RSDM Doc Focuses National Attention on Dental Insurance and Cancer Patients

Dr. Gayathri Subramanian

If dental procedures were covered as part of cancer treatment, patients would be far less likely to develop one horrible side effect: a disease that deadens the jawbone, called "osteoradionecrosis.''

RSDM's Dr. Gayathri Subramanian told the story of a patient who contracted the disease in a piece published last month in the influential journal Health Affairs, which is known for helping shape public policy.  Subramanian's paper, published in the monthly "Narrative Matters" section, raised questions about the consequences of regarding oral health as unrelated to overall health. Last week, the piece was excerpted in the Washington Post.

Subramanian's patient,  called "James" in the story to protect his identity, had severe tooth decay and should have had several extractions before radiation treatment for oral cancer. But James could not afford the procedure, which was not covered under his medical insurance, placing him at risk for osteoradionecrosis, where the dead jawbone is exposed in the mouth after it's weakened by radiation.

In the Health Affairs piece, Subramanian's explores how things might have turned out differently.

If my patient had had dental insurance alongside his medical insurance at the time he needed it, his story could have had a very different ending. He could have undergone his 18 tooth extractions well before his radiation treatment, at the same time that an ear, nose and throat specialist performed his diagnostic biopsy, all under general anesthesia. His extraction sites could have healed by the time his biopsy result was available and his radiation therapy was being planned. Or, even better, he could have taken his oral health seriously enough to have regular health checkups and periodic dental care. His tongue cancer could have been diagnosed several months earlier, and his teeth could have been stable enough to withstand the radiation without the need for extractions.

Subramanian has researched the link between cancer treatment and oral health for the past few years. In 2015, she and RSDM faculty Dr. Daniel Quek and Dr. Junad Khan received a $40,000 grant to study
medication-related osteonecrosis of the jaw (MRONJ), which can affects victims of metastatic breast cancer, multiple myeloma and prostate cancer who are on medications to manage the disease after it has spread to the bone. The most common treatments are bisphosphonate and denosumab.

The funding was a result of a Busch Biomedical Grant awarded by the Rutgers University Office of Research and Economic Development.