Introducing You to the World of Dental Oncology

JW: Welcome to SimplifiHealth. This is Dr. Jill Wade.

AB: I’m Aurelia Byrne, registered Dental Hygienist.

JW: We are so excited today to share with you our dear friend, Dr. Dennis Abbott.

DA: Hello, I’m glad to be here, thanks.

JW: We are honored to have you here. We are going to take some time today for everyone to get to meet Dr. Abbott. It’s been my pleasure and honor to know him for many, many years all the way from Baylor College of Dentistry. We are both Baylor grads. Our history is many years going on probably 25 years now.

DA: Yeah, that’s right.

JW: We both have a, I guess you would say, respect for each other all these years because we both have been on this journey of taking dentistry to a whole nother level. For me, it started with hormones and then went into this heart attack, stroke, and diabetes prevention. I feel like what I do looking at patients as a whole body, not just parts and pieces, Dr. Abbott also does but in a very special way, he looks at things from an oncology standpoint.

DA: That’s right, yeah. I’m probably one of the few people out there that does this type of work or does what I do. There are others but we’re kind of all few far in between. Anyway, I got started in this basically because I saw a need. I had a patient—that was actually never my patient—his wife was and they had moved kind of far away from the practice and he told us, “Hey, we’re going to be leaving.” One day, I got this call from his wife and she was kind of panicked and said, “Hey, Dr. Abbott, can you see my husband?” I’m like, “Sure, I thought you guys moved?” She was like, “We did but we went to go see this other dentist and they wouldn’t see him.” I’m like, “Okay. What’s going on?” She said, “He has cancer.” I was like, “Okay.” She said, “But he’s in remission.” I’m like, “Well, okay.” She’s like, “Could you see him?” I’m like, “Sure.” She’s like, “Oh, my gosh, thanks.” Anyway, long story short is they ended up driving back and forth from our office to their house about a 2 ½ hour trip each direction over the course about the next six months to kind of help get his mouth rehabilitated from some side effects that had been caused by dry mouth that he had had while he was in chemotherapy.

It kind of got me into thinking, I’m like, “If this guy have problems like that, there got to be other people out there who have problems like that.” I really started trying to learn as much as I could and then read a lot. I spent several years trying to kind of prepare myself to see if this was a viable part of a practice-type model that I could move into and if it was something that I could make it work in private practice. Obviously there are a lot of big cancer centers that will have a dental oncology department but is it something that we really could bring to the private practice setting? And I finally decided, “Yeah, I think this is something that we could make work.” That was 7 ½, 8 years ago, it’s just kind of history as they say. It’s been a great fulfillment for me personally and professionally. I think like I feel like I’m finally in the place where I’m supposed to be. That’s how I got started and launched off in this.

JW: Absolutely. Your patients are so lucky to have you in their lives to help them with their cancer journey. But let’s go back for just a second because I kind of don’t remember, did you go straight into private practice after you graduated from Baylor or did you go and do a couple of other related training?

DA: Yes, I did, I being neglecting for punishment that I was at the time. After I graduated from Baylor, I went to Buffalo, New York and put in this Tucson boy and three Buffalo runners was a main trip for sure. But I went off to Buffalo and I was actually working on a certificate in periodontal surgery and PhD in oral biology at the same time. It was a combined program for the PhD and the certificate that was supposed to last about five years. It was taking most people around seven to get out of there. Anyway, I spent 3 ½ there before I decided, “I don’t want to do this the rest of my life. I don’t want to be an active emission. I don’t want to be stuck in a research lab. I want to take care of people.” That was really my passion and my calling. I felt like I wasn’t able to fulfill that part of me.

But during those three years there, when I was at Buffalo, my first year was 100% straight pure science [inaudible 00:04:50] PhD work, no clinical, no really dental related type situation at all, it was all cellular biology based, that’s my undergraduate degree from [inaudible 00:04:59] and cellular biology and so I’m really cellular biologist who also practices as a dentist. Anyway, I was kind of working on that part of things and then started back into the clinics in my second and my third year while I was there getting an advanced training in periodontal health and surgery and stuff. I did that and when I left, it was a mixed emotion. Honestly, I gotten straight from undergrad to Baylor, Baylor to Buffalo, I was kind of hit and burned out after 11 ½ years of education. My family changed, my older son was born, my priorities changed, and there were just a lot of things going on that I was kind of like, “This is not where I’m supposed to be.” I kind of felt like, “I may just wasted 3 ½ years of my life but at least I’m going to be happy.” But during those 3 ½ years, it really, really set the foundation for the knowledge that I needed, I think, to be hopefully as effective as I can be in this type of work that I’m doing. If nothing else, being in the PhD program taught me how to teach myself which is important and how to read critically the literature that’s out there and understand and move the application from bench science to real world. That, I think, is one of the areas that I kind of pride myself, is being able to translate the pure science into clinical application and then make that understandable to a patient. That’s one of the things that I think is really, really important.

I think it helps in the world that I live in, in the oncology world, there are so many, words, diagnoses, and strange things that come about that a lot of times, people who are battling this, be it the patient or their caregiver, that they just don’t really fully understand a lot of what’s going on. Sometimes they’re going to go home and they’re going to Google, WebMD, or whatever. The better answers to really ask somebody who knows and can give them the right answer. I tell patients all the time, “Listen, if I don’t know the answer, I’m not going to make something up but I probably know somebody who does know the answer and we’ll get it for you.” I think it’s just important to rely on the professionals that are there to take care of you, to give the answers that are there, and hopefully they can. But that’s one of the things that I think that I’m, in addition to the services that I can provide. A lot of times, I’ll have patients that will ask me just, “Hey, Dr. Abbott, can you tell me about this? What does this lab report really mean? What is this?”

JW: Yeah. Just talk to them in real world language not doctor talk, not how bigger words can I use? How much can I impress you with my knowledge but giving it to them in real world circumstances and giving them hope and that this too shall pass.

DA: Yes. And providing the element there of hope with realty. I think, I always stay very careful to never make claims that I can’t backup. I never want to say, “Hey, everything’s going to be okay,” because this is real life and sometimes it’s not. Unfortunately, I’ve lost loved ones to cancer in my life, my mother-in-law, my grandfather, I’ve had an uncle who passed away from cancer. It’s definitely touched my life like it has everyone else’s. I don’t think anybody is immuned and this is unfortunately an equal opportunity disease that does not care if you’re a C-Suite level executive in the corner office or working three jobs to support your family. It is just one of those types that it affects us all. It gets really personal, very emotional sometimes, and really hard. But I think when we can have those honest, open, and real conversations with our patients, it’s providing them the service that they hired us to do and that is to take care of them, and to care. I’m not there to be a miracle worker but I’m there to care, show compassion, and do everything within my power to make their lives better.

JW: Absolutely. Okay. I’ve got a question for you.

DA: Sure.

JW: Let’s say that someone does have themselves or a loved one who gets diagnosed with cancer. Let’s take it from two different sources maybe, one just cancer in general, let’s say breast cancer or colon cancer, any type of cancer, what should be maybe the first two or three things that they think about as far as the oral cavity goes on their dental aspect of their health, there anythings that they should think about. Then on the flip side, let’s say it was truly oral cancer or head and neck cancer that they were dealing with, is there something a little bit different that you would suggest to those people over just general cancer?

DA: Absolutely. This is one of the things that a lot of times, we really have to explain to our physician colleagues sometimes that anyone who’s going through cancer really needs to have a dental oncologist on their team, really, because there are so many types of things that happen in the mouth as a relation to, let’s say chemotherapy in general, systemic chemotherapy, be it for breast cancer, liver cancer, kidney cancer, it doesn’t really matter, a leukemia, multiple myeloma, there are all kinds of issues that a lot of the different types of drugs that are used in the chemotherapy cocktail are going to cause dry mouth for example. A lot of them will cause a condition that we know as oral mucositis or mouth sores, these are ulcerations that happen in the mouth and they actually begin at the bottom layer of the soft tissue and then destroy from the bottom up. These wounds, these ulcers are very deep, very profound, and a lot of times painful and then become an open pathway like a gateway into the bloodstream from bacteria from the mouth to get into the bloodstream.

Chemotherapy in general is designed to attack rapidly dividing cells, that’s what cancer is, rapidly dividing cells. It does this through a variety of different mechanisms, be it oxidation, or other things, or different kinds of inhibitors, or working at the cellular pathway of things. But regardless of how it works and the mechanism, the outcome, for many times, is the same in that one of the rapidly dividing cells that gets attacked is one that occurs naturally in our bodies and that is blood cells. Consequently, what will happen is the ability to fight infection or what we call the immuno-suppression is going to happen and patients or people who are given these drugs—even though these drugs are needed to fight the cancer—are going to be more susceptible to let’s say other infections even like the common cold or just any other kinds of infection they may come in contact with in their lives on a daily basis, they’re going to be more susceptible to that. That is one of the things where we really can help with that like getting that bacterial count lower.

AB: When should a patient actually get treatment done before, in between the cancer treatments…

DA: From the dental aspect?

AB: Yeah, from the dental aspect.

DA: Yeah. Absolutely. Because of that immunosuppression, we would love to see the patient before they get into that situation.

JW: So before it even starts.

DA: Ideally before the treatment even begins, as soon after the diagnosis is given as possible is the best time for them to be able to consult either their dentist or if they have someone in their community who’s a dental oncologist, the dental oncologist. Because that’s the time when we have the freedom to get things done without running the risk of there being some kind of bacteria from the mouth that gets into the bloodstream and causes a problem throughout the entire body.

AB: How could somebody find a dental oncologist—we know you, in Texas here—but is there a big community of people out there, dental oncologist?

DA: A lot of times, I think the best source or the best resource for a person to look at is to ask their oncologist to see if there is somebody that their oncologist is familiar within their community. Perhaps if they’re at a larger institution, they may have a dental oncology department there or may have dental oncologist on staff at the facility that they are actually giving their cancer treatment in. If they’re going to a smaller type of office, that may not be something that is readily available like on site but maybe something that the oncologist has a relationship with a professional relationship with somebody that they know understands the process. Whether or not they’re actually somebody like myself who really has devoted their entire practice to this, there are several people out there who have taken some coursework to understand what to do in situations where they have patients that come in that are being affected by cancer.

AB: Yeah, that’s very important I think that these patients get the help that they need so that there’s not any further infections.

DA: Absolutely. I think it also stands to reason and this is something that I would really make sure that your listeners understand is to really ascertain to be certain that the doctor that they’re going to really does understand what they’re going through. Because unfortunately, a lot of times, they might think they know but they might not. And so quiz them a little bit if you need to. I enjoy questions from my patients all the time. My patients will come in and ask me questions and listen, I’m like, “If I can’t answer your questions, then you don’t need to be coming to me because you need to go to somebody who knows what’s going on,” you need to feel comfortable in that relationship where you can ask of the doctor, “Hey, are you really aware of this? Do you really understand the ramifications of this? What are you looking for when these things come up?”

For example—let me give an example that your listeners may be able to relate to—your dentist that you’re going to should be comfortable looking at your bloodwork, and understanding what your bloodwork means, because that is a true test, let’s say that you’ve already gotten into treatment, we’re beyond the diagnosis and we’re beyond that kind of an initial phase, and we’re into treatment, because that’s another realm altogether. If we’re into treatment, we need to make sure that the patient’s ability to fight infection is there and that the patient is not suffering from some kind of propensity for bleeding. Sometimes, get a situation where we’ll have a patient come in and we won’t even be able to tell because by looking at them, they look like they’re completely healthy just like you and me. But whenever I look at their numbers, whenever I look at their blood work, it’s a totally different story. That’s when you really need to have somebody who understands.

Getting back to your question, what you were asking, I think as soon after diagnosis is given, if we have a situation that is not head and neck, the big first thing that needs to happen is you need to get your teeth cleaned. I tell patients, “Unless it was done within the last six week, you need to get your teeth cleaned again,” because even if it was a couple months ago, you need to get your teeth cleaned again. That’s simply just to get that into oral bacterial load down as much as possible. The other thing that I think is important is to have just a regular exam done and make sure there aren’t any underlying dental infections or any decay that has the risk of getting into the nerve and understand that your mouth is going to get really dry. If there’s anything the dentist can help you with for that, they should be able to. That may need to be something that you began proactively pursuing.

AB: Because I think people don’t realize what happens in a dry mouth, that means, basically what we’re saying is that you no longer produce the same quality or quantity of saliva. 

JW: Saliva is the body’s natural protection against cavities and basically just kind of the overall oral health like from a periodontal disease standpoint. Without saliva, you have no buffering and no protection. But there are products out there that can help increase or let’s say neutralize the pH balance of the medicines that you’re on, create some comfort as far as we’ve all kind of have that “cotton mouth” before we’re you’re so dry, you can almost can’t even bring your tongue down off the roof of your mouth, those are things that like you were saying with the rapidly dividing cells and things like that being attacked in these huge types of ulcerated sores that can occur in the mouth. By keeping it moist, it’s so much more comfortable.

DA: From a standpoint too not only, you mentioned the buffering of the assets, but the remineralization component, the custom and [inaudible 00:18:43] that are found there to kind of strengthen, it’s just you’ve no idea really what’s going on till you miss it. It’s just during those times that decay can really happen very quickly and spread like wildfire.

Unfortunately, I’ve seen patients who, let’s say we had them on a fluoride supplement that was remineralizing fluoride that we are asking them to use on the daily basis just at home and trade carriers and they thought, “Nah, I really don’t need the same anymore,” unfortunately. Then they come back in and it’s like, “Oh, man,” and we’ve got this tooth has decay and this tooth has decay and this tooth has decay so bad that it’s not [inaudible 00:19:18] it has to be a crown. When you start getting a bunch of those [inaudible 00:19:20] it’s really expensive. The better answers just to kind of prevent that from happening...

JW: You just hit it right on the head. Just work on preventing it from the get go. The very first thing that happens, don’t forget about your oral health, get into the dentist, get those cleanings, get those products, really be on top of the best hygiene that you can possibly have at home so it keeps you basically one-upping—

DA: Exactly.

JW: In the sense that you are ahead of the game, you don’t have to play catch-up, because once you play catch-up, it’s expensive.

DA: It’s expensive and it’s time consuming. You’d ask me one other question, let me answer that before we go, in the head and neck realm, because there are a lot of people out there who are getting head and neck cancers now unfortunately. That realm is a totally different world. It’s funny because originally, like I was saying earlier, we have to kind of tell our physicians, “Hey, we need to be in for the breast cancer patients and with the lung cancer patient, and all these other things too,” but they automatically assume it’s just oral cancer that we deal with and it’s not, although that’s a big part of what we do. I would say this to your listeners, if they themselves have been diagnosed with oral cancer, or they have a loved one who has been diagnosed with oral cancer, or friend, we probably need to spend a whole session on just that.

JW: I think you’re right.

DA: Because it really is a different ball of wax altogether so to speak. The first things first would be, just like we said before, get in as soon as after diagnosis as possible, that’s going to be the fundamental stuff. But there I think there are whole lot of steps that we really need to go into that we can really hopefully begin to shed some light on things. There are a lot of questions surrounding oral cancer because a lot of it now is caused by HPV. I think that would be another topic that your listeners would probably be very, very interested in hearing about and I will be glad to talk about them.

JW: I would agree with you. We’re going to invite you back.

DA: Okay, listen, I love talking about things like this because knowledge is power. It really is. And for the listener to understand how they can really take control of their own health, be their own advocate, and empower them with the brought solid information helps them be able to make better choices, and that’s what we’re really all about. Looking like yourself at the entire person as an individual, not just a set of teeth, but a person with a body who has emotions, psychological needs, religious, health, and social needs. All of these things that come together that make us who we are. But that’s really who we have to focus on, it’s just our entire person and taking care of that person as best as we can. I’m happy to come back and happy to be a part of it. Thanks.

JW: Thank you, Dr. Abbott, for being here with us today. I know we share a lot of passion about what we do in taking care of our patients. I’m super excited that you are here today in order for us to share this with our listeners and that you’re coming back and we’ll get to share even more information. This is Dr. Jill Wade and I want you to know that I hope you keep smiling from the inside out.