Dental implications of managing oncology patients Flashcards
Oncology statistics
300,000 new cases per year
7500 new cases of oral cancer per year
Males (421) > females (376/100,000)
1200 cases of childhood oncology per year
Oral cancer types
90% squamous cell carcinoma Adenocarcinoma Teratoma Melanomas Rare lesions
Types of oropharyngeal oncology
Squamous cell carcinoma
- HPV positive
- HPV negative
Types of nasopharyngeal oncology
East Asia and Africa
-squamous cell carcinoma
-lymphoepithelioma
Both can be from Epstein-Barr virus
Types of salivary gland tumours oncology
Adenocarcinoma
Types of nasal and sinus cancers oncology
60% squamous cell carcinoma
10% adenocarcinoma
Lymphomas, plasmacytomas, melanoma
Head and neck oncology epidemiology
Low Socio-economic groups Smokers Increased Alcohol Consumption Poor users of Medical Services Increased rates of dental disease Poor dental attendance Dental phobia Virus Hormones Genetics
Oral implications of head and neck oncology
Direct as a result of the malignancy
Unwanted side effects of cancer therapy
90% Paediatric Oncology cases have oral complications
Survival rate continually improving
-implications for future dental treatment: longevity of the individual, QoL issues
Cancer therapy oral complications
Chemotherapy Radiotherapy to head and neck region Bone Marrow Transplantation (BMT)/Haemopoetic Stem Cell Transplantation (HSCT) -chemotherapy -total body irradiation Bisphosphonate Therapy Monoclonal Antibody Therapy
Oral care pathway
RCS England/ BSDH guidelines
Aim to minimise oral complications
90% H&N cancer pts have dental disease
Pre-treatment assessment, dental care in acute phase of cancer therapy, dental care post cancer therapy
Aims of pre-treatment assessment
Avoidance of unscheduled interruptions to 1. tx as result of dental problems
Pre-prosthetic planning/ treatment e.g., planning for primary implants/ imps for obturator
Planning for XLA for doubtful prognosis or at risk of dental disease in future and in an area at risk of osteoradionecrosis
XLA as early as possible in pt journey, at least 10 days prior to radiotherapy.
Planning for restoration of remaining teeth as required.
Preventive advice and treatment.
Assess potential for post treatment access difficulties e.g., trismus, microstomia
Oral Care Pathway - prevention
OHI & Dietary Advice ( +Smoking cessation) High dose fluoride toothpaste Saliva supplementation Regular scaling & polishing Topical Fluoride Mucositis
Dental Care in acute phase of cancer therapy
Avoided wherever possible -limit any dental treatment to emergency care only OH support Anti-fungals Denture care Mucositis -diet modifications -2% lidocaine mouthwash -treatment: Difflam (Benzydamine hydrochloride 15%), allopurinol
OH support in acute phase of cancer therapy
- professional hygienist support
- brushing, flossing, interdental cleaning
- alcohol free chlorhexidine
- anti viral therapy for children with HSCT
- maintain high dose F- toothpaste & saliva supplementation
- fluoride mouthrinses (0.05% NaF)
- topical Fluoride (2.2%)
Anti-fungals in acute phase of cancer therapy
Nystatin 100,000 units/ml, 7 days + 48 hours post resolution
Miconazole oral gel 24mg/ml – 10ml QDS
Fluconazole 50mg OD 7-14 days (Oropharyngeal candida)
( Azoles contraindicated with warfarin & statins )
Dental Care in acute phase of cancer therapy - radiotherapy
Dress
Extirpate pulps and dress
Dental Care in acute phase of cancer therapy - chemotherapy
Low platelet and white cell counts and anaemia
Plan care at optimum point in cycle
Monthly cycles
Dental Tx as close to start of next cycle as possible
Dental care post cancer therapy
Risk of uncontrolled dental disease following cancer therapy can continue for at least 12 months following Chemo, radiotherapy, total body irradiation and HSCT
> susceptibility to dental disease can be life long
Growth and development of facial structures and dentition should be closely monitored in children