The Effect of Radiation Therapy on the Oral Innate Immune Response, Oral Microbiome and Health-Related Quality of life in Head and Neck Cancer Patients
The purpose of this research is to investigate the potential of radiation therapy to directly impact the quantity and type of oral neutrophils as well as oral microbiome in head and neck cancer patients. Oral neutrophils and microbiome can affect patients’ life-long oral outcomes thereby affecting their dental treatment regimen and care. Furthermore, these oral biological outcomes can be used as prognostic oral biomarkers for oral complications associated with radiotherapy in head and neck cancer patients in the hopes of improving quality of life.
Investigation of Oral Innate Immune System Recovery in Bone Marrow Transplant/Stem Cell Transplant (BMT/SCT) Patients
The primary objective of this study is to investigate the potential for the predictive value of an oral rinse assay to determine outcomes in BMT/SCT to potentially allow physicians to gain important early information regarding their BMT/SCT patients. This will allow for more educated decision-making regarding patients’ care, specifically in terms of the nature and timing of care.
Development of Clinical Practice Guidelines Prior to Stem Cell Transplant
The objective of this prospective step-wedge study is to document clinical practice approaches and rates of odontogenic complications in patients pre-allogenic and autologous stem cell transplant for lymphoma patients. This step will be followed by adoption of risk classification guidelines to determine if rates of extraction can be normalized without increasing odontogenic complication rates.
Investigating the Role of Oral Inflammation in Cardiovascular Patients
The primary objective of this study is to investigate whether an association between neutrophils and microbiome in both the mouth and blood exists in patients with cardiovascular disease with periodontal disease. If this association can be demonstrated, oral neutrophils and microbiome found in patients with periodontal disease may have the potential to predict the development or advancement of cardiovascular disease, respectively.
Development of Consensus Guidelines for Pre-radiotherapy Dental Care in Head and Neck Cancer Patients Using the Modified Delphi Technique
The aim of this study is to describe the process of creating consensus guidelines for dental care in head and neck cancer patients undergoing radiation therapy using the Modified Delphi Technique. Dental Oncologists from across Canada are to be included by invitation. Responses will be utilized to develop guidelines for dental care in head and neck cancer patients before commencement of radiation therapy.
Clinical Practice Guidelines for Dental Management Prior to Radiation for Head and Neck Cancer
Limited evidence exists linking the specific preventative dental care provided prior to radiation therapy (RT) for head and neck cancer to outcomes like osteoradionecrosis (ORN). This study will utilize expert consensus to develop tooth-specific dental treatment pathways for head and neck cancer patients prior to radiation. The radiation dose at which clinicians would prophylactically remove teeth to prevent ORN was established as 70Gy in the maxilla and 60Gy in the mandible. Treatment pathways were developed for maxillary and mandible anterior/premolar and molar teeth receiving a dose at or above this threshold. Risk factors were established for carious, periodontally involved and third molar teeth. This cohort will be followed prospectively to evaluate the outcomes associated with tooth-specific dental treatments.
Validation of the Modified Schirmer Test as a Measure of Xerostomia
The goal of this study is to validate the use of the Modified Schirmer Test (MST) in its ability to measure xerostomia severity. The gold standard for measuring submandibular gland production is via collection using a Wolff device. We will perform a prospective study to correlate the MST with the Wolf collection device to validate the MST, as well as correlation with patient reported outcomes. This could have significant implications for clinical trials where patient reported outcomes have replaced salivary measures.
Assessment of Osteoradionecrosis Incidence in Patients Treated for Head and Neck Cancer
Using retrospective data on all head and neck radiation patients seen from 2011 to 2018 within our clinic a number of research questions regarding osteoradionecrosis will be addressed:
- Determine the relationship between the development of osteoradionecrosis when dental extractions were performed prior to radiation therapy and the time to development.
- The correlation between development of osteoradionecrosis in patients with and without dental insurance.
- Assessment of current staging systems for osteoradionecrosis
Financial Toxicity Study for Head and Neck Cancer Patients undergoing Radiation Therapy
This prospective study aims to assess the financial toxicity of pre-radiation dental care for patients being treated for head and neck cancer. We will assess cohorts of patients treated for head and neck cancer with radiation therapy at centres that have OHIP-funded pre-radiation dental care compared to those that do not. Metrics included and techniques employed will be cost of treatment and responses to a validated and standardized measure of financial toxicity.
Liquid Biopsy Detection of Early Oral Cancer in High-Risk Patients
This study will utilize the use of liquid biopsies (blood and saliva) for the detection of biological indicators of oral malignancy. This study will involve patients recruited from the High-Risk Oral Lesion (HROL) Clinic to determine if oral cancer can be detected at the earliest stage, which would allow for early oncologic intervention thus improving patient survival and decreasing treatment morbidity.