A culture shock in dental hygiene: Exploring the management of oral health after head and neck cancer

Abstract

Objectives Managing oral health after the treatment for head and neck cancer requires meticulous daily oral hygiene practices and regular professional dental care; however, the individual factors and health system structures required to achieve oral health are often not well considered. This study aimed to explore how oral health was understood and managed after head and neck cancer treatment and identify factors that influenced oral health behaviours and dental service utilization. Methods A qualitative, inductive approach was used for data collection and analysis. Sampling of participants was purposive, using a maximum variation approach, and data were analysed using thematic analysis. Participants were recruited from the maxillofacial clinic at a tertiary facility in Brisbane, Queensland, Australia. Results Twenty‐one participants took part in the study. Findings described individual and structural factors that influenced the management of oral health post‐treatment. Individual determinants of oral health behaviours included a cognitive shift towards lifelong oral health; management of unexpected barriers; and management of competing priorities. Structural factors included availability, accessibility of services, and continuity of care. The ability to fund oral health emerged as a salient theme that influenced both individual and structural factors. Conclusions Strong self‐efficacy and financial and spousal support enhanced the management of oral health, whereas difficulty managing competing issues post‐treatment, such as psychological and financial stress, limited participants’ capacity to prioritize and manage oral health. Policy initiatives are needed to address the structural barriers caused by a lack of timely access to general and preventive dental care post‐treatment.

Understanding oral health from the point of view of adults with disabilities and/or complex medical conditions: A scoping review

“…The participants presented various medical conditions and disabilities. Ten qualitative studies were found for individuals with cognitive or physical impairment, [34][35][36][37][38][39][40][41][42][43] six for people with mental illness, [46][47][48][49][50][51] five for elderly persons with comorbidities, [24][25][26][27][28] three for adults with dementia, [31][32][33] two for persons who had received head and neck cancer treatment, 44,45 two for individuals in palliative care, 52,53 one for adults with cardiovascular disease, 30 , one for stroke survivors. 29 The data extracted did not bring to light similarities or differences between the population subgroups.…”

“…Eleven studies reported the perspective of the participant's family members and carers. 29,30,33,37,38,[40][41][42][43]45,53 Four studies did not involve the subjects in the interviews. 32,[34][35][36] The characteristics of the populations and the study designs are detailed and presented in Table 2.…”

“…24,28,30,31,33,35,47,50,51 "I do not know, as long as my mouth looks fresh and does not hurt" (young woman, first episode psychosis, post-traumatic stress syndrome, drug abuse). 48 Interviewees express different concerns depending on the priority given either to financial difficulties 45 or to their medical condition, depending on the severity and fluctuation of symptoms. [25][26][27][28]33,35,36,38,48,49 "I don't give a damn now.…”

“…53 More anecdotally, some participants report losing the "self-cleansing function." 45 "It's frustrating. .…”

“…They also talk about how oral problems make them reluctant or unable to participate in group activities (leisure activities, sharing meals) and to build relationships. 27,31,44,45,51 "You wouldn't want to be seen" (participant, no description). For some participants with behavioral problems, oral problems can trigger tantrums which impact those around them.…”