Patient-Reported Barriers To Routine Dental Care And Postoperative Maxillofacial Prosthetic Rehabilitation In Head And Neck Cancer Patients: A Cross-Sectional Study

Abstract

Background: Survivors of head and neck cancer require sustained oral healthcare after cancer therapy; few cases may additionally need specialized maxillofacial prosthetic rehabilitation. Objective: To assess patient-reported barriers to routine dental care among post-treatment head and neck cancer patients and, among those requiring a maxillofacial prosthesis, to characterize barriers to postoperative prosthetic rehabilitation.

Methods: A cross-sectional survey was conducted among 194 post-treatment head and neck cancer patients. The routine dental-care questionnaire assessed education and counseling, follow-up, financial access, provider availability, transportation, travel, and persistent oral symptoms. Forty-eight patients (24.7%) required maxillofacial prosthetic rehabilitation and completed an additional 16-item prosthetic-access module scored from 1 (not a barrier) to 5 (very major barrier); scores of 4-5 were classified as major barriers. Proportions were reported with Wilson 95% confidence intervals. Factors associated with unmet dental-care need were evaluated using multivariable logistic regression.

Results: The cohort had a mean age of 59.8 ± 10.0 years, and 149 (76.8%) participants were male. Regular post-treatment dental follow-up was reported by 146 (75.3%), whereas 83 (42.8%) reported concern about dental-care costs and 69 (35.6%) reported an unmet dental-care need. Among the 48 patients requiring prosthetic rehabilitation, the most common major barriers were travelling distance (32; 66.7%), financial burden (31; 64.6%), and repeated appointments (29; 60.4%). Limited mouth opening was strongly associated with unmet dental-care need (adjusted odds ratio [aOR] 4.40, 95% CI 2.25-8.60; p<0.001). Cost concern (aOR 2.24, 95% CI 1.15-4.34; p=0.018) and difficulty finding an appropriate dentist (aOR 2.38, 95% CI 1.07-5.27; p=0.033) were also independently associated with unmet care.

Conclusion: Substantial barriers to oral healthcare persisted after head and neck cancer treatment. Patients requiring maxillofacial prosthetic rehabilitation faced an additional burden related to travel, cost, specialist availability, etc. These findings support integrated dental and maxillofacial prosthetic pathways within survivorship care.