Hygienist Adapts Procedure for an Oral Cancer Patient

Submitted by Beverly Frye, RDH, Seattle WA

Hygienist doing a cleaning on an oral cancer survivor

I was filling in for an RDH friend on vacation. The doctor told me about an afternoon patient on my schedule:  She had surgery for oral cancer,  wears an appliance, needs hand instrumentation rather than ultra-sonic and minimum water because several teeth and part of her palate were removed.  I had no idea what to expect but figured I could handle it.

The patient and I chatted about her medical history and the surgery.  I noticed she had difficulty talking and lost some muscle function on her left side. I asked if she needed the appliance in or if it had to be removed for the cleaning.  She told me it covered a lot of the remaining teeth and would need to be out.  She removed her appliance and I laid the chair back.

I was not prepared for what I saw. Most of the left side of her palate was missing and all of her molars on the left top and bottom arch were gone as well as most of the bone that held them in place.  I felt like I was looking into her skull, into her nose from inside the mouth and down her throat. Everything was exposed and covered with a whitish yellow film  from the newness  of the surgery and looked very fragile like it could open up and start bleeding with the slightest touch.   All of the anatomy that controls food and water from flooding your lungs and filling up your throat was just not there anymore.

Suddenly, I was filled with panic. I didn’t want to hurt her. How I could prevent her from choking on even her own saliva?  I calmly told her that I needed something and would be right back.  I went directly to the doctor telling him I didn’t know what to do. He put a hand on my shoulder and said, ‘You will be fine. Do what you can.’

I went back into the room and told the truth; ‘I never worked on a post surgical case like this before.  I need your guidance.’  She was appreciative of my honesty and told me that if I could work without laying her back all the way it would help.  I attached a foam bumper to the saliva ejector and  let her hold it. A few towels helped with the uncontrollable drooling. We got through the cleaning uneventfully! Afterwards, we were both able to relax and even laugh together.  I thanked her for being so gracious.  She thanked me back saying how having her teeth cleaned made her feel human again.

After hearing Eva’s story in Seattle at the Pacific Northwest Dental Conference,  I was reminded of this special day all those years ago when I made a small difference in the life of an oral cancer survivor.

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