Oral Health Problems in Older Adults With Head and Neck Cancer: What a Major Research Review Found

Table of Contents

• Key Points
• Background: Why This Research Matters
• What Are Head and Neck Cancer and Oral Potentially Malignant Disorders?
• Oral Side Effects of Head and Neck Cancer Treatment
• How the Researchers Conducted This Review
• Search Strategy and Study Selection
• Characteristics of the Included Studies
• Key Findings: Detailed Results
• Conflicting Evidence on Age and Oral Health
• Findings on Dry Mouth After Radiotherapy
• The Missing Evidence on Oral Potentially Malignant Disorders
• What These Findings Mean for Patients
• Limitations of This Review
• Recommendations for Patients and Caregivers
• Frequently Asked Questions
• Source Information

Key Points

• A review of eight studies found conflicting evidence on whether older adults have better or similar oral health outcomes after head and neck cancer treatment compared to younger patients.
• One study of 1,037 patients found older age was linked to higher risk and slower recovery from moderate-to-severe dry mouth after radiotherapy.
• No studies were found on oral health in older adults with oral potentially malignant disorders, despite searching 1,070 records.
• About one-third of patients develop dental caries and 18% to 68% develop periodontitis after radiotherapy for head and neck cancer.
• The overall risk of malignant transformation for oral potentially malignant disorders is 7.9%, and high-risk lesions should be surgically removed where possible.

Background: Why This Research Matters

The world's population is ageing rapidly. The United Nations projects that the number of people aged 60 years and over will double by 2050, reaching approximately 2.1 billion people worldwide. This shift is driven by longer life expectancy and falling birth rates.

This demographic change has major consequences for healthcare systems, social care, labour markets and family structures. While population ageing began in high-income countries, by 2050 two-thirds of the world's population aged over 60 years will live in low- and middle-income countries.

Common health conditions in older age include hearing loss, cataracts and vision problems, back and neck pain, osteoarthritis, and chronic obstructive pulmonary disease (a lung disease that makes breathing difficult). Common health conditions in older age also include diabetes, depression and dementia. As people age, they are more likely to experience several conditions at the same time.

Cancer risk generally increases with age. Most cancers are diagnosed in people over 70 years old. The risk of developing cancer rises significantly after age 25 to 29, particularly among women. Age-related changes in the body, including accumulated DNA damage and a declining immune system, contribute to this higher cancer risk.

What Are Head and Neck Cancer and Oral Potentially Malignant Disorders?

Head and neck cancer (HANC) is defined by tumour location. It is a group of cancers that mainly affect the oral cavity (mouth), nasal cavity, sinuses, salivary glands, pharynx (throat) and larynx (voice box). Over 625,000 new cases of head and neck cancer are diagnosed worldwide every year.

Head and neck cancer is primarily caused by tobacco and alcohol use. Other risk factors include Human Papillomavirus (HPV) infection, weakened immune systems, and exposure to certain chemicals or radiation.

The most common treatments for head and neck cancer are surgery or radiotherapy (radiation treatment). For more advanced tumours, doctors may use a combination of surgery and post-operative radiotherapy, or chemotherapy combined with radiotherapy. Approximately 34% to 75% of head and neck cancer patients are treated with radiotherapy, depending on where the tumour is located.

Older people (those over 60 years of age) may have lower survival rates and greater illness after head and neck cancer treatment than younger patients. However, the evidence on this point is conflicting.

Oral potentially malignant disorders (OPMDs) are a diverse group of conditions. They are defined as any abnormality of the oral mucosa (the lining inside the mouth) that is associated with a statistically increased risk of developing oral cancer. Globally, OPMDs account for 4.5% of oral lesions. They are linked to the use of tobacco, alcohol and the areca nut (a seed commonly chewed in parts of Asia).

OPMDs can be classified into higher-risk lesions and lower-risk or undefined-risk lesions:

• Higher-risk lesions: erythroplakia (red patches), non-homogeneous leukoplakia (white patches with mixed appearance), proliferative verrucous leukoplakia (a rare, progressive white patch condition) and actinic keratosis (rough, scaly patches caused by sun exposure)
• Lower or undefined-risk lesions: homogeneous leukoplakia (uniform white patches), oral submucous fibrosis (a condition causing stiffening of the mouth tissues) and oral lichen planus (an inflammatory condition causing white lacy patches and soreness)

The risk of malignancy (cancer development) in a patient with an OPMD varies. It depends on several factors, including clinical presentation, histological subtype (what the tissue looks like under a microscope), location, size and patient demographics. The overall estimated risk of malignant transformation for all types of OPMDs is 7.9%.

Malignant transformation is known to occur slowly, over many years, but it does not occur in all cases. Typically, OPMDs present as white and/or red patches with variable margins and surfaces that may be exophytic (growing outward), wrinkled or corrugated. Depending on the nature of the OPMD, other features may be apparent. These features include ulceration, loss of pigmentation, loss of tongue papillae (the small bumps on the tongue), leathery mucosa, fibrous bands, limited tongue mobility and limited mouth opening.

The gold standard method for diagnosing OPMDs is through a biopsy (taking a small tissue sample for laboratory examination). Management involves assessing risk, educating patients about features that could indicate malignant transformation, counselling on risk factors and arranging long-term regular review. Chemo-prevention trials (using drugs to prevent cancer) have been complicated by methodological limitations and adverse events. High-risk lesions should be excised (surgically removed) where possible, in the absence of any surgical complications.

Oral Side Effects of Head and Neck Cancer Treatment

The oral side effects of head and neck cancer treatments such as radiotherapy and chemotherapy have been well documented. Patients with head and neck cancer are at higher risk of post-radiotherapy dental caries (tooth decay) and periodontitis (gum disease that damages the tissues supporting the teeth). This is due to radiotherapy-mediated salivary gland hypofunction (reduced saliva production caused by radiation) and radiation damage to dental and periodontal hard tissues.

Approximately one-third of patients develop post-radiotherapy dental caries. Post-radiotherapy periodontitis has been shown to affect 18% to 68% of head and neck cancer patients.

Patients treated with head and neck radiotherapy or chemotherapy are more likely to develop:

• Hyposalivation (decreased salivary flow)
• Xerostomia (the subjective feeling of dry mouth)
• Oral mucositis (painful inflammation and ulceration of the mouth lining)
• Impaired oral health-related quality of life (OHRQoL) — meaning the mouth problems affect daily life, comfort and wellbeing

In addition, surgical excision of a locally advanced tumour may result in severe anatomical disfigurement (changes to appearance), loss of teeth, and extensive scarring. Surgical excision may also cause permanent changes to the structure and function of various tissues within the head and neck.

Previous research into OPMDs has also suggested possible associations between these conditions and xerostomia, periodontitis and impaired oral health-related quality of life. This is particularly the case among patients affected by oral lichen planus or oral submucous fibrosis.

The aim of this systematic review was to determine the impact of head and neck cancer or OPMD and their management on oral health in older adults. The researchers compared older adults with these diagnoses to two groups. The first group was older adults without a diagnosis of head and neck cancer or OPMD. The second group was younger patients (under 60 years) with head and neck cancer or OPMD.

How the Researchers Conducted This Review

This systematic review was carried out and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. These guidelines set international standards for how systematic reviews should be conducted and reported.

The protocol for this systematic review was registered via PROSPERO (the International Prospective Register of Systematic Reviews) under the registration number CRD420251003419. Registration means the researchers publicly stated their planned methods before starting the review.

The researchers used a PICO/PECO framework to guide their work. This framework stands for Population, Intervention/Exposure, Comparison and Outcome. The focus question was: What is the incidence or prevalence of adverse oral health among people aged 60 years or older? These people have been diagnosed with head and neck cancer or an OPMD. This is compared to people aged 60 years or older who have not been diagnosed with these conditions. It is also compared to younger people aged less than 60 years who have been diagnosed with these conditions.

The researchers planned to include studies involving older adults (patients aged 60 years and over). The exposure of interest was a diagnosis of malignant neoplasm (cancer) of the lip, oral cavity or pharynx. This is as defined by codes 2B6 in the International Classification of Diseases version 11. The exposure also included oral potentially malignant disorders such as erythroplakia and leukoplakia.

The outcomes of interest for this systematic review included:

• Dental caries (tooth decay)
• Gingivitis and periodontitis (gum disease)
• Tooth mobility and tooth loss
• Peri-apical infection (infection around the root tip of a tooth)
• Hyposalivation and xerostomia (reduced saliva and dry mouth)
• Oral health-related quality of life, including objective measures (such as OHRQoL scores and global health ratings) and subjective outcomes (such as pain, function and speech performance)

There was no language restriction on included studies. The search date was 4th April 2025, and publications from 1960 up to April 2025 were considered.

Search Strategy and Study Selection

The researchers searched four major databases: MEDLINE (Ovid), Embase, PubMed and The Cochrane Library. They also performed supplementary handsearches by checking the reference lists of all included studies for additional relevant research articles.

The search terms were developed using the PICO/PECO framework and combined with Boolean operators (OR, AND, and NOT) to construct the search strategy. The first reviewer performed the initial search across all specified databases. Any issues identified during the process were corrected and the search strategy was refined accordingly.

Search results from each database were imported into EndNote reference management software. The software automatically removed duplicate records as an initial step. Following this, three investigators independently screened titles and abstracts. Selected studies then underwent full-text review and data extraction based on mutual agreement between the three investigators.

When full-text articles were not available, or lacked sufficient detail, the reviewers contacted the corresponding author to try to secure additional details. Reference cross-checks and manual searches were also performed to identify studies that were not discovered via the search strategy.

The inclusion criteria for studies were:

• Clinical investigations of any study design related to the focus question
• Confirmed diagnosis of head and neck cancer or OPMD

The exclusion criteria were:

• Topic not relevant to the focus question
• Aggregated oral health data not stratified by patient age
• Review articles
• In vitro studies (laboratory studies not involving patients)
• Animal studies
• Insufficient participant information and no response from investigators when seeking clarification
• Previous investigations reporting on the same patient population (excluded but retained for reference)

Records were reviewed by at least three investigators independently. Disagreements were resolved by discussion, and authors were contacted for clarification when required.

Characteristics of the Included Studies

The search strategy detected a total of 1,480 records from the four databases: MEDLINE (PubMed) yielded 577 records, MEDLINE (OVID) yielded 231 records, Embase yielded 658 records, and CENTRAL yielded 14 records. The removal of duplicated records eliminated 410 records.

A total of 1,070 titles and abstracts were screened. Forty-seven full-text relevant records were identified and retrieved, along with two additional articles identified by a manual reference search of these 47 records. Therefore, a final list of 49 articles was full-text reviewed.

Of these 49 articles, 41 were excluded based on the following criteria:

• No objective or subjective measures of oral health: 7 studies
• Aggregated oral health data presented across all age groups: 17 studies
• Follow-up less than 6 months: 3 studies
• PICO/PECO not clearly defined: 10 studies
• Orodigestive cancer or non-head and neck cancer: 2 studies
• Review article: 1 study
• Study presented duplicated data to an already included article: 1 study

Finally, a total of eight studies with relevant data on oral health in older adults with head and neck cancer were included. There were no research studies identified that had specifically investigated the incidence or prevalence of oral health problems among older adults with OPMDs.

Of the eight included studies:

• Four were prospective or retrospective observational cohort studies (studies that follow groups of people over time)
• Three were cross-sectional in nature (studies that look at a population at a single point in time)
• One was a randomised controlled trial (the gold standard study design where participants are randomly assigned to different treatments)

Five of the eight included studies recruited people with cancer affecting any region of the head and neck. Two studies analysed participants with oral cancer only, and one study assessed patients with primary salivary gland cancers only. Five studies explored differences in oral health based on patient age, and three studies recruited people aged 65 years or over only.

All eight included studies recruited participants who had undergone surgery, radiotherapy, or chemotherapy, or a combination of these treatments. Seven of the eight studies assessed oral health-related quality of life using dedicated validated patient-administered questionnaires:

• EORTC QLQ-C30 (a cancer quality of life questionnaire): 4 studies
• Functional Assessment of Cancer Therapy—Head and Neck version 4 scale: 1 study
• University of Washington Head and Neck Quality of Life scale: 1 study
• The Bochum Questionnaire on Rehabilitation: 1 study

One study assessed chronic treatment-related toxicity using the Common Terminology Criteria for Adverse Effects (CTCAE) version 5.0.

Key Findings: Detailed Results

Because the methodologies of the included studies varied substantially, the researchers decided it was inappropriate to combine results via meta-analysis (a statistical method that pools results from multiple studies). Instead, they presented a narrative review only, describing the findings of each study individually.

In a cross-sectional study of 638 head and neck cancer patients, Laraway and colleagues found that people older than 65 years reported better functional outcomes for speech, swallowing and saliva. These better outcomes were reported 12 months after their cancer diagnosis or primary surgery than younger patients.

In relation to patient-reported salivary flow, the best scores were seen in patients aged 75 years and over. In relation to speech, there was a progression towards better scores in those aged 65 to 74 years, and scores were better still for those aged 75 years and over.

Approximately 7% to 8% of patients over 65 years reported serious problems with swallowing. Meanwhile, 3% to 6% of patients over 65 years reported serious issues with speech. Both of these rates were significantly less than patients under 65 years.

However, 9% to 11% of patients over 65 years reported serious issues with chewing, 6% to 9% reported serious issues with taste, and 6% to 14% reported serious issues with salivary flow. There were no statistically significant differences in these outcomes compared to those aged under 65 years.

In a prospective cohort study of 1,203 patients, Aoki and colleagues assessed oral health-related quality of life in older and younger patient groups. Both age groups reported greater or equal use of treatment modalities for head and neck cancer. All patients had a determination of initial treatment. The majority of patients had surgery, and 2% had radiotherapy. However, these issues were resolved in patients under 57 years after 6 months of treatment.

In another prospective cohort study of 1,037 patients, Beetz and colleagues found a linear relationship between patient age and the risk of moderate-to-severe xerostomia (dry mouth) after radiotherapy. Patients aged greater than 56 years had increased risk of moderate-to-severe xerostomia compared to younger patients. Overall, older patients had significantly reduced rate of recovery of the sensation of dry mouth at 6, 12, 18 and 24 months post-treatment compared to patients less than 56 years.

In a prospective cohort study of 1,214 patients with squamous cell carcinoma, Derks and colleagues assessed oral health-related quality of life domains. Squamous cell carcinoma is a type of cancer that begins in flat cells lining the mouth. These domains were teeth, mouth opening, dry mouth and saliva. Older patients aged 70 years and older used more of the EORTC QLQ-H&N35 questionnaire than younger patients aged 54 to 60 years. Treatment differed between the age groups: 31% of older patients and 60% of younger patients had surgery plus radiotherapy. Older patients without distant metastasis had 11% compared to younger patients. Older patients who had surgery only had 32% compared to younger patients. Older patients who had radiotherapy only had 11% compared to younger patients. Older patients who had chemotherapy had 4% compared to younger patients. Older patients who had radiotherapy had 16% compared to younger patients.

In a randomised controlled trial of 574 patients, Lafont and colleagues assessed head and neck cancer patients who underwent surgery. Between 14% and 15% of patients underwent driven interventions. The head and neck region quality of life scores showed no statistically significant differences in mean scores between the intervention and control groups. Overall, 13% to 14% of patients underwent driven interventions. The assessment found no effect on oral health-related quality of life for older patients (n = 238) or control patients (n = 237) who received standard care.

Conflicting Evidence on Age and Oral Health

The findings from the included studies demonstrated conflicting results. This is one of the most important conclusions of this systematic review.

Two cross-sectional studies demonstrated better post-treatment oral health-related quality of life across some domains for older patients with head and neck cancer than younger patients. These studies suggested that older age might be associated with better tolerance or adaptation to treatment effects.

However, this finding was contradicted by data from two prospective cohort studies. These prospective studies showed no differences in post-treatment oral health-related quality of life between older and younger patients with a history of head and neck cancer.

The researchers could not determine a clear reason for these conflicting results. The differences may relate to study design, the specific questionnaires used, the timing of assessments, or differences in the patient populations studied.

In a cross-sectional study of 1,319 patients, Linsen and colleagues found that at least 15.1% of patients had lost teeth. Patients aged 54 to 60 years were significantly more likely to have lost teeth. Besides surgical treatment, 35.9% of patients reported less oral rehabilitation, and 48.9% reported less temporomandibular joint (the jaw joint) function. Older patients aged over 60 years reported less pain after cancer treatment than patients aged 45 to 60 years.

Findings on Dry Mouth After Radiotherapy

Findings from a different prospective cohort study demonstrated a linear relationship between head and neck cancer patients' age and the incidence of post-radiotherapy moderate-to-severe xerostomia (dry mouth). This means that as patient age increased, the risk of experiencing significant dry mouth after radiation treatment also increased in a consistent, stepwise manner.

This finding is particularly important because xerostomia can have a major impact on daily life. Dry mouth affects eating, speaking, swallowing, taste and oral comfort. It also increases the risk of dental caries and oral infections.

The study by Beetz and colleagues followed 1,037 patients for up to 24 months after treatment. The researchers found that older patients had a significantly reduced rate of recovery from dry mouth at 6, 12, 18 and 24 months post-treatment compared to patients less than 56 years old. This suggests that older patients may experience more persistent dry mouth symptoms after radiotherapy.

The Missing Evidence on Oral Potentially Malignant Disorders

One of the most striking findings of this systematic review was the complete absence of data on oral health consequences among older adults with OPMDs. Despite searching four major databases and reviewing 1,070 records, the researchers found no studies that specifically investigated the incidence or prevalence of oral health problems among older adults with OPMDs.

This is a significant gap in the medical literature. OPMDs are relatively common, accounting for 4.5% of oral lesions globally. They are associated with tobacco, alcohol and areca nut use, and they carry a 7.9% risk of malignant transformation across all types.

The global population is ageing, and older adults are more likely to have multiple health conditions. Given this, the lack of research on oral health in older adults with OPMDs is concerning. The researchers could not draw any conclusions about how OPMDs affect oral health in this population.

What These Findings Mean for Patients

The overall conclusion of this systematic review is that the evidence on the impact of head and neck cancer and OPMD on oral health in older adults is inconclusive. The researchers could not provide a definitive answer to their research question.

For patients and their families, this means that doctors and dentists currently do not have high-quality evidence. This evidence would predict exactly how head and neck cancer treatment will affect an older person's oral health. The effects appear to vary widely between individuals.

Some older patients may actually report better oral function after treatment than younger patients. This could be because older patients have different expectations, or because their tumours or treatments differ in some way. Other studies suggest that older and younger patients experience similar oral health outcomes.

However, there is consistent evidence that older patients may experience more persistent dry mouth after radiotherapy. This finding appeared in a large prospective cohort study of 1,037 patients, which is a relatively strong study design.

The lack of research on OPMDs in older adults means that patients with these conditions cannot benefit from evidence-based guidance specific to their age group. This is an area where future research is urgently needed.

Limitations of This Review

This systematic review has several important limitations that patients and clinicians should understand.

First, only eight studies met the inclusion criteria. This is a small number of studies from which to draw conclusions, especially when the studies used different methods and measured different outcomes.

Second, the methodologies of the included studies varied substantially. The studies used different questionnaires to measure oral health-related quality of life, followed patients for different lengths of time, and included patients with different types and stages of cancer. This made it impossible to combine the results statistically through meta-analysis.

Third, the findings were conflicting. Some studies suggested older patients had better outcomes, while others found no difference between age groups. The researchers could not resolve these contradictions.

Fourth, there were no data at all on oral health consequences among older adults with OPMDs. This means the review cannot provide any guidance for this group of patients.

Fifth, the review excluded studies that presented aggregated oral health data across all age groups. This was necessary to answer the specific research question about older adults, but it means some potentially relevant data were not included.

Sixth, the review excluded studies with follow-up less than 6 months. While this ensures that only studies with meaningful follow-up were included, it may have excluded some relevant short-term outcome data.

Recommendations for Patients and Caregivers

Based on this systematic review, the researchers cannot make specific evidence-based recommendations for preventing or managing oral health problems in older adults with head and neck cancer or OPMDs. However, some general principles can be drawn from the findings.

1. Maintain regular dental care. Given the high rates of dental caries and periodontitis after head and neck cancer treatment, regular dental check-ups are essential. Approximately one-third of patients develop post-radiotherapy dental caries, and 18% to 68% develop post-radiotherapy periodontitis.
2. Be aware of dry mouth. Xerostomia (dry mouth) is a common side effect of radiotherapy, and older patients may experience slower recovery from this symptom. Patients should discuss dry mouth management options with their healthcare team.
3. Report oral symptoms promptly. Patients should tell their doctor or dentist about any problems with swallowing, speech, chewing, taste, saliva or mouth pain. These symptoms can often be managed with appropriate care.
4. Understand that age affects patients differently. Some older patients tolerate treatment better than expected, while others experience more persistent side effects. Individualised care is important.
5. Ask about OPMD monitoring. Patients with oral potentially malignant disorders should receive regular monitoring, as the risk of malignant transformation is 7.9% across all types. High-risk lesions should be excised where possible.
6. Discuss risk factors. Tobacco, alcohol and areca nut use are major risk factors for both head and neck cancer and OPMDs. Stopping these habits can reduce risk.

The researchers emphasise that more high-quality research is needed. Future studies should use standardised methods to measure oral health outcomes, include adequate numbers of older adults, and specifically investigate OPMDs in older populations.

Frequently Asked Questions

What did this review find about oral health in older adults with head and neck cancer?

The review included eight studies and found conflicting results. Some studies reported that patients over 65 had better speech, swallowing and saliva outcomes after treatment than younger patients, while other studies found no age-related differences. The researchers could not combine results statistically and concluded the evidence is inconclusive.

Does older age affect dry mouth after radiotherapy for head and neck cancer?

One prospective cohort study of 1,037 patients found a linear relationship between age and moderate-to-severe xerostomia after radiotherapy. Patients over 56 had a higher risk, and older patients recovered more slowly at 6, 12, 18 and 24 months. This suggests dry mouth may be more persistent in older adults.

Are there any studies on oral health in older adults with oral potentially malignant disorders?

No. The review searched four major databases and screened 1,070 records but found no studies that specifically investigated the incidence or prevalence of oral health problems among older adults with oral potentially malignant disorders. This is a significant gap in the medical literature.

What is the risk of malignant transformation for oral potentially malignant disorders?

The overall estimated risk of malignant transformation for all types of oral potentially malignant disorders is 7.9%. This transformation occurs slowly over many years and does not happen in all cases. High-risk lesions should be surgically removed where possible, and regular long-term monitoring is recommended.

What should patients and caregivers do based on this review?

Maintain regular dental check-ups, be aware of dry mouth and discuss management options, and report oral symptoms promptly. Understand that age affects patients differently, so individualised care is important. Patients with oral potentially malignant disorders should receive regular monitoring, and stopping tobacco, alcohol and areca nut use can reduce risk.

Why couldn't the researchers combine the results of the included studies?

The eight included studies used different methods, questionnaires and follow-up periods, and included patients with different cancer types and stages. Because of this substantial variation, the researchers decided it was inappropriate to pool the results statistically through meta-analysis, so they presented a narrative review instead.

I'm over 60 and just diagnosed with head and neck cancer — when should I get a second opinion about my treatment and dry mouth risk?

Evidence on how head and neck cancer treatment affects oral health in adults over 60 is conflicting, so a second opinion can help clarify your individual situation. Some older patients report better speech, swallowing and saliva outcomes than younger patients, while other studies find no age-related differences. Older patients may also recover more slowly from dry mouth after radiotherapy. Because findings vary and no studies cover older adults with oral potentially malignant disorders, reviewing your diagnosis, imaging and treatment plan with an independent expert is reasonable. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

Original article title: Adverse Oral Health in Older Adults With Head and Neck Cancer (And Oral Potentially Malignant Disorders): A Systematic Review.

Authors: Ciaran Moore, Niamh Walls, Shaima Abujaber, Amanda Willis, Finbarr Allen, Gerry McKenna

Author affiliations: Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Dublin, Ireland; Centre for Public Health, Queen's University Belfast, Belfast, UK; Centre for Dentistry, Queen's University Belfast, Belfast, UK; University College Cork, Cork, Ireland

Corresponding author: Gerry McKenna (g.mckenna@qub.ac.uk)

Journal: Gerodontology, 2026; 43:339–354

Publication details: Received 1 December 2025; Revised 10 March 2026; Accepted 13 March 2026

DOI: https://doi.org/10.1111/ger.70080

PROSPERO Registration: CRD420251003419

Keywords: Gerodontology, head and neck cancer, oral potentially malignant disorders, systematic review

This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and should not replace personalised medical advice from a qualified healthcare professional.