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SP17- Special Needs > Dental Oncology Services- Lasers and Meds > Flashcards

Dental Oncology Services- Lasers and Meds Flashcards

1
Q

True or False: The downside of treatment at a teaching hospital is that a team of doctors must get together to discuss a case.

A

False, team approach is a benefit

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2
Q

Name the different specialties that are often part of the treatment team.

A 
Otolaryngologist (ear and eye)
Internal med (oncologist)
Speech and Language Pathologist
Prosthetic Dentist
Radiologist
Pathologist
Diagnostic Radiologist
Plastic Surgeon
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3
Q

What is IHIS?

A

Integrated Health Information System (computerized charting system used at the James)

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4
Q

What are four typical steps taken at the James Dental Oncology Center for a patient in need of prosthetics?

A
  1. Pre/Post Treatment Exams
  2. Limited Oral surgery
  3. Pre/Post Chemo Therapy
  4. Prosthetics
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5
Q

What does SLP stand for?

A

Speech and Language Pathologist

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6
Q

Upon examination, tumors are staged. What is staging?

A
  • defining the SIZE and LOCATION of a tumor
    ex. face, oral, pharyngeal, vertebral level T1-3
  • defining METASTASIS (MX, 0, 1)
  • for NECK disease: define large node, unilateral, N0, N1, N2, a, b, c, etc.)
  • defining Mode of THERAPY (surgery, radiation, chemo)
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7
Q

During staging of neck cancers, the NXabc system is used. a=? b=? c=?

A 
a= unilateral
b= multiple nodes
c= contralateral nodes
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8
Q

True or False: The mode of therapy used most often is surgery.

A

False, depending on location…surgery could be contraindicated

Chemoradiation is main treatment for H&N SSC

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9
Q

True or False: Dental History is taken at the first examination appointment for a cancer patient in need of prosthesis.

A

True

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10
Q

What type of data is collected at the dental history exam?

A
  • frequency of care
  • general oral hygiene
  • caries
  • periodontal disease (PD, MGD, BOP, PI)
  • impactions
  • tori
  • radiographs
  • charting
  • photos
  • diagnostic impressions
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11
Q

According to Dr. Van Puten, periodontal disease is defined as pockets greater than _____mm and _____involvement.

A

> 4mm

furcation involvement

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12
Q

It is very important during the examination to note all _____ restorations when a patient is to receive radiation therapy (XRT).

A

metallic (amalgam and ESPECIALLY gold)

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13
Q

Why are metallic restorations of great importance during charting for XRT patients?

A

“back scatter”

reflection from metallic restorations causes more radiation to the surrounding tissues

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14
Q

What is XRT?

A

radiation therapy

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15
Q

The treatment plan for XRT patients often includes a fluoride treatment. What are the Fluoride delivery systems used most often?

A

1.1% NaFl toothpaste
0.4% Stannous Fl gel
MI paste
Fluoride trays 20-30 mins DAILY
Chlorhexidine rinse

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16
Q

____% Na-Fluoride
____% stannous fluoride
____% Chlorhexidine Gluconate

A
  1. 1 % NaF
  2. 4% Stannous
  3. 12% CHX
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17
Q

Extractions are often done in the ________.

A

Operating Room: often want to take a biopsy of tissue while patient is sedated

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18
Q

Tori size and location should be evaluated at the initial exam, why?

A

Mandibular and maxillary tori can be problematic following radiation: very difficult to control how much radiation contacts the tori = tissue breakdown = bisphosphonates, etc.

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19
Q

There are several XRT stents that are used for radiation therapy. How is the type determined?

A 
location
tumor type
tumor size
presence of metallic restorations
treatment goals of the radiologist
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20
Q

What are the common types of XRT stents?

A

stents are used to control radiation in the target field
MOTD (mouth opening tongue depressing)
Parotid (moves tongue to one side)
Ramp

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21
Q

Backscatter causes a variation in the amount of radiation received. For _mm, Gold Alloy increases by ____% and Amalgam increases by ____%

A 
0 mm
-Gold 70%
-Amalgam 62%
1 mm
-Gold 22%
-Amalgam 15%
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22
Q

What is IMRT?

A

intensity modulated radiation therapy

-multiple beams of radiation conform to the shape of the tumor in a 3-dimensional plane

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23
Q

How is IMRT different from Bilateral Opposed radiation?

A

Bilateral Opposed = two beams of single intensity radiation are distributed through the tumor and normal tissues
IMRT = targets the specific shape and size of the tumor with a specific intensity of radiation (greater control of the dose distribution)

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24
Q

A major benefit to IMRT is that multiple beams of varying intensities come from a number of angles to sculpt an efficient dose distribution. This allows for sparing of the _____, _____, and ______.

A

brain
brainstem
parotid glands

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25
Q

Mucositis includes _____, _____, _____, and _____.

A

inflammation
desquamation
infection
dysphagia (trouble swallowing)

26
Q

Radiation toxicities are defined as either____ or ___.

A

acute or late

27
Q

Acute toxicities are those seen ________. Late toxicities are those seen ______.

A

Acute: during treatment
Late: months to years after, can be permanent

28
Q

______ is a type of acute toxicity and has accompanying dysphagia.

A

Mucositis

29
Q

Name two types of salivary changes that are common with XRT.

A

increased salivary viscosity

xerostomia

30
Q

_______ can be severe with XRT and includes severe, confluent, moist desquamation.

A

Dermatitis

31
Q

True or False: Zirconia crowns have a back scatter effect.

A

True! zirconia = titanium = 30% increase in radiation

32
Q

Gold Crowns = ____% increase
Lg. Amalgam = ____% increase
Zirconia = ____% increase

A 
Gold = 70
Amalgam = 60
Zirconia = 30
33
Q

What is the main therapy used for head and neck SSC?

A

chemoradiation (given concurrently with radiation)

34
Q

What is the goal for care during chemoradiation?

A

PALLIATIVE CARE

-curative therapy immediately after chemoXRT

35
Q

How does the Aetna panel recommend that XRT mucositis be reduced during therapy?

A
  • use midline radiation blocks

- 3D radiation (stents)

36
Q

True or False: It is recommended that CHX rinse be used to prevent mucositis in patients with solid tumors of the head and neck that are undergoing chemoxrt

A

False, recommended NOT TO USE CHX

nutrients assist in the homeostatic balance between ROS and antioxidant defenses

37
Q

Rather than CHX rinse, it is recommended that patients use _____ and _____ to protect salivary glands against xerostomia.

A 
green tea
amla powder (goose berry)
38
Q

The major green tea polyphenol ____ has been shown to protect normal salivary gland cells but NOT the _____ cells from damage.

A

EGCG

tumor

39
Q

True or False: High level laser therapy is a safe approach for managment and prevention of oral mucositis.

A

False, LOW LEVEL laser therapy (LLLT)

40
Q

LLLT is in the ____ joule range.

A

3 to 6 J

41
Q

Most studies showed that _______ reduced the severity of mucositis and delayed the appearance of severe mucositis.

A

photobiomodulation

42
Q

LLLT alone is most effective in delaying the appearance of severe oral mucositis; however, in order to reduce the incidence of severe lesions, the use of both ____ and ____ was effective.

A

laser

aluminum hydroxide

43
Q

In general, lasers vary based on energy and penetration. High nm = ___ water absorption = ____ penetrance.

A

high nm = high water absorption = low penetrance

44
Q

The ErCrYSGG laser (WaterlaseMD) is a ____nm laser.

A

2780

45
Q

The ErCrYSGG laser is 2780nm which means it has ____ penetrance and is used for _______.

A

low penetrance

debridement of the lesion

46
Q

The Diode lasers are 940nm or 830nm which means they have _____ penetrance and are used for ____.

A

high

deep penetration of the lesion

47
Q

The diode laser with 940nm is absorbed by _____ pigmented tissue. The diode laser with 830nm is absorbed by _____.

A 
940= red pigmented tissue (hemoglobin)
830= cytochrome c oxidase (inner membrane)
48
Q

Cytochrome c is the essential component of the ____.

A

electron transport chain

49
Q

Hemoglobin (targeted by Epic 940nm) has ____metal atom(s). Cytochrome C (targeted by Microlight 830nm) has ____ metal atom(s).

A

hemoglobin = 1 metal = iron

Ctyochrome c = 4 metal = iron, copper, zinc, magnesium

50
Q

Lasers in the range of _____ nm are beneficial for wound healing, tissue repair, relief of inflammation, pain, edema, and prevention of tissue death.

A

600-950 nm

51
Q

How does the absorption of photons by molecules lead to tissue repair?

A
  • absorption leads to electronically excited states which leads to acceleration of electron transfer reactions and increased production of ATP
  • ALSO, light causes localized production/release of nitric oxide which stimulates vasodilation through cGMP
52
Q

True or False: Laser debridement may be done without anesthesia.

A

True

53
Q

True or False: Mucositis treatment may be done with Epic or Microlight lasers combined with the WaterlaseMD laser.

A

True,
waterlaseMD = debridement
Epic - 940, Microlight-830 = pentration of tissues

54
Q

What is the most severe side effect of radiation therapy?

A

osteoradionecrosis

  • the bone is less able to withstand trauma and avoid infection
  • can be spontaneous or result from trauma
  • risk does not diminish with time
  • bony tissues less apt to healing due to fibrosis and hypovascularization
55
Q

How often does osteoradionecrosis (ORN) occur?

A

1-3% of patients

avoid extractions after radiation

56
Q

What are the best methods for avoiding ORN?

A
  • extract decaying teeth prior to XRT
  • daily fluoride
  • stents to eliminate scatter
  • nutrition counseling
57
Q

True or False: Strong evidence suggests that hyperbaric oxygen is effective at reducing risk for ORN.

A

False, WEAK evidence

without HBO = 7%
with HBO = 4%
with AB = 6%

58
Q

A combination of pentoxifylline and tocopherol (vitamin E) has shown clinical benefit with more than ____% regression of ORN in 12 patients at 6 months

A

50%

59
Q

What is pentoxifylline (PTX)?

A

it improves microcirculation and tissue oxygenation by increasing RBC deformability and oxygen release which decreases blood viscosity, platelet aggregation, and thrombus formation (aka: increases blood flow)

60
Q

The antifibrosis protocol includes:

A

Pentoxifylline 400 mg
Vitamin E
Clodronate

SP17- Special Needs (9 decks)

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