The multidisciplinary team in palliative care

A Palliative Care unit generally consists of physicians, psychologists, social workers, and nurses, who receive "satellite" support from other health professionals trained in the care of patients with advanced diseases and limited life expectancy, such as an endodontist with academic training in Palliative Care (³). Although the role of the endodontist is not central to the Palliative Care team, their involvement is recognized as essential during the initial diagnosis and throughout the course of the disease. Palliative dentistry involves the prevention, diagnosis, and management of oral conditions that may complicate or aggravate the patient's health status or simply affect their overall well-being and, consequently, their quality of life (⁴).

The endodontist is responsible for addressing dental needs arising from infections or complications in the oral cavity, which is particularly important for individuals who, due to their underlying disease or medical treatment, are more susceptible to developing oral pathologies. In many cases, these conditions result from the side effects of treatments for primary illness (⁷).

Early diagnosis and treatment of subclinical pathologies

Early diagnosis of dental pathologies is fundamental in palliative care, as it prevents major complications during the course of the disease. The endodontist must conduct a comprehensive clinical and radiographic examination, evaluating both soft and hard tissues, searching for potential infection sites or subclinical pathologies that do not present evident symptoms but can be detected through imaging studies and pulp sensitivity tests.

The use of diagnostic techniques such as intraoral radiographs, panoramic X-rays, and tomography enables the endodontist to identify potential problems that could become infectious or painful foci during advanced stages of the disease (⁶). In this context, early detection can prevent the need for invasive interventions, such as extractions or surgeries, in later stages when the patient's health may deteriorate, and invasive treatments could be riskier.

The endodontist with training in Palliative Care can also be part of the Palliative Care Unit and conduct home visits to assist in the diagnosis of pulp and periodontal diseases, determining the best treatment plan for patients who can be transferred to a dental clinic for necessary treatment.

In more advanced stages, ambulatory home treatments may be provided to improve the affected person's quality of life (³).

Impact of ctx measurement and bisphosphonate use

The endodontist in a palliative role must also be aware that the patient population they serve may have been on medications such as bisphos- phonates for several years. These drugs are prescribed for osteoporosis and metastatic bone cancer treatment and can increase the risk of maxillary osteonecrosis following surgical procedures or extractions (⁷). To minimize this risk, it is recommended that the professional conduct a thorough oral examination before the patient begins bisphosphonate therapy or rely on laboratory tests such as CTX to assess the risk level of developing osteonecrosis after a surgical or dental extraction procedure (¹⁰).

Ethical considerations in palliative endodontic care

Endodontic care for patients in Palliative Care involves a series of ethical challenges that must be approached with sensitivity and profes- sionalism. Key considerations include the principle of patient autonomy, informed consent, and treatment proportionality (¹).

The endodontist must ensure that the patient, their family, and the healthcare team understand the benefits and risks of each intervention. In many cases, conservative treatments should be prioritized to minimize pain and improve quality of life without causing additional suffering. Furthermore, shared decision-making with the multidisciplinary team is essential to ensure comprehensive and respectful treatment for the patient’s situation.