oncology Flashcards
if pt tells you reason for teeth being broken should you include in your notes?
yes
needs to be clear if known cause as pt can come back with legal claim in months to come
e.g. upper teeth broken during intubation procedure for surgery
omeprazol
proton pump inhibitor
reflux
tramadol
strong painkiller
citalopram
antidepressant
recommended untis of alcohol per week
14
how to explain units to pt
ask what she is drinking
use drink aware website to show
if pt says they use non-fluoride toothpaste
ask why
explain benefits of F - strengthen tooth mineral
not going to give cancer
evidence based - cochrane reviews
is you get a dentally anxious pt how to deal with them
ask why they are anxious?
trigger? past experience? anything you can do to help? would they be interested in relaxation techniques?
BPE 2
supra gingival plaque and calculus
BOP
<3.5mm pocket
BPE 3
probe goes into pocket but black band partially visible 3.5-5.5mm
supragingival plaque and calculus
BOP
managment BPE 2
OHI
calculus and overhang removal
management BPE 3
6PPC in that sextant after tx
pre cancer therapy dentally fit key
remove all potential sources of infection
prevention for pt about to go into chemo
enhanced prevention level F - emphasise importance due to dental health risk during chemo (lower immune)
take impressions for F trays and secondary ones incase splint needed if mucositis or ulceration occurs
diet diary to evaluate caries risk and modifications that can be made
radiographic report
A
21 and 11 - can see fracture on 21
RCT - adequate down to apex and no voids/air bubbles, 11 GP exposed clinically - could expose to bacteria and saliva - inadequate seal - may need redone
Periapical healthy - OK, PDL ligament widening on mesial 21, not PA lesion on 11 as can see PDL going round tooth
what if you saw this toth in a pt about to go into chemo tx and it has previously been RCT
GP exposed risk infection
- Chemo - extract
If fit and healthy - maybe post crown
- ferrule? tooth tissue that surround that is able to support post - don’t want flat top
radiographic report
A
- No overlap
- Can see crowns clearly
Restorations occlusal 16 and 46 amalgams, 47 (composite)
Interproximal caries possible 45 and 46
- Just into enamel so don’t want to go into (depending on caries risk assessment)
45 likely just into dentine distal xrays 6 months behind
- When go into 5 assess 6 with probe
White shadow in 17 - pulp stones - calcifications - asymptomatic
radiographic report
A old be 2 (as want to see mesial distal entirely)
- Minimal overlap, Crowns seen
- likely clearer on clinical screen
37 - secondary caries mesial
36 mesial caries
Gross caries distal 25 and 26
- Breach pulp - no pain - non-vital
- extract
Widening PDL 37
Bone loss upper left
chemotherapy aims
Kill cancer cells and stop reproducing
Targets specific cells - rapidly dividing cells
side effects chemotherap (10)
- Tired
- weaken immune system - infection risk
- Hair loss
- Nausea/vomitting
- Reproductive issues
- Urine issues
- dry mouth
- mucositis
- oral infection
- haemorrhage
variation
mucositis
inflammation of mucous membranes
Can vary widly
- Sometimes cant eat/drink, speak, sleep
- Take away indpedence
10 days to occur post chemo - 5 days to peak and 5 days to resolve
- Endless cycle through chemo tx
mucositis aids
Topical anaesthetic to relieve before eating
- lidocaines sprays, mouthrinse - can be nippy to apply
Oral hygiene
- Gauze (muslin cloth) with chlorohexidine/salty water (if too nippy gently) wipe round
- Soft silk toothbruhses
Mouth rinse - cooling (calcisol)
Oral cooling - ice lolly or suck on ice to help soothe
F trays
- bumps in retainers to place toothpaste in and prevent rubbing - prevent sore rubbing and apply F
grades of mucositis
based on side effects
- 0 (none)
- I (mild)
- II (moderate)
- III (severe)
- IV (life-threatening)
WHO Oral mucositis grading scale
mucositis grade 0
no side effects
grade I mucositis
oral soreness
erythema
grade II mucositis
oral erythema
ulcers
solid diet tolerated
grade III mucositis
oral ulcers
liquid diet only
grade IV mucositis
life-threatening
oral alimentation impossible
white oral lesion that can be scaped off and removed
fungal - candida
(can leave skin raw/bleed)
candida infection type
oppurtunistic
takes advantage when immune system low
tx for candida
topical antifungals
- miconazole gel
- nystatin liquid
if neither work consider a systemic antifungal (fluconazole) - issue interact with many medications (warfarin etc)
what is this lesion
can be scraped off
candida infection
can occur in cancer tx as immune system down and oppurtunistic infection
what is this
cold sores
how can cold sores occur due to cancer tx
immunosuppressed so herpes simplex virus can run rampant and cause multiple cold sores
tx for herpes simplex caused cold sores
antivital medicatins
acyclovir tablets (5 tablets daily for 7 days)
if prone to cold sores can be given prophylatically
what is this
dry mouth
polypharmacy
tx for dry mouth
regular sips of plain water
saliva replacement - orabalance (SDCEP)
some contain gelatin - warn
if pt comes in middle of chemotherapy with buccal abscess
what are concerns
infection
- Spread to blood stream and has weakened immune system due to chemo
- can die due to chemo dental infection spread
chemotherapy affect on blood cells
Pancytopenia - reduction in all
- white blood cells reduced - infection
- RBC - anaemic risk
- Platelets down - bleeding risk
- < 50 don’t touch not stop bleeding,
- >50 - delicate but should stop bleeding
Need FBC before tx
tx options for buccal abscess during chemotherapy
- Do nothing - don’t recommend
- Remove the tooth - platelet and healing issue
- Incise and Drain the abscess - short term measure - as can come back - wont deal with problem - bleeding and infection risk
- re-RCT - timely, multiple appointments, lower success rates compared to 1st time
- Antibiotics - tiding someone over until in a better state to get tx
Consult oncology team
if pt had cancer tx in past what would you like to know
- what tx they had - radiotherapy, chemotherapy, combination?
- where
- duration of
- any side effects
- how long been in remission/no tx
plan his tx in future
likely if had radiotherapy in past will affect him now
radiotherapy of head and neck cancers
radiation hit towards certain points
- mask, immobilise head and neck so cant move
- got to get through tissues to reach target - side effects on surrounding tisues
smoking and alcohol oral cancer link
both individually increase the risk of oral cancer
cumulative effect together
smoking 3 As
ask - how long? what? considered quitting?
advice - health benefits - reduce systemic disease risk
act - signpost to specialist cessation services, get pharamacy quit kits
report
OPT radiograph - A
Caries 37 DO, 17 D
- radiation caries - saliva issue, cervical margin region caries (not pit and fissure)
8s weird angle on mandible - close proximity to IAN
Severe bone loss lower right (only 48 present)
- necrotic bone - Osteoradionecrosis
Need reconstruct with bone from femus
osteoradionecrosis
death of bone due to radiation - small BV get endoarteritis obliterans - shrink down so not deleiver blood –> bone death
5 years post radio or longer
- Extractions wont heal - gum not close over - infection
- Denture wont sit possibly
- Lower jaw can fracture as no healthy bone to keep together
side effects of head and neck radiotherapy
osteoradionecrosis
fibrosis of muscles
impact of fibrosis of head and neck muscles
thicker
less stretch
smaller mouth opening - access harder
- OHI and dental care issue
importance of dental pre-assessment to cancer tx
can provide tx necessary before unable to as reduced mouth opening
OHI and prevention instructions
