Cancer CBL Tutrorial Flashcards
what is tramadol
○ Analgesic
○ Strong painkiller used to treat moderate to severe pain
○ Works by blocking pain signals from travelling along the nerves to the brain
○ Side effects: § Feeling sick § Dizzy § Headaches § Feeling sleepy § Dry mouth § Low energy
○ Best to avoid drinking alcohol as you are more likely to get side effects like feeling sleepy
○ Dose can vary but normally no more than 400mg per day
○ If taking for a long time and patient comes off it suddenly they can experience unpleasant withdrawal symptoms such as; § Feeling agitated § Feeling anxious § Sweating § Shaking
○ Do not take with codeine-containing painkillers ~ side effects
what is omeprazole
○ Reduces the amount of acid your stomach makes
○ Proton pump inhibitor
○ Side effects:
§ Headaches
§ Feeling sick
§ Stomach pain
what is citalopram
○ Antidepressant known as selective serotonin reuptake inhibitor (SSRI)
○ Side effects:
§ Dry mouth
§ Sweating
§ Tiredness / weak
what is a unit of alcohol
Unit = depends on type of alcohol you drink
Ask what type of alcohol she drinks
1 unit = short of vodka / whiskey etc
what is the recommended weekly alcohol amount
14 units
who can you refer a patient with cancer on to for dental treatment
- dental hospital
- special care dentist in the public dental service
should the patient be dentally fit before starting chemo
yes
Want her mouth infection free before chemo
Don’t want any issues whilst she is having chemo treatment
on a radiograph how does the PDL look if there is a periodical lesion
if there was a periapical lesion the dark line would spread around the pathology
in a healthy tooth we can see the PDL well defined around the tooth
what do you look for in success root treatment
- good quality
- filled to the apex / to length
- want to make sure the filling material doesn’t come out anywhere
- is it well condensed
- make sure there are no air bubbles or voids
what is a ferrule
Amount of tooth tissue that goes around that could support the post coming in
Need enough tooth tissue to support post otherwise can fracture the root
what are pulp stones
- Calcification in the pulp chamber
- Makes root treatment more difficult
- Most patients won’t realise they have it
appears white in the pulp chamber on a radiograph
how can mucositis vary
- Little bit of redness
- To complete oral ulceration where the patient can no longer take liquids or food orally so the patient cannot eat (bad for the patients recover, not keeping up their strength)
Need feeding tubes
what can dentists do to help with mucositis in patients
- Topical anaesthetic
○ Can put on at home
○ Relieve some pain
○ Reduce symptoms especially when eating ~ helps paitent not to be put off food
○ Lidocaine sprays and ointments or mouthwashes
○ Can be sore to put on
○ Doesn’t last very long - OH
○ Gauze / muselin cloths (soft) with chlorhexidine (even salty water or diluted chlorhexidine) to wipe around their mouth
○ Brush could be too abrasive
○ Silk toothbrushes are softer as well
- Mouthrinses ○ Can help to calm it ○ Calphazol ○ Cooling / soothes the tissues a little ○ Reduce symptoms
- Numbing sprays
- Ice cooling
○ Numbs things
- Fluoride trays ○ Can make before they go for treatment ○ Make sort of like retainers ○ Can put toothpaste or fluoride gel in and these are smoother than teeth ○ Protect tissues and gets fluoride
what is the grading system of mucositis
- Grade 0 (none)
> none - Grade I (mild)
> oral soreness
> erythema - Grade II (moderate)
> oral erythema
> ulcers
> solid diet tolerated - Grade III (severe)
> oral ulcers
> liquid diet only - Grade IV (life-threatening)
> oral alimentation impossible
> unable to take oral liquids or solids
what is oral thrush
oral candidiasis
○ Fungal infection
○ White patch which can be scraped off and removed
○ Can leave skin underneath red or bleeding a bit
opportunistic infection
what antifungals can be used to treat oral thrush
○ Fluconazole ~ systemic
○ Myconazole ~ topical
§ Good as a gel if patient wears dentures
○ Nystatin ~ local, liquid
§ Rinse around mouth and spit out
§ Can swallow for a more systemic effect but they interact with everything then you need to be careful especially if patient is on statins or warfarin
what are the possible treatment options for a buccal abscess
- Extract tooth
○ Bleeding risk - Incise and drain abscess
○ Short term measure to get rid of swelling and infection but risk it could come back
○ Wont deal with problem very well
○ Also a bleeding risk and further infection risk - Re-root canal
○ See if you can sort infection
○ Multiple appointments, takes a lot of time, low success rates - Do nothing
○ Not recommended - Antibiotics
○ Doesn’t fix problem but patches problem up until after treatment
○ Not ideal but gives time
what are the concerns with treating a buccal abscess in patient receiving chemo treatment
- Infection spread due to weakened immune system
○ Could spread rapidly
○ Can cause death - White blood cells down
- As well as red blood cells and platelets
○ Anaemic potentially
○ Bleeding risk increased
○ Want to look at bloods before treatment
§ Get a full blood count
□ White blood cells tell you how bad the infection is
□ Under 50 platelets = do not take tooth out they wont stop bleeding
□ Over 50 = probably get them to stop with packing etc, still delicate however
§ Consult with oncology team
how can radiotherapy affect dentistry
Radiotherapy: don’t get symptoms at the time but issues arise a few years down the line
what is osteoradionecrosis
Osteoradionecrosis = death of the bone because of radiation therapy
Tends to happen 5 years after radiotherapy but can be longer
what is radiation caries
○ Salivary glands affected
○ Dry mouth
○ Not normal pattern of caries
○ Getting cervical margin of caries
