Dental Treatment for the Cancer Patient

Question 1

What is the role of the dentist in cancer patients?

Answer 1

• early detection of soft tissue lesions
• pre-treatment assessment and dental care
• maintenance of oral and dental health post-treatment
• palliative care

Question 2

What guidelines can we refer to when treating cancer patients?

Answer 2

• NICE: improving outcomes in head and neck cancers
• BAHNO/MULTIDISCIPLINARY management guidelines
• SIGN 90: diagnosis and management of head and neck cancer

Question 3

What is involved in pre-cancer-treatment dental assessments?

Answer 3

• oral and dental assessment prior to start of cancer therapy
• radiographs
• any necessary treatment carried out
• PMPR
• impressions for soft splints
• fluoride therapy

Question 4

What are the priorities of the pre treatment dental assessment in cancer patients?

Answer 4

• oral hygiene
• reduce treatment complications (PREVENTION)
• reduced post treatment complications (PREVENTION)

Question 5

How can dental complications that interfere with cancer treatment be reduced?

Answer 5

• avoid unscheduled interruption of chemo regime
• avoid exacerbation of mucositis
• remove potential sources of infection

Question 6

How can post-cancer-treatment dental complications be reduced?

Answer 6

• remove teeth of poor prognosis
• institute PREVENTION REGIME!
• plan rehabilitation

Question 7

What is oral mucositis?

Answer 7

• inflammation and ulceration of mucosa
• severe pain
• associated with chemotherapy and radiotherapy

Question 8

What can oral mucositis have an effect on?

Answer 8

• quality of life (extremely painful)
• eating/drinking
• oral hygiene

Question 9

What general measures can be avoided to reduce likelihood of development of oral mucositis during cancer treatment?

Answer 9

• smoking
• spirits
• spicy foods
• tea & coffee
• non prescription mouthwash

Question 10

What topic measures can be used to reduce likelihood of development of oral mucositis during cancer treatment?

Answer 10

• topical lignocaine
• saline mouthwash
• gelclair
• oral cooling

Question 11

How does saliva change in cancer patients?

Answer 11

Xerostomia very common
- reduced salivary flow
- high viscosity saliva
- low pH saliva

Question 12

What are the side effects of Xerostomia?

Answer 12

• dysphagia
• dysarthria
• dysgeusia
• poor quality of life
• increased: caries, perio disease, candidosis

Question 13

How can osteoradionecrosis be prevented in cancer patients?

Answer 13

• remove teeth of poor prognosis in the radiotherapy field
• must be 3 weeks prior
• liaise with oncologist
• OH prevention

Question 14

Why can radiotherapy cause trismus?

Answer 14

Fibrosis of muscles of mastication