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BDS3 - Special Care Dentistry > cancer > Flashcards

cancer Flashcards

1
Q

what is the role of the dental team in head and neck cancer

A
  • 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
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2
Q

what can happen after chemo or radiotherapy

A
  • deterioration of dentition

- gross destruction of alveolar bone

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3
Q

what must we not do during cancer treatmetn

A
  • try and not do anything invasive during their treatment
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4
Q

what are signs that could suggest head and neck cancer

A
  • 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
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5
Q

what are some signs that could suggest thyroid cancer

A
  • 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
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6
Q

what can oral cancer impact on

A
  • airway
  • upper GI tract
  • major sense
  • very visible and difficult to hide
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7
Q

what is involved in pre-assessment and treatment

A
  • 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
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8
Q

what are dental assessment priorities

A
  • oral hygiene and fluoride
  • reduce treatment complications
  • reduce post treatment complications
  • complex as outcomes is unpredictable
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9
Q

how do we reduce treatment complications

A
  • avoid unscheduled interruption of chemotherapy regimen
  • avoid exacerbation of mucositis
  • remove potential sources of infection
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10
Q

how do we reduce post treatment complications

A
  • remove teeth of dubious prognosis
  • institute preventive regime
  • plan rehabilitation
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11
Q

what are the aims of pre-treatment assessment

A
  • 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
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12
Q

what dental work may be needed during oncology treatment

A
  • oral ulceration
  • oral infection
  • emergency dental treatment
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13
Q

how is dry mouth a common affect from radiotheray

A
  • salivary glands are hit heavily from it
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14
Q

how common is traumatic ulceration

A
  • very common

- trauma from lower teeth which is why we often then provide a soft splint

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15
Q

what is mucositis ulceration

A
  • radiotherapy and chemotherapy induced
  • inflammation and ulceration
  • severe pain
  • analgesia required
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16
Q

what can mucositis impact on

A
  • eating = need PEG/RIG
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17
Q

where is the most common area for cancer ulcer

A
  • lateral border of the tongue
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18
Q

what are some measures to manage mucositis

A
  • 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
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19
Q

how can mucositis be prevented

A
  • aloe vera
  • amifostine
  • chlorohexidine
  • cryotherapy
  • granulocyte
  • IV glutamine
  • honey
  • keratinocyte growth factor
  • laser
  • sucralfate
20
Q

what is the treatment of mucositis

A
  • low level laser light therapy = very successful in children, not used as much in adults
  • morphine
21
Q

what is oral candidiasis

A
  • oral carriage of yeasts common among cancer patients
  • frequent clinical problem
  • also called thrush
22
Q

what are some viral infectiosn

A
  • 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
23
Q

what prevention is included in post treatment care

A
  • diet
  • OH
  • fluoride
  • trismus smoking
24
Q

what monitoring is done post treatment

A
  • increased frequency of check-ups
  • dry mouth management
  • prosthodontics
  • appropriate referral
25
Q

what is there a risk of post treatment

A
  • xerostomia
  • radiation caries
  • ORN
  • trismus
  • all are lifelong
26
Q

what are the features of xerostomia

A
  • 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
27
Q

how often can salivary glands be affected from radiotherapy

A
  • 60% of patients

- affects = chewing, swelling, speech, taste, quality of life

28
Q

what is dysphagia

A
  • difficulty swallowing

- may be short or long term

29
Q

what is dysarthria

A
  • difficulty articulating
30
Q

what is dysgeusia

A
  • altered taste

- due to both xerostomia and direct effect on taste receptors

31
Q

what can xerostomia cause an increased risk of

A
  • caries
  • periodontal disease
  • candidiasis
  • siladenitis = infection of salivary glands
  • prosthodontics difficulties
32
Q

what are some management strategies for xerostomia

A
  • 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
33
Q

what does lack of saliva mean

A
  • reduced buffering effect
  • reduced clearance
  • alteration of microflora to favour cariogenic bacteria
34
Q

what is radiation induced caries

A
  • very prevalent
  • smooth surface caries at cervcial region
  • eventually caries can become circumferential and tooth snaps off
35
Q

how many hospice patients are affected by periodontal disease

A
  • 36%
36
Q

what is included in diagnosis and management of it

A
  • 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
37
Q

where is osteoradionecrosis more common

A
  • in mandible
38
Q

how can osteoradionecrosis be prevented

A
  • remove teeth of doubtful prognosis in the radioterhapy field
  • prevention is key
  • extractions completed at least 20 days prior to radiotherapy
  • liaise with oncologist
39
Q

what is done in pre-radiotherapy assessment

A
  • 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
40
Q

how common is infected osteoradionecrosis (IORN)

A
  • between 4-35%
41
Q

are implants useful in treatment of osteoradionecrosis

A
  • revolutionising rehabilitation

- reduced success of implants in irradiated bone

42
Q

what are some dental problems for these patients

A
  • 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
43
Q

what is trismus

A
  • fibrosis of muscles of mastication
  • endarteritis of tissues affected with reduction in their blood supply
  • irreversible
44
Q

what can trismus impact on

A
  • eating
  • speaking
  • OH
  • dentures
  • dental treatment
  • can be exacerbated by surgically induced microstomia
  • can try and stretch open mouth wider and wider everyday
45
Q

what is the role of the dental team before cancer treatmetn

A
  • prevention of chemo/radiotherapy complications

- plan rehabilitation

46
Q

what is the role of the dental team during cancer treatment

A
  • mucositis

- emergency treatment

47
Q

what is the role of the dental team after cancer treatmetn

A
  • prevention
  • rehabilitation
  • long-term care and monitoring

BDS3 - Special Care Dentistry (19 decks)

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