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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
Mucositis includes _____, _____, _____, and _____.
inflammation desquamation infection dysphagia (trouble swallowing)
26
Radiation toxicities are defined as either____ or ___.
acute or late
27
Acute toxicities are those seen ________. Late toxicities are those seen ______.
Acute: during treatment Late: months to years after, can be permanent
28
______ is a type of acute toxicity and has accompanying dysphagia.
Mucositis
29
Name two types of salivary changes that are common with XRT.
increased salivary viscosity | xerostomia
30
_______ can be severe with XRT and includes severe, confluent, moist desquamation.
Dermatitis
31
True or False: Zirconia crowns have a back scatter effect.
True! zirconia = titanium = 30% increase in radiation
32
Gold Crowns = ____% increase Lg. Amalgam = ____% increase Zirconia = ____% increase
``` Gold = 70 Amalgam = 60 Zirconia = 30 ```
33
What is the main therapy used for head and neck SSC?
chemoradiation (given concurrently with radiation)
34
What is the goal for care during chemoradiation?
PALLIATIVE CARE | -curative therapy immediately after chemoXRT
35
How does the Aetna panel recommend that XRT mucositis be reduced during therapy?
- use midline radiation blocks | - 3D radiation (stents)
36
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
False, recommended NOT TO USE CHX | nutrients assist in the homeostatic balance between ROS and antioxidant defenses
37
Rather than CHX rinse, it is recommended that patients use _____ and _____ to protect salivary glands against xerostomia.
``` green tea amla powder (goose berry) ```
38
The major green tea polyphenol ____ has been shown to protect normal salivary gland cells but NOT the _____ cells from damage.
EGCG | tumor
39
True or False: High level laser therapy is a safe approach for managment and prevention of oral mucositis.
False, LOW LEVEL laser therapy (LLLT)
40
LLLT is in the ____ joule range.
3 to 6 J
41
Most studies showed that _______ reduced the severity of mucositis and delayed the appearance of severe mucositis.
photobiomodulation
42
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.
laser | aluminum hydroxide
43
In general, lasers vary based on energy and penetration. High nm = ___ water absorption = ____ penetrance.
high nm = high water absorption = low penetrance
44
The ErCrYSGG laser (WaterlaseMD) is a ____nm laser.
2780
45
The ErCrYSGG laser is 2780nm which means it has ____ penetrance and is used for _______.
low penetrance | debridement of the lesion
46
The Diode lasers are 940nm or 830nm which means they have _____ penetrance and are used for ____.
high | deep penetration of the lesion
47
The diode laser with 940nm is absorbed by _____ pigmented tissue. The diode laser with 830nm is absorbed by _____.
``` 940= red pigmented tissue (hemoglobin) 830= cytochrome c oxidase (inner membrane) ```
48
Cytochrome c is the essential component of the ____.
electron transport chain
49
Hemoglobin (targeted by Epic 940nm) has ____metal atom(s). Cytochrome C (targeted by Microlight 830nm) has ____ metal atom(s).
hemoglobin = 1 metal = iron | Ctyochrome c = 4 metal = iron, copper, zinc, magnesium
50
Lasers in the range of _____ nm are beneficial for wound healing, tissue repair, relief of inflammation, pain, edema, and prevention of tissue death.
600-950 nm
51
How does the absorption of photons by molecules lead to tissue repair?
- 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
True or False: Laser debridement may be done without anesthesia.
True
53
True or False: Mucositis treatment may be done with Epic or Microlight lasers combined with the WaterlaseMD laser.
True, waterlaseMD = debridement Epic - 940, Microlight-830 = pentration of tissues
54
What is the most severe side effect of radiation therapy?
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
How often does osteoradionecrosis (ORN) occur?
1-3% of patients | avoid extractions after radiation
56
What are the best methods for avoiding ORN?
- extract decaying teeth prior to XRT - daily fluoride - stents to eliminate scatter - nutrition counseling
57
True or False: Strong evidence suggests that hyperbaric oxygen is effective at reducing risk for ORN.
False, WEAK evidence without HBO = 7% with HBO = 4% with AB = 6%
58
A combination of pentoxifylline and tocopherol (vitamin E) has shown clinical benefit with more than ____% regression of ORN in 12 patients at 6 months
50%
59
What is pentoxifylline (PTX)?
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
The antifibrosis protocol includes:
Pentoxifylline 400 mg Vitamin E Clodronate

SP17- Special Needs (9 decks)

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