.

The guidance will continue evolving as new questions emerge and guidelines are updated. Ultimately, our aim is to support clinicians in providing optimal, integrated patient care, an ethos celebrated each year on National Dental Hygienist and Dental Therapist Day (1 May).

For more guidance and resources, please visit the BSDHT’s website. For access to the full guidance sheet on medical conditions and supporting resources, visit tinyurl.com/BSDHTmemberarea.