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BDS3 SPECIAL CARE DENTISTRY > 13 - Head and neck cancer > Flashcards

13 - Head and neck cancer Flashcards

1
Q

Describe the patient journey for head and neck cancers.

A
  • screening and referral (GDP)
  • investigation and diagnosis
  • treatment planning by MDT
  • dental pre-assessment (GDP)
  • caner treatment
  • dental support during treatment
  • end of treatment
  • restorative (GDP)
  • maintenance post treatment
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2
Q

What is required of the GDP at the screening and referral stage?

A
  • early detection through soft tissue exams
  • photographs
  • referral and pre-treatment assessment
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3
Q

When should GDPs refer for a H&N cancer assessment?

A
  • stridor
  • persistent lumps for more than 3 weeks
  • ulceration or swelling of mucosa for more than 3 weeks
  • red/red and white patches on the mucosa for more than 3 weeks
  • persistent hoarseness for more than 3 weeks
  • persistent pain in throat for more than 3 weeks
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4
Q

What can be done to investigate H&N cancer referrals?

A
  • OMFS new patient assessment
  • biopsy
  • CT scan (extent of tumour or metastasis)
  • lymph node biopsy
  • baseline medical testing
  • staging and grading
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5
Q

Who is part of the MDT for treatment planning?

A
  • oncologist
  • radiologist
  • surgeons
  • clinical nurse specialist
  • speech and language therapist
  • dietician
  • dentist (restorative specialist)
  • physio
  • OT
  • psychologist
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6
Q

How long should a patient wait maximum for their first appointment after referral?

A

14 days

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7
Q

What is the deadline for the start of H&N cancer treatment from referral?

A

62 days

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8
Q

What is involved in the dental pre-assessment?

A
  • detailed exam
  • radiographs (OPT and PAs)
  • OHI
  • fluoride treatment (varnish, tooth mousse)
  • PMPR
  • definitive restoration of carious teeth or XLA
  • impressions for fluoride trays or soft splints
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9
Q

What treatments are used to treat H&N cancers?

A
  • surgical resection +/- reconstruction
  • radiotherapy
  • chemo
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10
Q

What are the side effects of resection?

A
  • alterations to normal anatomy
  • adverse effects on function and appearance
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11
Q

What are the side effects of radiotherapy?

A
  • damage to surrounding tissues
  • increased risk of ORN
  • xerostomia
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12
Q

What are the side effects of chemotherapy?

A
  • acute mucosal and haematological toxicity
  • xerostomia
  • mucositis
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13
Q

What is the dentist’s role during cancer treatment?

A
  • oral and denture hygiene
  • antibacterial mouthwash for when brushing is too sore
  • diet advice
  • fluoride application
  • management of mucositis and xerostomia
  • monitor viral/fungal diseases
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14
Q

What is mucositis?

A
  • 1-2 weeks post treatment (usually chemo)
  • lasts up to 6 weeks
  • severe pain caused by ulceration of mucosa
  • inhibits OH
  • can prevent eating
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15
Q

How do you manage mucositis?

A
  • neutral supersaturated calcium phosphate mouth rinse (caphosol)
  • sodium hyaluronate gel (gelclair)
  • mucoadhesive oral rinse (mugard)
  • soluble aspirin
  • benzydamine hydrochloride (difflam spray)
  • aloe vera or Manuka honey
  • good OH helps to resolve quicker
  • remove sharp edges (teeth or dentures)
  • soft splint
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16
Q

What are the grades for mucositis?

A

1-3

17
Q

Describe grade 1 mucositis.

A
  • voice normal
  • normal swallowing
  • lips are smooth and moist
  • tongue is pink, moist and papilla are present
  • watery saliva
  • mucosa is pink and moist
18
Q

Describe grade 2 mucositis.

A
  • voice deeper or raspy
  • pain on swallowing
  • lips are cracked/dry
  • tongue is shiny, loss of papilla and +/- redness
  • thick saliva
  • mucosa is reddened or coated without ulceration
19
Q

Describe grade 3 mucositis.

A
  • difficulty or painful speaking
  • unable to swallow
  • lips are ulcerated and bleeding
  • tongue is blistered or cracked
  • absent saliva
  • mucosa is ulcerated +/- bleeding
20
Q

What oral issues can arise during cancer treatment?

A
  • Candida infection
  • HSV reactivation
  • traumatic ulceration
  • xerostomia
  • trismus
  • erosion
  • caries
  • perio
  • ORN
21
Q

How do you manage candidal infections during cancer treatment?

A
  • offer antifungals as prevention
  • chlorohexadine mouthwash
  • topical miconazole
  • systemic fluconazole
22
Q

How do you manage traumatic ulceration during cancer treatment?

A
  • teeth rubbing delicate mucosa
  • soft splint constructed
23
Q

How do you manage reactivated HSV during cancer treatment?

A
  • pain prior to ulceration kwon as prodromal period
  • urgent systemic antivirals
  • clinical presentation is more extreme in those undergoing cancer treatment
24
Q

How do you manage xerostomia during cancer treatment?

A
  • oral gels or lubricants (Biotene, BioXtra, saliva orthana)
  • pilocarpine HCl can stimulate glands that have some function
  • sugar free chewing gum
  • frequent sips of water
25
Q

Describe xerostomia in cancer patients.

A
  • reduced flow up to 60% in first week
  • consistency is affected, more viscous and acidic which is damaging to dentition
  • recovery may or may not happen over a few years
  • affects chewing, swallowing, speech and taste
  • higher risk of caries, perio, candida, sialadenitis
26
Q

How do you manage trismus during cancer treatment?

A
  • early intervention and compliance essesntial
  • passive and active stretching exercises
  • therabite
  • stacked tongue depressors
27
Q

Describe radiation induced caries.

A
  • chemo and radiotherapy induced
  • reduced salivary flow
  • widespread and circumferential around teeth or incisal edges
28
Q

How do you manage ORN during cancer treatment?

A
  • XLA of poor prognosis teeth
  • prevention and OH advice
  • XLA must be 10 days prior to radiotherapy
  • encourage healing with primary closure and sutures
29
Q

Who is at increased risk of ORN?

A
  • dose >60Gy
  • local trauma eg XLA, perio
  • immunodeficient
  • malnourished
30
Q

What are the stages of ORN?

A

0-3

31
Q

Describe stage 0 of ORN.

A

Mucosal defects only, bone is exposed

32
Q

Describe stage 1 of ORN.

A

Radiological evidence of exposed bone, dento-alveolar only

33
Q

Describe stage 2 of ORN.

A

Radiographic findings including the IAN canal

34
Q

Describe stage 3 of ORN.

A

Clinically exposed radionecrotic bone, with skin fistulas and infection +/- pathological fracture

35
Q

When are implants appropriate for reconstruction?

A
  • dose <45Gy
  • patient must possess manual dexterity for OH
36
Q

What is an obturator?

A
  • used as part of a denture or a splint to fill a deficiency due to resection or hold open an area to allow fluid to drain
  • should be worn 24/7 for first 6 months to allow area to heal around
  • improve speech

BDS3 SPECIAL CARE DENTISTRY (19 decks)

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