Head and Neck Cancers

Question 1

What indicates a referral for Head & Neck cancers?

Answer 1

Stridor- emergency referral required
Persistent unexplained head and neck lumps>3 weeks
Ulceration or unexplained swelling of the mucosa >3 wks
All red or mixed red and white patches of the mucosa>3 weeks
Persistent hoarseness >3 weeks
Dysphagia or pain on swallowing > 3 weeks
Persistent pain in the throat lasting >3 weeks

Question 2

What are some dental issues that occur during cancer treatment?

Answer 2

Oral Mucositis
Candida Infections
Traumatic Ulceration
Reactivation of Herpes Simplex
Xerostomia
Trismus
Dental Erosion
Caries
Radiation-Induced Caries
Periodontal Disease
Osteoradicular Necrosis (ORN)

Question 3

What is Oral Mucositis?
How long does it last?
Prevention and Management?

Answer 3

Severe pain produced by mucositis may inhibit OH measures
Begins 1-2 weeks after treatment starts, lasts until 6 weeks after treatment is complete
Prevention & Management:
Neutral supersaturated calcium phosphate mouth rinse (Caphosol)
Sodium hyaluronate gel (Gelclair)
Mucoadhesive oral rinse (Mugard)
Benzydyamine hydrochloride (difflam) 15ml 4-8 times a day before radiotherapy and continuing for 2-3 weeks afterwards

Question 4

What is a Candida Infection?
Management?

Answer 4

Common fungal infection
Preventative antifungals used to treat
Chlorhexidine (mouthwash, gel)
Miconazole (topical)
Fluconazole (systemic)

Question 5

What is Trismus?
Following cancer treatment, what can cause Trismus?
Treatment?

Answer 5

Restricted or limited mouth opening
Causes:
Post-surgical inflammation
Fibrosis of those tissues due to chemo and radiotherapy
Trismus that follows radiotherapy can occur rapidly over the first 9 months after treatment, tends to be progressive and may be irreversible
Treatment:
Physical therapy modalities (passive and active stretching exercises and use of devices for stretching MoM)

Question 6

What is Radiation-Induced Caries?

Answer 6

Indirect effect of non-surgical treatment (chemo&radiotherapy)
Develops rapidly
Widespread caries can result around the teeth and may affect incisal edges

Question 7

What is Osteoradicular Necrosis (ORN)?

Answer 7

An area of exposed bone of at least 3 months duration in an irradiated site and not due to tumour recurrence

Question 8

How can you prevent ORN from occuring?

Answer 8

Remove teeth of doubtful prognosis within the radiotherapy field
Extractions need to be completed at least 10 days prior to radiotherapy

Question 9

What is the staging for ORN?

Answer 9

Stage 0- mucosal defects only: bone exposed
Stage I- radiological evidence of necrotic bone, dento-alveolar only
Stage II- positive radiographic findings above ID canal with denuded bone intraorally
Stage III- clinically exposed radionecrotic bone. Radiological evidence of bone necrosis within the radiation field. where tumour recurrence has been excluded

Question 10

What is involved in Reconstruction and Maintenance of ORN?

Answer 10

Implants
–Reduced success in irradiated bone. Requires maintenance in self-care and professional support
Dentures
–Should be avoided where possible
Obturators (removable pros)
–Review regularly, do not leave out at night for first 6 months after treatment, may be worn at night for comfort and function after 6 months
–Daily cleaning is mandatory