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Special Care Dentistry > Oncology > Flashcards

Oncology Flashcards

1
Q

when would a chemotherapy patient experience dry mouth

A

during treatment but then returns to normal after treatment

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2
Q

what is mucositis

A

inflammation of the oral mucosa

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3
Q

when would mucositis appear

A

from 7-14 days after initiation of chemotherapy

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4
Q

how would mucositis present to the patient

A

mucosal irritation accompanied by ulcer development

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5
Q

what treatment would be given for mucositis

A

opioid analgesics
oral care
avoid spice/hard/hot food and drinks
oral cryotherapy
laser therapy
recombinant keratinocyte factor 1
topical anaesthetics
caphosol and chlorhexidine
soluble aspirin
difflam spray

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6
Q

what is used to monitor oral mucositis progression

A

WHO oral mucositis grading scale

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7
Q

what should be done to a cancer patient prior to chemotherapy

A

remove any current source or potential source of infection
institute prevention

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8
Q

what is the total dose that is given during radiotherapy

A

64-70Gy

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9
Q

what do patients with advanced cancer present with in regards with oral complications

A

dry mouth, sore mouth, taste disturbance, difficulty wearing dentures
oral fungal infections

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10
Q

how does trismus result in cancer patients

A

due to replacement fibrosis of muscles of mastication
tumour growth/infection/surgery

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11
Q

when would trismus due to radiotherapy become apparent

A

3-6 months after radiotherapy

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12
Q

what oral complications occur from radiotherapy

A

dry mouth
trismus
loss of taste
radiation caries
ORN

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13
Q

how does radiotherapy lead to ORN

A

it induces endarteritis obliterans which leads to progressive fibrosis and capillary loss leaving bone susceptible to avascular necrosis

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14
Q

when is ORN risk greater

A

at radiotherapy doses over 60Gy
local trauma (extraction)
uncontrolled periodontal disease
ill fitting prosthesis
immunodeficiency
malnourished person

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15
Q

how can ORN be prevented

A

avoid extractions after jaw irradiation
remove unsalvageable teeth at least 2 weeks prior to start of radiotherapy

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16
Q

what try of prevention is good for radiotherapy patients

A

fluoride toothpastes, fluoride trays, CPP-ACP

17
Q

what is the role of the GDP in head and neck cancer

A

detect through soft tissue exam
photograph
referral
pre-treatment assessment

18
Q

when do we refer for possible head and neck cancer

A

stridor
persistent unexplained head and neck lumps
ulceration or unexplained swelling of oral mucosa
red or white and red patches of oral mucosa
persistent hoarseness
dysphagia or odynophagia
persistent pain in throat

19
Q

how long should symptoms last for before sending a patient for referral

A

> 3 weeks

20
Q

what do we provide at the pre-assessment

A

detailed oral hygiene
topical fluoride
tooth mousse
dietary advice - oral comfort
PMPR
chlorhexidine mouthwash and gel
restore caries
remove trauma
impressions for fluoride trays/soft splints
denture hygiene and instructions
remove ortho
extractions

21
Q

what should we provide during cancer treatment

A

oral and denture hygiene
chlorhexidine
diet advice
fluoride
exam for fungal and viral infections
treatment of mucositis and xerostomia

22
Q

how long does mucositis last

A

6 weeks after treatment complete

23
Q

what antifungals are used for candida infections

A

chlorhexidine
miconazole
fluconazole
nystatin

24
Q

what is traumatic ulceration caused by

A

teeth rubbing against delicate intraoral tissues

25
Q

what is needed to treat reactivation of herpes simplex during cancer treatment

A

systemic antivirals

26
Q

what happens to saliva during cancer treatment

A

more viscous and acidic
reduces 50 % in first week then a further 20%

27
Q

what does xerostomia affect

A

chewing, swallowing, speech, taste, quality of life

28
Q

what is higher risk once xerostomia is present

A

periodontal disease, caries, candida, sialadenitis, pros difficulties

29
Q

how does xerostomia occur in cancer patients

A

ionising radiation damage to salivary tissue

30
Q

what is used to treat xerostomia

A

pilocarpine HCL 5mg three times daily
replacements (saliva orthana, biotene)
stimulants (chewing gum, water, pastilles)

31
Q

what saliva replacement do we avoid in dentate patients and why

A

glandosane - it is acidic

32
Q

what is the treatment for trismus

A

physical therapy
passive and active stretching exercise
use of devices for stretching muscles of mastication

33
Q

how does radiation induced caries occur

A

reduced salivary flow and altered saliva function in combination with high protein and calorie diet

34
Q

what is ORN

A

area of unexposed bone of at least 3 months duration in an irradiated site and not due to tumour recurrence
osteoradionecrosis of jaw

35
Q

when would you want to extract teeth before cancer therapy

A

ideally 2 weeks but at least 10 days prior

36
Q

when is the patient discharged to GDP

A

when side effects settle, cariogenic food intake stopped, good OH is re-established and fluoride products tolerated

Special Care Dentistry (15 decks)

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