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BDS3 Special Care Dentistry > Cancer (c) > Flashcards

Cancer (c) Flashcards

1
Q

What are the roles of the dentist and dental team in patients with H+N cancer?

A

roles of the dentist and dental team:

  • early detection of soft tissue lesions
  • pre-treatment assessment and dentla care
  • minimal role during treatment unless special interest
  • maintenance of oral and dental ehalth post-tretament
  • palliative care
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2
Q

In patients with H+N cancer, the role of the dental team is to ensure that oral cancer X dental disease

A

X - does not mean that there is/does not equal

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3
Q

What is a H+N cancer patient’s journey with the dentist?

A

H+N cancer patient’s journey:

  • screening and referral
  • investigations
  • dental pre-assessment
  • support through treatment
  • restoration
  • maintenance and post-treatment management
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4
Q

What should every H+N cancer patient have prior to entering their cancer treatment?

A

every H+N cancer patient should have been dentally screened prior to entering their cancer treatment

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5
Q

Whta will oral cancer have an impact on?

A

oral cancer will have an impact on:

  • aiway
  • upper GI tract
  • major senses
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6
Q

What is involved in the pre-assessment and treatment of a H+N cancer patient?

A

pre-assessment and treatment of a H+N cancer patient:

  • medical, dental and social history
  • oral and dental assessment prior to starting cancer therapy
  • radiographs
  • any necessary treatment carried out:
    • make the patient dentally fit prior to oncological care
    • availability needed for immediate treatment sometimes
  • pre-treatment dental scaling by hygienist
  • impressions for fluoride trays
  • start fluoride therapy for dentate patients
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7
Q

What are the priorities of pre-treatment dental assessment in H+N cancer patients?

A

priorities in pre-treatment dental assessment in H+N cancer patients:

  • oral hygiene and fluoride
  • reduce treatment complications
    • avoid unscheduled interruption of chemotherapy regimen
    • avoid exacerbation of mucositis
    • remove potential sources of infection
  • reduce post-treatment complications
    • remove teeth of dubious prognosis
    • institute preventive regime
    • plan rehabilitation
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8
Q

What are some skin and mucosa effects of cancer treatement?

A
  • erythema
  • ulceration
  • mucositis
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9
Q

How can cancer treatments for H&N affect muscles and connective tissue?

A

trismus (less than 35mm opening)

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10
Q

How can cancer treatments for H&N affect the salivary glands?

A

dry mouth is caused by salivary gland dysfunction

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11
Q

Do you want to be treating a patient dentally during oncology treatment?

A

no, you don’t want to be treating a patient dentally during oncology treatment

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12
Q

What are common oral pathologies during onoclogy treatment?

A

common oral pathologies during oncology treatment:

  • Ulceration (traumatic or mucositis)
  • Infections
    • Candida infections
    • Reactivation of herpes simplex
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13
Q

What can be made to prevent traumatic ulceration from lower teeth during oncology treatment?

A

a soft splint can be made to prevent oral ulceration from lower teeth during oncology treatment

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14
Q

What can mucositis be induced by?

A

mucositis can be induced by either radiotherapy or chemotherapy

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15
Q

What is mucositis?

A

inflammation and ulceration of oral mucosal tissues which causes severe pain

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16
Q

What can mucositis have an impact on?

A

mucositis can have an impact on eating and oral hygiene

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17
Q

What is the commonest site for oral tumours?

A

the commonest site for oral tumours is the lateral border of the tongue

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18
Q

Generally, what should be avoided in patients that have mucositis?

A

in patients that have mucositis, the following should be avoided:

  • smoking
  • spirits
  • spicy foods
  • tea and coffee
  • nono-prescription mouthwashes
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19
Q

What may be required for pain relief in mucositis?

A

narcotic analgesia may be required for pain relief in mucositis

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20
Q

What can be used for prevention of mucositis?

A

prevention of mucositis:

  • aloe vera
  • amifostine
  • cryotherapy (ice chips)
  • granulocyte-colony stimulating factors
  • itravenous glutamine
  • manuka honey
  • keratinocyte growth factor
  • laser
  • polymixin/tobramycin/amphotericin antibiotic pastille/paste
  • sucralfate
21
Q

What topical agents can be used for managing mucositis?

A

topical agents for managing mucositis:

  • topical lignocaine
  • saline mouthwash
  • sodium bicarbonate
  • benzydamine hydrochloride
  • Gelclair
  • caphosol
  • tea tree oil mouthwash
  • oral cooling with ice
22
Q

What can be used as a treatment for mucositis?

A

mucositis treatment:

  • low level laser light therapy
  • morphine
23
Q

The oral carriage of X is common among cancer patients

A

X - yeasts

24
Q

Can there be painful oral ulceration with the reactivation of herpes simplex?

A

yes, there can be painful oral ulceration with reactivation of herpes simplex

25
Q

What can be said about the onset of reactivation of herpes simplex?

A

there can be a sudden onset of reactivation of herpes simplex

26
Q

There is usually a prodromal period with viral infectiosn - what does this mean?

A

there is usually a prodromal period with viral infections - this means that pain comes before ulcers appear

27
Q

What prevention would you want to do post cancer treatment?

A

post-treatment care - monitoring:

  • diet
  • oral hygiene
  • fluoride
  • trismus
  • smoking
28
Q

What would you want to monitor post treatment for cancer and how would you do this?

A

post-treatment care - monitoring:

  • increaesd frequency of check ups
  • dry mouth management
  • prosthodontics
  • appropriate referral
29
Q

What can be said about the decrease of salivary flow in the first week of radiotherapy?

A

in the first week of radiotherapy, there is a large decrease in salivary flow (50-60%)

30
Q

What can be said about the viscosity of saliva following cancer treatment?

A

there is an increase in saliva viscosity due to cancer treatment

31
Q

What can be said about the change in pH of saliva during cancer treatment?

A

during cancer treatment, there is a decrease in pH of saliva

32
Q

What can be said about the recovery of xerostomia from cancer treatment?

A

the recovery of xerostomia from cancer treatment will happen over a period of years and sometimes the saliva will not return to normal

33
Q

With xerostomia, what is there an increased risk of?

A

with xerostomia, there is an increased risk of:

  • caries
  • periodontal disease
  • candidosis
  • sialadenitis (salivary gland infections)
34
Q

What can occur due to xerostomia?

A

xerostomia:

  • dysphagia
  • dysarthria
  • dysgeusia
  • quality of life altered
  • prosthodontic difficulties
35
Q

What can be used to manage xerostomia?

A

managing xerostomia:

  • OralBalance
  • tooth mousse
  • sugar free chewing gum
  • sipping water throughout the day
36
Q

What can be done to prevent osteoradionecrosis?

A

preventing osteoradionecrosis:

  • removing teeth of doubtful prognosis in the radiotherapy field
  • OH prevention
  • extractions completed at least 10 days prior to radiotherapy
  • liaising with oncologist
37
Q

How have dental implants contributed to rehabilitation of cancer patients?

But, what is needed once they are done?

A

Revolutionised it

Good maintenance is required:

  • self care
  • professional support
38
Q

What can happen to the muscles of mastication during radiation therapy?

A

Fibrosis of the muscles of mastication causing trismus

39
Q

Is trismus caused by fibrosis of muscles of mastication reversible?

A

This type of trismus isn’t

The radiation induces fibrosis

40
Q

What does trismus have an impact on?

A

trismus has an impact on:

  • eating
  • speaking
  • oral hygiene
  • dentures
  • dental treatment
41
Q

What is the role of the dental team before cancer treatment?

A

role of the dental team before cancer treatment:

  • prevention of chemotherapy/radiotherapy complications
  • plan rehabiliation
42
Q

What is the role of the dental team during a patient’s cancer treatment?

A

role of the dental team during cancer treatment:

  • mucositis
  • emergency treatment
43
Q

What is the role of the dental team after cancer treatment?

A

role of the dental team after cancer treatment:

  • prevention
  • rehabiliation
44
Q

How can cancer treatments for H&N affect the teeth and supporting structures and bone?

A

Teeth and supporting structures:

-Dental caries and sequelae (very common as mouth becomes dry and acidic)

Bone:

-Osteoradionecrosis

(caused due to little blood vessels being affected by the radiotherapy and therefore lack of blood flow)

45
Q

Describe the reactivation of the herpes simplex virus. What is it like?

A
46
Q

Describe the characteristic pattern of caries that is seen in patients that undergo head and neck radiotherapy. What is the term used to decribe caries like this?

A
  • Radiation indued caries
  • Characteristic pattern of cervical caries
  • Happens due to the reduced salivary flow and clearance from these areas
  • The caries becomes circumferential and the crowns end up just snapping off
47
Q

What is the success of implants like in patients with irradiated bone?

A

Reduced success

48
Q

Describe the kind of pallaitve care you may have to provide.

A

In cases where tumours etc havent been managed, you need to keep the area clean and comfortable

Just try and keep the patients out of pain

BDS3 Special Care Dentistry (9 decks)

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