Dental implications of managing oncology patietns

Question 1

head and neck cancer regions

Answer 1

• 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

Question 2

age and what can affect age of getting H and N cancer

Answer 2

70+

HPV causes it in younger pateints

Question 3

aetiology of H and N cancer

Answer 3

• cigarettes
• alcohol
• lifestyle
• genetics
• virus – HPV
• hormones

Question 4

signs of cancer

Answer 4

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

Question 5

what happens after referral

Answer 5

looked at by a MD team

Question 6

aims of pretreatment assessment

Answer 6

planning for extractions of teeth with doubtful prognosis
planning for restorations
OHI
assess potential for post treatment difficulties
avoid unscheduled interruptions

Question 7

treatment sideeffects of radiotherapy

Answer 7

mucositits
infeciton
xerostomia
taste loss

Question 8

what can help with mucositis

Answer 8

SLS free toothpaste

Question 9

what is common following chemo or radio

Answer 9

oral candida infections

Question 10

long term effect of cancer treatment

Answer 10

altered anatomy 
dental caries
trismus
mastication difficulties
osteoradionecrosis
xerostoma

Question 11

which type of radiography reduces risk of xerostomai

Answer 11

IMRT

Question 12

prevention of trismus

Answer 12

at home exercise and continue for 9 month following start of radiotherapy

Question 13

cancer treatment options

Answer 13

radiation
chemo
surgery

Question 14

surgical rehabilitation options

Answer 14

soft tissue reconstruction

composite reconstruction

Question 15

obturators

Answer 15

restore the partition between oral and nasal cavities to enable normal swallowing and speech
restore palatal contours and replace needed dentition/restore occlusion

Question 16

success of implants depends on

Answer 16

primary implant anchorage and stablisation
formation of clot between surface and implant of osteotomy site
release of GF, angiogenesis and osteoprogenitor cells to implant

Question 17

types of radiotherapy

Answer 17

conventional radiotherapy
intensity modulated radiotherapy
brachytherapy

Question 18

IMRT

Answer 18

multiple beams of non uniform intensity

limits dose to normal surrounding tissue structure

Question 19

what can lead to osteoradionecrosis

Answer 19

healing capacity of the bone is reduced due to lack of blood supply
extraction may lead to necrotic hole

Question 20

when can implants be placed

Answer 20

before or after surgery

Question 21

primary dental implants best when

Answer 21

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

Question 22

chemotherapy works on

Answer 22

active cells that are growing and dividing into more of the same type of cell

Question 23

what can be used to treat mucostitits

Answer 23

benzylamine hydrochloride

Question 24

chemotherapeutic drugs

Answer 24

cis platin

fluropyrimidines

Question 25

cisplatin

Answer 25

cytotoxic drug damages DNA and inhibits DNA synthesis

Question 26

fluropyrimdines

Answer 26

increase effectiveness of radiation

increases radiation sensivitiy in cancer cells that uptake it

Question 27

when should you refer to secondary dental care where the socket has not healed

Answer 27

after 8 wks

Question 28

when can invasive dental treatment be given in primary care

Answer 28

• 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