Your NHS dentistry and oral health update 

6 December 2024 

A focus on cancer and oral health

Dear colleague,

I am delighted to share with you our latest publication: Oral Healthcare Provision for Cancer Pathways – a guidance document of clinical and commissioning standards. 

This document represents a significant milestone in our efforts to shed light on the intricate relationship between oral health and cancer. It offers a valuable opportunity to integrate oral health and dental care into cancer diagnosis and treatment pathways.

Around 50% of the population will experience cancer in their lifetime and this guidance aims to ensure equitable and timely access to oral healthcare for people of all ages diagnosed with cancer in England. It specifically outlines an 'oral health in cancer pathway' for: patients with a diagnosis of head and neck cancer, patients who will receive chemotherapy or immunotherapy for any cancer type and location, and patients that will undergo bone marrow transplantation.

This guidance references relevant clinical standards and information on the relationship between cancer treatment and oral health. It also supports the development of appropriately prioritised dental services for people with a diagnosis of cancer that involves the provision of radiotherapy above the shoulders and/or chemotherapy.  

The document emphasises the importance of multidisciplinary working, with oncology and dental teams working together to support cancer patients and minimise the impact of oral health problems on cancer therapy outcomes. It reflects NHS England’s Core20PLUS5 objectives to supply integrated care systems with the guidance required to achieve enhanced healthcare service access, experiences and outcomes.   

We believe that this guidance will serve as a valuable resource for commissioners, pathway coordinators, and healthcare professionals, including those working outside of dentistry, who are seeking to develop their knowledge and integrate oral health considerations into cancer care protocols. I invite you to read the guidance and share it with your colleagues and networks to improve patient outcomes and quality of life when it comes to oral health and cancer. 

It would be remiss of me not to take this opportunity to highlight the NHS 10 Year Health Plan for England consultation. In November I chaired a call with NHS England and dental leaders to discuss the strategy behind the consultation and how the learnings will benefit the profession. I would encourage all colleagues to share their insights via the consultation portal.

In addition, we are keen to hear your views, feedback and ideas as part of NHS England's rapid review into bureaucracy across the NHS. Please complete this short survey by 16 December or email england.redtapechallenge2024@nhs.net.

Finally, a reminder that NHS front-line healthcare workers are eligible for winter vaccinations. Please ensure your colleagues are aware and you can use these supporting communications.

Kind regards,

A diagnosis of cancer - oral health inclusion

The care that patients receive should also be safe and effective, while being tailored to meet the needs of the individual. Visit the Royal College of Surgeons of England website to read clinical guidelines on the oral management of patients prior to, during, and following cancer therapy. 

The focus of the models of care described in our new guidance Oral Healthcare Provision for Cancer Pathways is achieving stable oral health to facilitate timely initiation of cancer treatment, minimising oral health urgent care episodes, and encouraging continuity of care with prevention advice and interventions. Services should provide local populations with swift access to high quality, evidence-based oral healthcare and the confidence that the service is designed at a local level to meet local needs.

This guidance sits alongside the dental commissioning standards produced to support the transformation of NHS England dental services. Each standard sets out a framework for local work and should be read with the Introductory Guide for Commissioning Dental Specialties.

How prevalent is head and neck cancer?

The State of Mouth Cancer UK Report 2024 produced by the Oral Health Foundation, has found that new cases of mouth cancer in the UK rose to 10,825 individuals being diagnosed in 2023, equivalent to 30 people per day. This represents an increase of 38% over the last decade and 133% compared with 20 years ago.

Unfortunately, awareness of major signs and symptoms for mouth cancer amongst the UK population remains as low as 20%, with awareness of major risk factors as low as 8%.

There is substantial geographical variation in the prevalence of head and neck cancers. Clinicians should be aware of the demographics of the public they are treating, as well as how common contributing risk factors are in their local area.

The Atlas of health variation in head and neck cancer in England, published by the Office for Health Inequalities and Disparities (OHID), highlights the trends and geographical variation in the incidence and mortality of head and neck cancers as well as associated risk factors. An interactive webpage has been produced alongside the document summarising key details.

Medication-related osteonecrosis of the jaw

Medication-related osteonecrosis of the jaw: guidance for the oncology multidisciplinary team focuses on all aspects of medication-related osteonecrosis of the jaw (MRONJ) in relation to oncology patients.

The guidance was produced by a multidisciplinary working party on behalf of the UK Chemotherapy Board, with specialist representation from medical, dental and nursing teams. It is endorsed by the Clinical Standards Committee of the Faculty of Dental Surgery of the Royal College of Surgeons of England.

The most common dental intervention leading to MRONJ is dental extraction. The risk of MRONJ is present in all patients treated with either bone-modifying agents (BMAs) or anti-angiogenic drugs (AADs), but varies between differing regimens for metastatic and non-metastatic cancer.

We encourage all members of the dental team to review the MRONJ guidance, serving as a source of collective information for oncology teams on the prevention and management of MRONJ. It proposes protocols that oncology departments can adapt to fit local delivery of services and a series of simple communication adjuncts that can be adapted to assist communication between the oncology multidisciplinary team, patients, dental practitioners and hospital dental specialists. 

Mouth cancer: information and support

We want to encourage as many people as possible to check their mouth regularly for the early warning signs of mouth cancer as early diagnosis is vital for beating the disease.

NHS advice is for a patient to see a GP or dentist if the symptoms below do not get better within three weeks, particularly if the patient drinks alcohol or smokes. Symptoms include:

• sore mouth ulcers that do not heal within several weeks
• unexplained, persistent lumps in the mouth that do not go away
• unexplained, persistent lumps in the lymph glands in the neck that do not go away

The NHS website, Cancer Research UK. Macmillan Cancer Support and the Oral Health Foundation all have a range of information for patients on mouth cancer.

Resources on the Mouth Cancer Foundation website, for both dental teams and patients, include:
an oral care guide for care staff, referral assistance documents, a patient handbook, a cookbook for those with difficulty swallowing, and details of support groups. 

If you are ever in doubt about a suspected diagnosis, please contact your local Oral Medicine or Oral and Maxillofacial Surgery specialist service for expert opinion. Key information on mouth cancer can be found in a previous edition of the NHS dentistry and oral health update bulletin.

Further resources for clinicians include a mouth cancer awareness leaflet for dental teams and an oral cancer toolkit created by the British Dental Association in partnership with Cancer Research UK. 

What can you do to raise awareness of mouth cancer?

As well as sharing the information and resources highlighted in this bulletin, you and your team could:

• Join the Mouth Cancer Foundation’s annual Mouth Cancer 10km Awareness Walk as a practice. Each year hundreds of patients and healthcare professionals take part (pictured above: Jason Wong taking part in this event).
• Support patients through the Mouth Cancer Foundation’s ‘Saving Voices’ mission. With the aid of modern technology, patients can bank their voice before they are no longer able to speak from surgery or rebuild their voices post-surgery.
• For those who have greater plans for involvement, the Mouth Cancer Foundation awards grants. 
• Take part in the Oral Health Foundation's National Smile Month from 12 May - 12 June 2025.

Word of mouth – Karen Liesching-Schroder

When asked if she had any idea that it would be cancer, she replied “I had no idea, I’m a healthy person, I run, don’t smoke, don’t drink much and I eat healthy food”.

A treatment plan of radiotherapy, a neck dissection and surgery to have the side of her tongue removed followed. Further difficulties included an aggressive form of oral thrush, learning to speak properly again and concerns about cancer returning.

Years on from her initial diagnosis, Karen is determined to use her story to help raise awareness of the disease, “If you are worried about an unusual change in your mouth then get it checked out. Don’t be frightened but it’s important that you don’t suffer in silence and to remember that the sooner it’s checked out, the sooner it can be sorted”. 

Karen has worked tirelessly in improving support for others affected by mouth cancer, forming a Facebook community which meets online weekly. It is for this reason she was awarded Mouth Cancer Foundation’s inaugural special achievement award earlier this year. 

Word of mouth – CDS delivers free checks for mouth cancer 

Chief Operating Officer Glen Taylor, one of the dentists involved in the initiative, said: “Early diagnosis is vital for beating the disease, and this initiative was an excellent opportunity to focus on oral cancers and share important messages of being mouth aware".

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