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3 Special Care Dentistry > Oncology > Flashcards

Oncology Flashcards

1
Q

What is the role of a GDP in head and neck cancer?

A

Screening and referral:
Early detection through soft tissue examination
Photographs
Onward referral
Pre-treatment assessment

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2
Q

When should patients be referred for suspected head and neck cancer?

A

Stridor - emergency referral
Persistent unexplained head and neck lumps >3 weeks
Ulceration or unexplained swelling of the oral mucosa >3 weeks
Red or mixed red and white patches of the oral mucosa >3 weeks
Persistent hoarseness for >3 weeks, request chest X-ray at same time
Dysphagia or odynophagia (pain on swallowing) >3 weeks
Persisting pain in the throat for >3 weeks

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3
Q

What happens during investigation and diagnosis of head and neck cancer?

A

New patient assessment within OMFS
Biopsy to confirm diagnosis
CT scan to investigate extent of tumour
Lymph node biopsy
CT scan to investigate for metastasis
Baseline medical testing
Stage and grade cancer

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4
Q

What are some aims of pre-assessment in cancer patients?

A

Full detailed exam
Radiographs essential
Identify existing oral disease and risk of disease
Remove infection and potential infection
Prepare patient for expected side effects of cancer therapy
Establish an adequate standard of OH to meet the increasing challenges during cancer therapy
Develop a plan for maintaining OH, providing preventative care, completing oral rehabilitation and follow up

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5
Q

What can a GDP provide during pre-assessment for cancer patients?

A

OH
Fluoride - topical, mouthwash, toothpaste
GC tooth mousse - free calcium
Dietary advice coinciding with the dietitian
PMPR to stabilise periodontal condition
Consider chlorhexidine mouthwash and gel
Definitively restora carious teeth
Extract teeth with dubious prognosis no less than 10 days before start of tx
Denture hygiene instructions
Ortho - discontinue and remove
Smoking and alcohol advice

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6
Q

What cancer treatments are available?

A

Surgery
Radiotherapy
Chemotherapy
Adjuvant radiotherapy or chemotherapy may be required after surgery

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7
Q

What are the side effects of surgical tumour resection?

A

Can produce alterations to normal anatomy which adversely affect function and appearance

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8
Q

What are the side effects of radiotherapy?

A

Radiation damage to normal tissues surrounding the tumour, affecting their function

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9
Q

What are the side effects of chemotherapy?

A

Acute mucosal and haematological toxicity

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10
Q

What are the oral effects of cancer treatment?

A

Adverse effects on respiration, mastication, swallowing, speech, taste, salivary gland function, mouth opening and outward appearance

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11
Q

What is the dentists role during patients’ cancer therapy?

A

OH support
Denture hygiene support
Antibacterial outhwash is a short term alternative to brushing
Diet advice
Fluoride preparations
High risk of viral and fungal infections - examine and prophylaxis or treatment prescribed by cancer team
Relief of mucositis, xerostomia
Emergency treatment - liase with cancer team
Avoid dental treatment

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12
Q

Describe oral mucositis during cancer treatment

A

Begins 1-2 weeks after tx starts
Lasts until around 6 weeks after tx is complete
Severe pain that may inhibit oral measures
Severe impact on eating

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13
Q

Give examples of preventative and management methods of oral mucositis?

A

Soluble aspirin
Aloe vera
Manuka honey
2% lidocaine mouthwash before eating
Oral cooling (ice)

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14
Q

What can be used for candida infections during cancer treatment?

A

Preventative antifungals often prescribed by cancer team
Antifungals:
Chlorhexidine mouthwash, gel
Miconazole - topical
Fluconazole - systemic

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15
Q

What causes ulceration during cancer treatment?

A

Teeth rubbing delicate intra oral tissues
Breach in protective epithelium

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16
Q

Describe the Herpes Simplex virus during cancer treatment?

A

Cold sore virus
Painful oral ulceration with sudden onset
Needs treated with systemic antivirals

17
Q

Describe xerostomia during cancer treatment

A

Reduced salivary flow 50-60% in first week with a further 20% in next 5-6 weeks
Saliva becomes more viscous and acidic
Higher risk of caries, periodontal disease, candida, sialadenitis, prosthodontics difficulties

18
Q

What causes xerostomia in cancer treatment?

A

Ionising radiation damage to salivary tissue in the radiotherapy fields

19
Q

How can xerostomia following cancer treatment be treated?

A

Saliva replacement
Frequent sips of water
Eg - Biotene Oral Balance Gel, BioXtra Gel, saliva orthana

20
Q

What causes trismus during cancer treatment?

A

Post-surgical inflammation
Fibrosis of tissues from chemotherapy and radiotherapy

21
Q

How is trismus from cancer treatment treated?

A

Physical therapy - passive and active stretching exercises
Devices to stretch the muscles of mastication

22
Q

What causes dental erosion in cancer treatment?

A

Low saliva pH
Use of glandosane - artificial saliva
Acidic drinks
Dry mouth

23
Q

What causes caries in cancer treatment?

A

Xerostomia
OH difficult to perform
Change in diet
Using supplements

24
Q

What is radiation-induced caries?

A

Indirect effect of chemotherapy and radiotherapy
Result of reduced salivary flow, high protein and calorie diet
Often circumferential around the teeth and may affect incisal edges
Can be difficult to restore

25
Q

What is ORN?

A

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

26
Q

How is ORN prevented?

A

Remove teeth of doubtful prognosis
Extractions completed at least 10 days prior to radiotherapy
Liase with oncologist
Encourage healing by primary closure/sutures where possible

27
Q

Which patients are at higher risk of ORN?

A

If total radiation dose exceeds 60Gy
If dose fraction was large with a high number of fractions
Local trauma as the result of an extraction (especially mandibular)
Person is immunodeficiency
Person is malnourished

28
Q

What are the stages of ORN?

A

0, I, II and III

29
Q

What is the prognosis of implants in patients following cancer treatment?

A

Revolutionary
Reduced success in irradiated bone
Failure less likely with radiation dose <45Gy
Requires maintenance - self care and professional support

30
Q

What is the prognosis of dentures in patients following cancer treatment?

A

Should be avoided where possible
Where essential they aid ability to chew, social adaptation and weight gain
Denture hygiene is essential due to risk of candida infection

31
Q

How should obturators be used?

A

Review regularly
Don’t leave out at night for first 6 months after treatment
May be worn at night after 6 months for comfort and breathing
Daily cleaning mandatory

32
Q

When are patients discharged from special care to GDP following cancer treatment?

A

When initial side effects have settled, frequent intake of cariogenic food and drinks have been stopped, good OH is established and use of fluoride products is comfortably tolerated

3 Special Care Dentistry (7 decks)

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