Dental implications of managing oncology patients Flashcards

Question

What to do if faced with potential need to extract?

Answer 1

``` Antibiotic cover Amoxicillin/Coamoxiclav Metronidazole (if penicillin allergy) 0.2% chlorhexidine pre-rinse Adrenaline free LA Atraumatic Root canal treatment De-coronate & RCT HBOT - specialist care (rest you can do at GDS) ```

Answer 2

``` Leave out at night – except for obturators in first 6 months Salivary substitutes > risk of oral candidiasis -Miconazole gel -Modified soft liners/tissue conditioners (Nystatin 500,000-1,000,000 units in Viscogel©, Tea tree oil in Coe Comfort©) -Fluconazole for persistent infections Replace poor dentures Tooth borne appliances ```

Answer 3

0: Mucosal defect I: Radiological evidence of necrotic bone, mucosa intact II: Radiographic findings + denuded bone visible III: Exposed necrotic bone with infection + skin fistulas

Answer 4

``` Referral to oral surgery/ special care dentistry, but maintain shared care Meticulous oral hygiene -brushing lesion -chlorhexidine gel Soft diet Gentle scaling/debridement of lesions Removal of dentures Monitor lesion by specialist -surgical intervention -high dose antibiotic regimes -HBOT ```

Answer 5

BRONJ – Bisphosphonate related ONJ ARONJ –Anti-resorptive Agent-induced ONJ

Answer 6

``` Oral or IV (Zoledronic Acid) Bone Metastatic Spread Risks -oral < IV 1/10,000-1/100,000 1/10 – 1/100 -length of therapy -extractions -oral surgery -intra oral trauma eg poor fitting dentures ```

Answer 7

Derived from a single B Cell Lymphocyte clone No batch to batch variance, therefore effect is more predictable -Denosumab < Oc differentiation, activity and survival; inhibits bone resorption; SC injection 6 monthly

Answer 8

``` Meticulous oral hygiene RCT vs Extractions Removal/modification of dentures No periodontal surgery No implants ```

Answer 9

Refer for specialist care - atraumatic extractions - achieve primary closure - regular follow-up

Answer 10

``` Meticulous oral hygiene -brushing lesion -chlorhexidine gel Soft diet Gentle scaling/debridement of lesions Removal/modification of dentures Monitor lesion by specialist -surgical intervention -high dose antibiotic regimes -HBOT ```

Answer 11

``` *Multidisciplinary team* Anaesthetist with a special interest in head and neck cancer Gastroenterologists, radiologists, surgeons, and other health professionals with expertise in gastrostomy creation, feeding tube placement and support for patients who require tube feeding Ophthalmologist Pain management specialist Therapeutic radiographer Maxillofacial/dental technician Dental therapist/hygienist Benefits advisor Clinical psychologist Physiotherapist Occupational therapist Neurosurgeon (for skull base) Neuro-otologist (for skull base) Palliative care specialist (doctor or nurse) GMP GDP ```

Answer 12

Mucositis: inflammation and ulceration of the mucosal lining of the oral cavity. Infection: chemotherapy induced neutropenia makes the patient susceptible to bacterial, viral, and fungal infections. Oral candidal infections are extremely common following chemo or radiotherapy. Xerostomia: dry mouth resulting from a decrease in the production of saliva as a result of radiotherapy.

Answer 13

Altered anatomy Rampant dental caries: thought to be result of < salivary flow as well as possible direct radiogenic damage to the ADJ Trismus: may be caused by surgical scarring or by radiotherapy induced fibrosis of MoM Mastication difficulties: if significant number of opposing pairs of teeth are lost Osteoradionecrosis: hypovascularity and necrosis of bone followed by trauma induced or spontaneous mucosal breakdown, leading to a non-healing wound. Xerostomia

Answer 14

Maintenance of good oral hygiene by effective tooth brushing; flossing daily. Dietary Advice with regard to caries prevention. Daily topical fluoride application (2800ppm or 5000ppm fluoride toothpaste) in custom-made trays or brush-on. Daily fluoride mouthrinse. Daily use of GC Tooth Mousse TM containing free calcium Saliva replacement therapy/ use of frequent saline rinses Jaw exercises to reduce trismus (therabite).

Answer 15

Multidisciplinary decision-making should include the patient, surgeon (often in conjunction with plastics) and dental prosthodontist/restorative specialist. Prosthetics or reconstructive options -reconstructive should be considered as the defect becomes larger and more complex

Answer 16

A palatal obturator is a prosthesis that totally occludes an opening such as an oronasal fistula They are similar to dental retainers, but without the front wire

Answer 17

``` Wide variation between UK centres Pre vs Post RXT Primary vs secondary First line of care vs care when conventional removable failed Fixed vs Removable ISPs ```

Answer 18

``` Need to have a competent maxillofacial technician Correct materials Possible alternate application for “dental” implant Similar prosthodontically driven tx plan Often conducted by plastics Eyes -can have custom painted iris -motorised Ears Noses Cheeks ```

Answer 19

The mohs procedure had pulled the nasal septum to the right hand side due to scar tissue formation. Accepted position and worked to maximise the aesthetics from a face-on and lateral view. the glasses were also tried on with the wax try in to ensure the prosthesis would not lift away from the nasal base. A small acrylic plate was made to attach the soft silicone prosthesis to, in the area of the bridge of the nose to allow for a strong attachment to the glasses.

Answer 20

The prosthesis was constructed separate from the glasses in the lab. A primary try in was conducted and shades taken for extrinsic staining. At fit, small adjustments were made to the amount of silicone flaring over the skin of the cheek with a scalpel. After painting the finishing touches to the extrinsic staining at the chair-side, the glasses were attached to the prosthesis using cold cure PMMA resin, after roughening the frame with an acrylic bur

Answer 21

Where there is continuity of the mandible In patients who require the prosthetic obturation of significant maxillary defects Where retention of the obturator is likely to be compromised In pts undergoing rhinectomy or orbital exenteration.