225 General discussion 7 Previous studies suggested dental conditions to be risk factors for weight loss [108, 109]. It has also been suggested that extractions, mastication, and swallowing are interrelated. Such as having functional dentures and the number of occlusal units (OU), which are positively associated with masticatory performance [3], and patients with oral cancer lacking OU who had an increased risk for swallow impairment [110]. For now, it remains unclear whether the negative effect of tooth extractions on body weight is the result of a decrease in functional units or that it is the result of disrupting the existing masticatory system in its motor-sensory functionality and/or willingness to eat. Since body weight maintenance is important for completing planned oncological treatment and for supporting the recovery phase, further weight loss caused by tooth extractions should be minimized or avoided as much as possible. Besides the maintenance of body weight, a person’s social integration is often linked to the presence of functional teeth [111]. Patients suffer not only from the underlying oncological diseases, but also from the demands of therapy. The removal of teeth is generally negatively connoted [1, 89]. With greater accuracy of tooth extraction, the masticatory system will be better preserved and the loss of functional units will be limited, which has a direct effect on food intake [1, 3, 86-89, 112]. So further research into the adverse effects of tooth extractions and disruption of the masticatory system is desirable. The support provided by the insurance system in the Netherlands will continue to be important in this regard. The treatment of possible oral infection sites and the resulting prosthetic rehabilitation are currently covered by the national insurance schemes in the Netherlands. It would be ideal if later preventive care to prevent further damage to the masticatory system in these vulnerable mouths does not depend on someone’s financial possibilities. In conclusion, masticatory function and patient satisfaction of edentulous patients with HNC significantly improves with implant treatment. The placement of implants should therefore be considered for every patient with a edentulous mandible who is having retention problems and for every patient with a maxillary defect who is being rehabilitated with an obturator prosthesis. For dentate patients with HNC who will undergo RT treatment, there is an indication to reduce the number of tooth extractions prior to RT. More research is needed to safely de-escalate the current guidelines, without increasing the risk of ORN.
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