HJAR Sep/Oct 2024

48 SEP / OCT 2024 I  HEALTHCARE JOURNAL OF ARKANSAS ORAL HEALTH ORALHEALTH CLEARANCE (OHC) is a term indicating that a dentist has examined and, if necessary, treated the oral cavity of a patient and attests there is no current infection or active disease present. Since physicians do not typically examine the oral cavity, this attestation assists in preparing for the treatment needs of their patients who are very ill and require critical surgery and/or therapy. OHC helps mitigate potential risks and complications for successful surgery and therapy outcomes. Infection or disease existing in the mouth can greatly affect the outcome of heart surgery, cancer radiation therapy and/or chemotherapy, joint replacements, organ transplants, and other essential life-saving therapies. 1 At times, when treatment is critical and therapy proceeds before the necessary dental treatment is completed, it can result in disastrous outcomes. It is also not optimal that life-saving therapies are delayed until there is no infection or disease present in the oral cavity, which is why medical-dental integration is important. The mouth is the point of origin for dis- seminating pathologic bacteria, which trav- el to various body sites, particularly in ill or medically compromised patients. 2 This fact raises the level of importance of medical- dental integration for a multidisciplinary approach to treat in the best interest of the patient and in a comprehensive method. Years ago, I was asked to examine a hos- pitalized patient. The patient was diagnosed DIALOGUE COLUMN ORAL HEALTH reconstruction, and multiple teeth must be extracted. Leaving carious lesions or infec- tions in the mouth can lead to poor outcomes for the patient’s therapy. 5 In preparation for receiving chemotherapy, radiation, and surgery, such as bone mar- row transplant to treat acute leukemia types, OHC is required. Chemotherapy decreases neutrophils, which compose the majority of white blood cells that battle infection and heal damaged tissue. 6 If patients have exist- ing disease or infection intraorally, the treat- ment is already compromised. For organ transplants, OHC is extremely important since oral infection could lead to systemic infection after the transplant. It is equally important that post-transplant, pa- tients continue and maintain their healthy oral status, as active periodontal disease and caries are potential sources for future infection. 7 Unmanaged or uncontrolled oral infection can even lead to life-threatening sepsis, so oral health is not to be overlooked. In the last few years, the recommenda- tion forAPbefore joint replacement has been somewhat controversial. It is considered pru- dent that a thorough examination and any necessary dental treatment be completed prior to joint replacement surgery. OHC can identify any current issues and prevent an infection, thus avoiding postoperative infec- tion in the joint. 8 In the treatment of head and neck cancer therapies, it is of utmost importance that OHC is completed. Often when radiation with subacute bacterial endocarditis and needed surgery. There were questions on why this patient, who appeared healthy, had this condition. After an oral examination, the mystery was solved. There were numerous decayed teeth and periodontal issues, and the oral bacteria were the cause of the infection. In cardiovascular surgeries, it is extremely important that caries and periodontal issues have been treated. The bacteria in the oral cavity, such as the Viridans streptococci and most commonly the Streptococcus mutans and sanguis, have a predilection to heart tissue and previous vegetations on heart valves. 3 For this reason, it is essential the oral cavity is healthy. Poor oral health is a risk fac- tor for infective endocarditis (IE). Antibiotics used prophylactically are required for certain conditions, such as prosthetic valves, ven- tricular assist devices, and previous IE. For a complete list of the antibiotic prophylac- tic (AP) recommendations, see theAmerican Heart Association guidelines. 4 Since cancer therapies can include a com- bination of chemotherapy, radiation, and/or surgery, the option selected necessitates the needed pre-treatment preparations. Many times, the patient will need an extensive amount of dental treatment to rid the oral cavity of infection or disease. Depending on the severity of the dentition status, treat- ment could include a simple prophy, one to multiple fillings, a single tooth extraction, or full mouth extractions. When cancer thera- py is urgent, there is no time for full mouth Oral Health Clearance: Why It’s Necessary for Life-Saving Therapies