cancer Flashcards
what is the role of the dental team in head and neck cancer
- early detection of soft tissue lesions
- pre-treatment assessment and dental care
- minimal role during treatment unless special interest
- maintenance or oral and dental health post-treatment
- palliative care
- ensure oral cancer ≠ dental disease
what can happen after chemo or radiotherapy
- deterioration of dentition
- gross destruction of alveolar bone
what must we not do during cancer treatmetn
- try and not do anything invasive during their treatment
what are signs that could suggest head and neck cancer
- persistent unexplained head and neck lumps for > 3 weeks
- ulceration or unexplained swelling of oral mucosa persisting for > 3 weeks
- all red or mixed red and white patches of oral mucosa persisting for > 3weeks
- persistent hoarseness lasting > 3weeks
- dysphagia or odynophobia lasting > 3weeks
- persistent pain in the throat lasting for > 3 weeks
what are some signs that could suggest thyroid cancer
- solitary nodule increasing in size
- thyroid swelling in a pre-pubertal patient
- thyroid swelling with one or more of the following risk factors =neck irradiation, family history of endocrine tumour, unexplained hoarseness, cervical lymphadenopathy
what can oral cancer impact on
- airway
- upper GI tract
- major sense
- very visible and difficult to hide
what is involved in pre-assessment and treatment
- history taking
- oral and dental assessment prior to start of cancer therapy
- radiographs = OPT/periapicals
- any necessary treatment carried out = dentally fit before oncological care, availability of immediate treatment, treatment needs to be radical
- pre-treatment dental scaling by hygienist
- impressions for fluoride trays
- start fluoride therapy for dentate patients
what are dental assessment priorities
- oral hygiene and fluoride
- reduce treatment complications
- reduce post treatment complications
- complex as outcomes is unpredictable
how do we reduce treatment complications
- avoid unscheduled interruption of chemotherapy regimen
- avoid exacerbation of mucositis
- remove potential sources of infection
how do we reduce post treatment complications
- remove teeth of dubious prognosis
- institute preventive regime
- plan rehabilitation
what are the aims of pre-treatment assessment
- avoid unscheduled interruptions to primary treatment
- pre-prosthetic planning/treatment
- planning for extraction of teeth which are of doubtful prognosis or at risk of dental disease in the future
- plan for restoration of remaining teeth as required
- preventive advice and treatment
- assess potential for post treatment access and difficulties = trismus, microstomia
what dental work may be needed during oncology treatment
- oral ulceration
- oral infection
- emergency dental treatment
how is dry mouth a common affect from radiotheray
- salivary glands are hit heavily from it
how common is traumatic ulceration
- very common
- trauma from lower teeth which is why we often then provide a soft splint
what is mucositis ulceration
- radiotherapy and chemotherapy induced
- inflammation and ulceration
- severe pain
- analgesia required
what can mucositis impact on
- eating = need PEG/RIG
where is the most common area for cancer ulcer
- lateral border of the tongue
what are some measures to manage mucositis
- general avoidance = smoking, spirits, spicy foods, tea and coffee, mouthwash containing alcohol
- topical = topical lignocaine, saline mouth wash, sodium bicarbonate, benxydamine HCl
- gelclair
- caphosol
- tea tree oil mouthwash = also contained aloe vera
- oral cooling = ice
how can mucositis be prevented
- aloe vera
- amifostine
- chlorohexidine
- cryotherapy
- granulocyte
- IV glutamine
- honey
- keratinocyte growth factor
- laser
- sucralfate
what is the treatment of mucositis
- low level laser light therapy = very successful in children, not used as much in adults
- morphine
what is oral candidiasis
- oral carriage of yeasts common among cancer patients
- frequent clinical problem
- also called thrush
what are some viral infectiosn
- reactivation of herpes simplex
- often intra-oral and clinically atypical
- painful oral ulceration of sudden onset
- more extensive, slow healing and aggressive
- high index of clinical suspicion
- there is a prodromal phase
what prevention is included in post treatment care
- diet
- OH
- fluoride
- trismus smoking
what monitoring is done post treatment
- increased frequency of check-ups
- dry mouth management
- prosthodontics
- appropriate referral
what is there a risk of post treatment
- xerostomia
- radiation caries
- ORN
- trismus
- all are lifelong
what are the features of xerostomia
- reduced salivary flow = 50-60% in first week, further 20% in next 5-6 weeks
- saliva consistency changes = increased viscosity, decrease pH
- recovery takes years = often not return to normal
how often can salivary glands be affected from radiotherapy
- 60% of patients
- affects = chewing, swelling, speech, taste, quality of life
what is dysphagia
- difficulty swallowing
- may be short or long term
what is dysarthria
- difficulty articulating
what is dysgeusia
- altered taste
- due to both xerostomia and direct effect on taste receptors
what can xerostomia cause an increased risk of
- caries
- periodontal disease
- candidiasis
- siladenitis = infection of salivary glands
- prosthodontics difficulties
what are some management strategies for xerostomia
- oral balance
- sugar free chewing gum
- water
- tooth mousse
- none work really well, and patients don’t like them and would rather just keep having some water
what does lack of saliva mean
- reduced buffering effect
- reduced clearance
- alteration of microflora to favour cariogenic bacteria
what is radiation induced caries
- very prevalent
- smooth surface caries at cervcial region
- eventually caries can become circumferential and tooth snaps off
how many hospice patients are affected by periodontal disease
- 36%
what is included in diagnosis and management of it
- clinical and radiographic examination
- OHI
- scaling and root planing
- modern caries management
- avoidance of extraction
- +/- surgery
- antimicrobials for acute conditions
- try best to avoid extraction
where is osteoradionecrosis more common
- in mandible
how can osteoradionecrosis be prevented
- remove teeth of doubtful prognosis in the radioterhapy field
- prevention is key
- extractions completed at least 20 days prior to radiotherapy
- liaise with oncologist
what is done in pre-radiotherapy assessment
- extract poor prognoses teeth
- prevention
- interruption of radio/chemotherapy can have detrimental effect on cancer treatment
- extractions carried out at least 2 weeks prior to radiotherapy to allow healing
- multiple extractions may affect the fit of radiotherapy mask
how common is infected osteoradionecrosis (IORN)
- between 4-35%
are implants useful in treatment of osteoradionecrosis
- revolutionising rehabilitation
- reduced success of implants in irradiated bone
what are some dental problems for these patients
- as common in this group as in other sectors of population
- treatment plan according to stage of illness
- routine treatment possible if well enough to attend
- minimum intervention in terminal stages
what is trismus
- fibrosis of muscles of mastication
- endarteritis of tissues affected with reduction in their blood supply
- irreversible
what can trismus impact on
- eating
- speaking
- OH
- dentures
- dental treatment
- can be exacerbated by surgically induced microstomia
- can try and stretch open mouth wider and wider everyday
what is the role of the dental team before cancer treatmetn
- prevention of chemo/radiotherapy complications
- plan rehabilitation
what is the role of the dental team during cancer treatment
- mucositis
- emergency treatment
what is the role of the dental team after cancer treatmetn
- prevention
- rehabilitation
- long-term care and monitoring
