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Malnutrition is prevalent in patients with head and neck cancer (HNC) at diagnosis but can occur at any stage of the treatment pathway. The impact of disease burden and treatment side effects can lead to altered anatomy, compromised quality and quantity of saliva and impaired swallowing function, which can result in deleterious effects on nutritional status. Optimising nutrition status is critical, as malnutrition is adversely associated with treatment tolerance and outcomes, wound healing, morbidity, mortality, quality of life and survival. Dietitians are integral members of the HNC multidisciplinary team and are uniquely qualified in the assessment, management and optimisation of nutritional status across the care pathway. This includes providing informational counselling to patients and carers on the short- and long-term nutritional impact of planned treatments alongside multidisciplinary members. Dietitians lead on the recommendation, provision and monitoring of nutrition support, which can be via the oral, enteral or parenteral route. Oral nutrition support includes dietary counselling, nourishing dietary, food fortification advice and high energy/protein oral nutritional supplements. Enteral nutrition support, or tube feeding, can be required on a short- and/or long-term basis and dietitians support appropriate decision-making for the type of tube and timing of placement across the care pathway. Key points Head and neck cancer (HNC) is a multifaceted disease requiring multi-disciplinary intervention. The impact of tumour burden and treatment side effects can lead to altered anatomy, impaired swallowing function and deleterious effects on nutritional status. Many patients are at risk of malnutrition which can occur at any stage of the care pathway. Dietitians are core members of the HNC multi-disciplinary team and lead on the nutritional management of patients at any stage of the treatment pathway, from diagnosis until death, palliation and/or survivorship. Nutrition support is vital in the prevention and treatment of malnutrition. This includes dietary counselling, nourishing dietary advice and the provision of high energy/protein oral nutritional supplements, as well as enteral tube feeding on a short- and/or long-term basis when indicated. Dietitians work alongside restorative dentists to balance nutritional needs with prevention of dental caries.

Patients treated for head and neck cancer may be susceptible to a higher incidence of dental disease due to long-term sequelae of treatment for head and neck cancer. Most patients with head and neck cancer are discharged from a hospital environment and responsibility for long-term dental care is transferred back from the restorative dentistry team to the dentist and dental care professionals in primary care. Treatment of these patients should be undertaken in a supportive environment, taking into account the physical and psychological repercussions of previous treatment. With the exception of some surgical procedures, routine dental care is not contraindicated in patients after head and neck cancer treatment and it is expected that the dentist and dental care professionals will be responsible for long-term routine dental treatment. Primary dental care practitioners should be aware of the process to refer patients back to the head and neck cancer multidisciplinary team if they note a suspicious change during their routine clinical examinations. Referral to a restorative dentistry consultant for planning and carrying out complex items of care may sometimes be necessary, but patients should always remain under the long-term care of their primary dental care practitioner. Key points Following discharge from the specialist cancer centre after head and neck cancer treatment has completed, patients should receive routine ongoing dental care within the primary care setting, supported by restorative dentistry services when appropriate. Surgery and radiotherapy have long-term side effects which may predispose patients to greater incidence of primary dental disease; prevention is key to minimise dental complications. Osteoradionecrosis of the jaw is a risk of surgical procedures in sites which have received radiotherapy. Advice should be sought from the multidisciplinary team if considering surgical procedures.

Surgical treatment of head and neck cancer can cause loss of teeth, loss of hard and soft tissues and result in significantly altered anatomy. Prosthodontic rehabilitation for such patients can be challenging, requiring pre-surgical planning at a time-sensitive point in the patient's cancer pathway. Rehabilitative outcomes are optimised by early and collaborative planning at the multidisciplinary team discussion, involving surgeons, oncologists and consultants in restorative dentistry. Conventional and implant-based prosthodontics contribute to the armamentarium of rehabilitative approaches used in this patient cohort. In order to achieve the best possible outcomes for patients, collaborative planning and teamworking between head and neck surgeons and restorative dental consultants is required from the outset. Each plan is bespoke, considering the patient's needs and wishes within the context of their holistic and cancer-specific care and their general and dental health. Key points All patients planned for surgical treatment for head and neck cancer should have the need for an oral rehabilitation plan discussed with the multidisciplinary team. Optimal prosthetic rehabilitation is achieved by close collaboration between the ablative surgeon and the restorative dentistry consultant. Implant-borne prostheses should be considered wherever feasible to optimise rehabilitation outcomes.

Historically, oral and dental issues for head and neck cancer patients were often not considered until after cancer treatment was complete. As a result, outcomes for oral rehabilitation were sometimes suboptimal. Inconsistencies in service delivery models and qualification, training and experience of staff delivering dental care often compounded this problem, making research and audit almost impossible. Collaborative working by consultants in restorative dentistry from all over the UK as part of a Restorative Dentistry-UK (RD UK) subgroup, renamed more recently as the RD-UK Head and Neck Cancer Clinical Excellence Network (CEN), has re-emphasised the importance of specialist restorative dentistry intervention at the outset of the head and neck cancer pathway to optimise outcomes of patient care. The CEN has driven several initiatives, reflecting Getting It Right First Time (GIRFT) principles aimed at reducing unwarranted variation. This improved consistency in approach and optimised collaborative working of the team now presents a better environment for multicentre audit and research. Ultimately, this should result in a continued improvement in patient and carer experience. Key points Optimal management of oral and dental care in the pre-treatment phase of the head and neck cancer pathway is key to producing the best possible outcomes for patients. Restorative dentistry consultants are core members of the head and neck cancer multidisciplinary team. The development of the Restorative Dentistry-UK Head and Neck Cancer Clinical Excellence Network has facilitated the standardisation of evidence-based pathways and models of care. It also provides support for all restorative dentistry consultants working in head and neck cancer, particularly those working single-handedly in district general hospitals.

The gender balance on boards is an important issue because any imbalance represents gender inequality and is not acceptable. We describe data that we have gathered on the current balance of the UK dental boards and then outline potential ways forward to address any imbalance.Key pointsUnderstand the current gender balance of the UK dental boards.Identify whether this is a problem.Consider possible solutions.