Dental Mangement

Question 1

Pre-Cancer Tx Dental Screenings:

Purpose

Answer 1

To locate and eliminate oral foci of infection

Question 2

Pre-Cancer Tx Dental Screenings:

Role of Dental Provder

Answer 2

1. Establish dental care at time of pt’s diganosis
2. Establish onset, duration, and nature of therapy
3. Perform comprehensive oral health exam to rule out oral disease, establish baseline assessment, and reduce oral discomfort during therapy

Question 3

Pre-Cancer Tx Dental Screenings: When do we want to schedule a comprehensive exam before cancer treatment?

Answer 3

Ideally 1 month prior to beginning cancer treatment

Question 4

Pre-Cancer Tx Dental Screenings: What types of oral conditions do we want to treat before cancer treatment

Answer 4

Low-grade and acute oral infections

Question 5

Pre-Cancer Tx Dental Screenings: Describe low-grade and acute oral infections

Answer 5

Caries, periodontal diseases, endodontic diseases, mucosal lesions

Question 6

Pre-Cancer Radiation Treatment: When should oral surgical procedures be done before radiation therapy?

Answer 6

At least 10-14 days; ideally 21 days

Question 7

What should be placed in custom gel-applicator trays?

Answer 7

0.4% stannous fluoride gel or 1.0-1.1% neutral NaF gel

Question 8

Pre-Cancer Radiation Treatment: Describe what should be done with carious teeth

Answer 8

Consider extraction of teeth with any deep lesions especially on root surfaces or in proximity to bone/at gingival line. Consider extraction of partially erupted teeth.

Question 9

Pre-Cancer Radiation Treatment: Describe what should be done with periodontally involved teeth

Answer 9

Any teeth with moderate to severe bone loss should be extracted, pocket depths greater than 6 mm, significant mobility, purulence upon probing, and any furcation involvement should be extracted. Removal all subgingival calculus

Question 10

Pre-Cancer Radiation Treatment: Describe what should be done with previously endo-treated teeth

Answer 10

Extract all failed endodontically treated teeth, no retreats.

Question 11

Pre-Cancer Radiation Treatment: Describe what should be done with apically diseased teeth

Answer 11

If in field of radiation -> consider extraction

If not in field of radiation -> treat with endo

Question 12

When should denture fabrication begin after radiation therapy?

Answer 12

3-4 months after surgery and radiation

Question 13

Chemo targets the vasculature and can cause delayed______

Answer 13

Healing

Question 14

Chemo targets hematopoietic cells of the bone marrow and can lead to

Answer 14

Anemia, thrombocytopenia and leukopenia

Question 15

When should oral surgeries be scheduled before chemo?

Answer 15

At lest 7 to 10 days before

Question 16

All dental treatment should be performed at least ____ week before chemotherapy begins

Answer 16

1

Question 17

What lab values require postponing dental care during chemo?

Answer 17

Platelet count less than 50,000

ANC less than 1000

Question 18

During Chemo: When does a prophylatic antibody become necessary for dental treatment?

Answer 18

When ANC is less than 1000

Question 19

During Chemo: When is oral mucositis usually seen? When does it heal?

Answer 19

1-2 weeks after initiation; heals 2-4 weeks after treatment

Question 20

After Chemo: When can patient recieve dental care?

Answer 20

When chemo is done and side effects/immunosupression has resolved

Question 21

What is the single most important factor with delays in diagnosis?

Answer 21

Patient Delay