Dental Manifestations of Cancer

Question 1

Acute Leukemia facts?

Answer 1

= 1/3 of all childhood malignancies

80% are Acute Lymphocytic Leukemia

Question 2

How to calculate ANC?

Answer 2

%PMN X total WBC/ (100)

Question 3

Absolute ANC cut off?

Answer 3

<1000mm3 –> consult heme onc re: abx and elective dental treatment

Question 4

Platelet cut off?

Answer 4

> 50,000 platelets/mm3 for elective dental surgery

Question 5

Skeletal lesions found in patients undergoing cancer treatment?

Answer 5

Loss of Lamina Dura, PDL widening

Generalized loss of trabeculation

Loss of follicles/crypts of developing teeth

Teeth displacement (leukemic infiltrate)

Question 6

What’s a “left shift?”

Answer 6

increase in proliferation of naive cells

Question 7

Common oral findings in Leukemia patients

Answer 7

Pallor (anemia) -100%
Oral lesions -94%
Petechial ecchymosis -60%
Lymph node enlargement -50%

Question 8

Oral manifestations of Leukemia include?

Answer 8

Petechiae, Purpura, Hemorrhagic Bullae (especially when platelet counts <20k mm3

+ Pallor from anemia

Question 9

Gingival change associated with ALL

Answer 9

Mucosal bleeding

Question 10

Gingival change associated with AML

Answer 10

Gingival hypertrophy (Leukemic cell infiltraiton)

Question 11

Leukaemia Poor prognosis indicators

Answer 11

<2 or >10
High initial wbc
hepatosplenomegaly

Question 12

3 Cancer Tx options

Answer 12

Chemotherapy (systemic)
Radiation (intense, local)
Surgery

Question 13

What is incomplete remission vs relapse?

Answer 13

Incompletete Remission –> persistent bone marrow abnormality

Relapse –> remission, followed by bone marrow abnormality

Question 14

Phases of Leukemia Treatment

Answer 14

Induction
Consolidation –> keep remission, methotrexate to prevent relapse
Interim Maintenance –> maintain remission 2-3 years

Question 15

Chemo side effects:

Answer 15

Nausea, vomit
Mouth sores* (slowed cell turnover)
Lowered CBC counts*
Weight gain (prednisone)

Question 16

How long on average does it take for oral sores to heal?

Answer 16

10 days

Question 17

Side effects of Radiation

Answer 17

Xerostomia
Radiation caries –> increase Fl-

Long term:
Trismus
Hemifacial hypoplasia
Osteoradionecrosis

Question 18

Major cause of death from chemo?

Answer 18

Infection

Question 19

ANC levels

Answer 19

take counts day of

200-500 sepsis risk

Question 20

Platelet levels

Answer 20

20k-50k moderate bleeding risk, defer elective treatment
<20k = spontaneous bleeding

Question 21

Best phase for dental treatment?

Answer 21

In Maintenance phase
1 day before chemotherapy (counts will drop after chemo)

Question 22

Dentist goals for chemo patients

Answer 22

1) Control bleeding and infection
2) Prevent dental disease

Question 23

Why is a panorex important prior to chemotherapy?

Answer 23

Establish dental baseline
Assess skeletal lesions from leukemic infiltrate

Question 24

What defects may be cause by chemotherapy and radiation?

Answer 24

Chemo –> arrested root development, dentin/enamel defects

Radiation –> tooth agenesis

Question 25

Goals in maintenance phase

Answer 25

Tx oral sequelae
Consistent oral care & evaluation

Question 26

What may GVHD present like?

Answer 26

thick white persistent plaque & limited mouth opening (tx: corticosteroids)

Question 27

Oral manifestations post chemo in maintenance phase?

Answer 27

Ulcers
Stomatitis (MTX)
Opportunistic infections
Xerostomia & Caries
Osteoradionecrosis
Trismus