Dental implications of managing oncology pts Flashcards
What does H and N cancer cover?
Anything above the hypopharynx to skull base
What does the dental pre-treatment assessment consist
of?
Avoid unscheduled interruptions to primary tx as a result of dental problems
Pre-prosthetic planning/tx
Planning for tooth extractions if doubtful prognosis or at risk of dental disease in future and in an area at risk of osteoradionecrosis
Extractions completed as early as possible but at least 10 days before radiotherapy (bone gets worse the longer after RT)
Planning for restoration of remaining teeth
Preventive advice and tx
Assess potential for post tx access difficulties - trismus
Which areas of the body won’t recover well from RT?
Bone and salivary glands = xerostomia
What to do if a pt has had RT years ago in the area of a tooth that needs extracting?
Leave the root in bone
When can normal dental tx resume after RT?
3 months after RT
Short term RT side effects?
Mucositis - inflam and uceration of the mucosal lining of the oral cavity
infec - chemo induced neutropenia = pt susceptible to opportunistic infec - oral candida common
Xerostomia
Long term RT effects?
Altered anatomy - prosthetic rehab challenging
Rampant dental caries - decreased saliva flow and sweet tooth during RT
Trismus from surgical scarring or RT induced fibrosis of the masticatory muscles
Mastication difficulties
Osteoradionecrosis
Xerostomia
What reduces the risk of xerostomia and osteoradionecrosis after Tx?
IMRT = RT that spares major salivary glands and BVs
Preventive management?
Maintain good OH
Diet advice
Daily topical F application - 2800ppm, 5000ppm F
Daily F mouthrinse
Daily use of GC tooth mousse TM containing free calcium (ca supplements)
Saliva replacement therapy/use of frequent saline rinses
Jaw exercises to reduce trismus (therabite)
What causes H&N cancer?
Cigarettes Alcohol Lifestyle Genetics Virus -HPV Hormones
Types of soft tissue reconstruction?
Radial forearm flap Rectus adbominus Flaps based on scapular Pedicle tongue flap Anterior thigh flap
Types of mandibular reconstruction?
Fibula flap
Deep circumflex iliac artery flap
Scapular flap
RFF
What is involved in rehabitilation?
Multidisciplinary decision making
Prosthetic options redce morbidity of tx and can give good results
Choice of reconstruction or prosthetics requires discussion with many people
Impants
Pre and post RXT
Primary and 2ndry - primary before tx
Fixed vs removable ISPs
