Dental Oncology
If your oncologist told you to see a dentist before chemotherapy, radiation, or cancer surgery begins, that referral is a standard, protective step in cancer care, not an afterthought. Dr. Debbie Lee, DMD practices in Manhattan, close to the hospitals and cancer centers where many patients are already being treated, and completed a specialized dental oncology fellowship at Memorial Sloan Kettering, where she evaluated and treated patients at every phase of cancer treatment. Here is why this visit matters and what it involves.
Request a Dental Clearance Visit → Call (212) 872-1432 →Quick Answer
Oncologists refer patients for a dental exam before chemotherapy, radiation, or cancer surgery because an active infection in the mouth can interfere with treatment. Bacteria from an infected tooth or inflamed gum tissue can become a problem at the exact time your immune system is least able to manage it, which can delay or complicate a treatment plan your care team wants to keep on schedule. A pre-treatment dental clearance confirms your mouth is stable enough to move forward, and if it isn't, addresses it first, on a timeline coordinated with your treatment start date.
The oral cavity is a source of infection risk that most patients never think to ask about.
Very few people are aware that the oral cavity can be a source of infection that compromises a cancer treatment plan, and this isn't limited to cancers of the mouth, head, or neck. It applies to any cancer diagnosis, because the concern isn't where the cancer is located, it's whether an untreated infection in your teeth or gums can affect your body at a moment when treatment has already reduced your ability to fight it off. This is easy to overlook when your care team, and your own attention, is focused entirely on the cancer diagnosis itself, which is exactly why the referral to a dentist can come as a surprise.
During her fellowship at MSK, Dr. Lee routinely performed dental clearance for head and neck cancer patients prior to their stem cell, radiation, chemotherapy, and surgical treatments, identifying and treating any oral infections before they could compromise those outcomes. That same evaluation is the foundation of the dental oncology care she now provides at Manhattan Oral Health, for patients facing any type of cancer treatment, not only head and neck cases.
A focused sequence, timed around your treatment start date.
Step 1
Comprehensive oral exam
Dr. Lee examines your teeth and gum tissue for anything that could become an infection risk once cancer treatment begins, using in-office CBCT imaging, digital scanning, and low-dose x-ray to see what a visual exam alone would miss.
Step 2
Treating active infection
Severely infected teeth are extracted so they cannot compromise your chemotherapy, stem cell, radiation, or surgical treatment once it's underway.
Step 3
Planning ahead of surgery
For patients facing a surgical resection, appliances can be planned and made in advance, so teeth can be replaced immediately once they're needed. Dr. Lee's in-office mill can fabricate crowns and appliances same day, which matters when a treatment date leaves little room for extra appointments.
Step 4
Clearance to begin treatment
With infection risk addressed, you move into chemotherapy, radiation, or surgery on a stable oral foundation, on the timeline your oncology team set.
If your treatment includes radiation to the head and neck, dental clearance carries extra weight. Radiation can affect blood supply to the jawbone, so a tooth with severe periodontal disease left untreated, or extracted after radiation rather than before, carries a higher risk of complications during healing. That's why teeth at risk in this area are identified and treated ahead of radiation, rather than during or after it.
Two sides of the same pre-surgical plan.
Removing what can't wait
Teeth with severe infection are extracted before treatment starts, so they can't compromise chemotherapy, stem cell, or radiation therapy once it's underway.
Replacing what's removed
For patients facing a planned surgical resection, Dr. Lee can plan replacement appliances in advance as part of full mouth rehabilitation, so an extraction doesn't have to mean going without teeth in the meantime.
Three years of hospital-based training beyond dental school.
Dr. Lee's approach to dental oncology comes from three years of additional hospital-based training beyond dental school: a general practice residency, an anesthesia fellowship, and her oncology training at Memorial Sloan Kettering. That combination is what makes her comprehensive approach possible, she considers the entire patient and how their cancer therapies interact with their oral health, not only the mouth in isolation.
With 32 years of clinical experience overall, Dr. Lee positions herself at the intersection of dentistry and medicine when treating cancer patients, which is not how the average Manhattan dental practice approaches this kind of care. You can read more about her background and training on the About Manhattan Oral Health page.
Manhattan Oral Health is a boutique practice, which matters most when a treatment date is already on the calendar. Dr. Lee is directly accessible rather than routed through a large multi-provider office, and the in-office CBCT imaging, digital scanning, and same-day mill described above exist specifically to reduce the number of separate appointments a pre-treatment plan requires, a real consideration when chemotherapy, radiation, or surgery is scheduled to begin soon.
If your oncologist has referred you for a pre-treatment dental exam, or you simply want to understand what's involved before your treatment date arrives, reach out and we'll find a time that works around your schedule, whether that's weeks away or a matter of days.
Request a Dental Clearance Visit →Because an infection in your mouth can compromise your treatment plan. Before chemotherapy, radiation, or cancer surgery, your immune system may be less able to fight off an infection, so any bacteria hiding in a damaged tooth or inflamed gum tissue is addressed ahead of time, rather than during treatment, when it's harder to manage safely.
Dr. Lee performs a comprehensive oral exam to identify any teeth or gum tissue that could pose an infection risk once treatment begins. Anything that needs to be treated or extracted is addressed on a timeline coordinated with your treatment start date, and for patients facing a surgical resection, replacement appliances can be planned in advance.
Yes. An oral infection can affect a cancer treatment plan regardless of where the cancer itself is located, because the concern is the infection itself at a vulnerable point in treatment, not the cancer's location. Dr. Lee's fellowship training at Memorial Sloan Kettering covered dental clearance across all phases and types of cancer treatment, not only head and neck cases.
Osteoradionecrosis is a complication where radiation affects the jawbone's ability to heal, so a tooth extraction or untreated periodontal disease in that area afterward can leave the bone unable to recover properly. Addressing at-risk teeth before radiation to the head and neck begins is one of the main reasons this evaluation is timed ahead of treatment rather than after it.
Not necessarily. For patients facing a planned surgical resection, Dr. Lee can plan and fabricate replacement appliances ahead of time, so an extraction doesn't have to mean going without teeth, the replacement can be ready close to when it's needed.
As soon as your treatment date is set. Dental clearance needs enough lead time to treat or extract anything necessary and let tissue heal before treatment begins, so the earlier your oncology team refers you, the more scheduling flexibility there is. If your treatment start date is close, call the office directly at (212) 872-1432 to arrange prompt scheduling.
Dr. Lee's office is equipped with in-office CBCT imaging, digital scanning, and a same-day mill for crowns and appliances, which exist specifically to compress a pre-treatment plan into fewer appointments. As a boutique practice, Dr. Lee is also directly accessible for scheduling rather than routed through a large multi-provider office, which helps when a treatment date is already close.