Oral Hygiene

Poor oral hygiene has also been separately demonstrated as an independent risk factor for the development of HNSCC and has been associated with poorer overall survival in several series.76-80 In addition to the mechanism of pathogenic oral cavity and oropharyngeal bacteria in the development of carcinoma and pneumonia, improved oral hygiene may also reduce mortality. Decrease in mortality may be associated with decreased pneumonia incidence and severity as well as the oncologic benefits conferred through routine dental and oral cavity surveillance.81-83 This further underscores the importance of maintaining a healthy oral cavity, particularly in older patients and those with previously treated HNSCC.65,66,84 In all, increased attention should be paid to modifiable risk factors including smoking, oral hygiene, and nutrition status in order to mitigate aspiration risks.
CONCLUSIONS :
Primary COVID-19 infections are more likely to cause pulmonary complications (and mortality) in men, older patients, those with underlying prior or current cancers, and patients with concomitant lung conditions (such as COPD and prior smoking). Patients with head and neck cancer share similar attributes with those at highest risk for adverse outcomes with COVID-19 infection.3-6 Toxicities from CRT have been demonstrated to significantly increase rates of aspiration and pneumonia within this cohort.6-8 HNSCC patients are at increased risk for a variety of viral and bacterial pulmonary infections, which depend upon the underlying mechanism of immunosuppression. Interventions designed to decrease smoking and alcohol use, improve oral hygiene, maximize nutrition, and treat underlying medical comorbidities are central to the short and long-term management of patients with HNSCC, especially during the COVID-19 era.