Dental implications of managing oncology patietns Flashcards
head and neck cancer regions
- larynx (can affect pts voices, laryngectomy, may remove the voice box)
- oral cavity
- oropharynx
- hypopharynx
- nasopharynx
- major salivary gland
- nose and sinus
- bones of the jaw
age and what can affect age of getting H and N cancer
70+
HPV causes it in younger pateints
aetiology of H and N cancer
- cigarettes
- alcohol
- lifestyle
- genetics
- virus – HPV
- hormones
signs of cancer
non healing ulcer red/white patches loose teeth jaw pain swelling or sore that does not heal lump persistant sore throat hoarseness or change in voice double vision
what happens after referral
looked at by a MD team
aims of pretreatment assessment
planning for extractions of teeth with doubtful prognosis
planning for restorations
OHI
assess potential for post treatment difficulties
avoid unscheduled interruptions
treatment sideeffects of radiotherapy
mucositits
infeciton
xerostomia
taste loss
what can help with mucositis
SLS free toothpaste
what is common following chemo or radio
oral candida infections
long term effect of cancer treatment
altered anatomy dental caries trismus mastication difficulties osteoradionecrosis xerostoma
which type of radiography reduces risk of xerostomai
IMRT
prevention of trismus
at home exercise and continue for 9 month following start of radiotherapy
cancer treatment options
radiation
chemo
surgery
surgical rehabilitation options
soft tissue reconstruction
composite reconstruction
obturators
restore the partition between oral and nasal cavities to enable normal swallowing and speech
restore palatal contours and replace needed dentition/restore occlusion
success of implants depends on
primary implant anchorage and stablisation
formation of clot between surface and implant of osteotomy site
release of GF, angiogenesis and osteoprogenitor cells to implant
types of radiotherapy
conventional radiotherapy
intensity modulated radiotherapy
brachytherapy
IMRT
multiple beams of non uniform intensity
limits dose to normal surrounding tissue structure
what can lead to osteoradionecrosis
healing capacity of the bone is reduced due to lack of blood supply
extraction may lead to necrotic hole
when can implants be placed
before or after surgery
primary dental implants best when
useful whsere no Md recession /patients with large maxillary defect where obtuator retention is compromised
those with md reconstruction implant survival and usefulness improved by delaying placement
chemotherapy works on
active cells that are growing and dividing into more of the same type of cell
what can be used to treat mucostitits
benzylamine hydrochloride
chemotherapeutic drugs
cis platin
fluropyrimidines
cisplatin
cytotoxic drug damages DNA and inhibits DNA synthesis
fluropyrimdines
increase effectiveness of radiation
increases radiation sensivitiy in cancer cells that uptake it
when should you refer to secondary dental care where the socket has not healed
after 8 wks
when can invasive dental treatment be given in primary care
- are currently receiving radiotherapy to areas other then H and N
- received chemo more than 6 months ago
- are receiving biological or hormonal therapues for their cancer
