David R. Dean, DDS, MSD

Why do you care for patients with oral problems associated with cancer and treatment?

Early in my career, the spouse of a close family friend was diagnosed with acute myeloid leukemia. She and her husband reached out to me a few times during and after her treatment with questions about the oral side effects she was experiencing. I realized that a lot of people who go through cancer treatment, particularly stem cell transplantation, have no oral care support outside of what they receive in the hospital. Once treatment is over, many people don’t have anyone to help them deal with the oral problems that crop up, and these issues can significantly interfere with quality of life. Talking with my friend and his wife helped crystallize for me that this was a real area of need — and where I wanted to focus my efforts. Fred Hutch is one of the few places in the country that offers oral medicine care for people before, during and after cancer treatment. I feel really lucky to be able to offer these services to patients.

What advice do you often offer patients?

I like to remind people how important it is to communicate with their medical team. You can never ask too many questions. We’re here not only to take care of your health but also to make sure that all aspects of your diagnosis and treatment make sense to you. In oral medicine care, we tend to prescribe a lot of topical medications; sometimes this can seem overwhelming, or perhaps these very medicines have failed to work well for you in the past. I encourage people to speak up if what I’m recommending doesn’t seem like a good fit so that we can work together on finding a solution that meets your needs.

Provider Background

Area of Clinical Practice
Oral complications of cancer and treatment

As the director of Fred Hutch’s Oral Medicine Service, I treat patients with oral complications of cancer and treatment. I frequently work with people who undergo hematopoietic (blood-forming) stem cell transplantation, providing pre-transplant dental evaluations and helping to manage post-transplant, mouth-related issues, such as mucositis and oral graft-versus-host disease. I also assess a variety of oral concerns for patients at Fred Hutch who receive other forms of treatment. Many cancer therapies can cause changes in the mouth that accelerate tooth decay, which can compromise a person’s dentition if left untreated.

My current area of research involves studying the long-term oral effects of chronic graft-versus-host disease. This post-transplant condition can occur when donor immune cells perceive the recipient’s cells as foreign and attack them. Another area of interest is exploring how to prevent or minimize oral infections post-transplant. In addition to caring for patients and conducting research, I teach graduate students at the University of Washington and lead national and local continuing education workshops.