Dental Implications of Managing Oncology Patients

Question 1

H+N can affect anywhere

Answer 1

Above hypopharynx

Up to skull base

Question 2

Oral cancer stats

Answer 2

2% of all cancer cases

Question 3

MDT

Needed for

Answer 3

Multi disciplinary team
Diverse nature of disease
(MPT)

Question 4

SIGN 90

Answer 4

Pre op assessment by experienced dental practitioner

Assess needs post surgery

Question 5

Aims of pre assessment

Answer 5

Avoid unscheduled interruptions
Pre-prosthetic planning
Planning of extractions 
Extractions as early as possible 
Preventative

Question 6

Why are extractions important at start

Answer 6

Risk of trismus post RT

Osteoradionecrosis

Question 7

RT

Some tissues are more…
Results in…
Bone healing

Answer 7

7 week course of patient 
Plastic mask
Photosensitive than others e.g bone and salivary glands 
Xerostomia 
Gets worse with time

Question 8

Alternative for extraction post RT

Answer 8

Coronectomy and root fill to preserve bone

Question 9

Wait for 3 months after RT for dental extractions

Answer 9

Allows regeneration

Question 10

Side effects of RT

Answer 10

Mucositis- inflammation and ulceration of mucosal lining of oral cavity
Infection - chemo induced neutropenia - immunosuppression
Xerostomia - taste changes also

Question 11

Long term side effects of RT

Answer 11

Altered anatomy 
rampant dental caries 
Trismus
Mastication difficulties
Osteoradionecrosis 
Xerostomia  - biotine gel and saliva substitute (salivase/saliva orthana for dentate patients)

Question 12

IMRT

Answer 12

Modulated radiotherapy

Spares major vessels and glands

Question 13

Prevention

Answer 13

Maintenance of oral hygiene 
Dietary advice 
Topical fluoride or fluoride toothpaste/Mouthwash 
Tooth Mousse containing free calcium 
Jaw exercises - with callipers or sticks

Question 14

Aetiology

Answer 14

Cigarettes
Alcohol - makes mucosa more permeable 
Lifestyle
Genetics
Virus - HPV 16+18 - tonsil and tongue base 
Hormones

Question 15

Chemotherapy in H+N

Answer 15

Just to increase radio sensitivity for RT

Question 16

Rehab

Answer 16

Directly close area

Question 17

Implants

Answer 17

Wide variation in provision 
Pre or Post RXt 
Primary placement (before) or earlier on