13 General introduction 1 Role of the maxillofacial prosthodontists in rehabilitation Therefore, there is a need and demand among patients for dental rehabilitation aimed at restoring orofacial form and function as well as overall well-being. Dental rehabilitation begins at the time of diagnosis, and a multidisciplinary approach is critical for optimal treatment outcomes [49]. Dental and prosthodontic rehabilitation and the planning required to achieve it are preferably performed by a maxillofacial prosthodontist and should preferably begin on the day of the initial admission [52]. Rehabilitation is performed in concert with reconstructive surgical options and requires cooperation with oral and maxillofacial surgeons, head and neck oncologists, radiation oncologists, anaplastologists, general and differentiated dentists, and allied health care providers. Maxillofacial prosthodontics is a differentiation of dentistry that involves rehabilitation of patients with defects or disabilities that were present when born or acquired due to disease or trauma. The patients with HNC belong to the group of acquired defects. The rehabilitation consists of replacing missing bone and other tissues and restoring oral functions such as chewing, swallowing, and speaking. Often this rehabilitation is combined with traditional dental therapy to restore oral health, function and esthetics, especially when the oral cavity is compromised by RT [53, 54]. During the initial consultation, a comprehensive assessment of the patients and their oral condition is critical. A thorough pretreatment oral and dental screening, including the patient’s medical and dental history and clinical and radiographic examination, should be performed considering patient-related factors such as age, patient preferences, dental awareness, level of oral hygiene, and cancer treatment-related factors such as clinical staging and tumor location, cure or palliation decisions, treatment modality, type, dose, and range of RT, and immediacy of treatment [17, 42, 43]. The dentate patient In patients with remaining natural teeth, removal of teeth with limited prognosis identified as potential cause of oral cavity infection before head and neck RT is associated with a lower risk of developing ORN than tooth extractions after or during RT [55]. In the Netherlands, oral health recommendations prior to RT are based on a 1992 protocol, which was revised in 2018 [42, 43, 56]. To give extraction wounds sufficient time (at least 10 to 14 days) to heal before starting RT, decisions
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