Oncology management in Children Flashcards
Name the guidance used in the dental care of adults and children treated by oncology
The Royal College of Surgeons of England = ‘‘The Oral Management of
Oncology Patients
Requiring
Radiotherapy, Chemotherapy
and / or Bone Marrow
Transplantation’
Summarise the pathway (stages) of care for oncology patient
Pre-treatment assessment, acute phase of cancer therapy, discharge following acute treatment phase
Identify the aims of a pre-treatment assessment for oncology patients
Identify existing oral disease and potential risk of oral disease.
Remove infectious dental / oral foci before the start of cancer therapy.
Prepare the patient for expected side effects of cancer therapy.
Establish an adequate standard of oral hygiene to meet the increasing
challenges during cancer therapy.
Develop a plan for maintaining oral hygiene, providing preventive care,
completing oral rehabilitation and follow-up.
Establish the necessary multidisciplinary collaboration within the cancer
centre to reduce / alleviate oral symptoms and sequelae before, during
and after cancer therapy.
What dental care advice / treatment should be given to oncology patients at their pre-treatment assessment?
- OHI
- Dietary advice
- Use of CHX
- Periodontal treatment
- Dental caries
- Removal of trauma sources
- Impressions - obturators, stents and mouthguards
- XLAs 10 days prior commencement of treatment
- ABx prophylaxis in cases of neutropenia
- Orthodontics discontinued
What levels of neutrophils would warrant ABx cover for dental treatment
Antibiotic prophylaxis prior to invasive oral procedure may be warranted in
the context of neutropenia (neutrophils less than 2000/mm3) although liaison
with the oncologist should take place and clinical judgement exercised.
Haematological support may also be required
What dental care advice and treatment should be undertaken to oncology patients during active treatment phase?
- Hygienist support
- OHI/denture hygiene
- Antibacterial mouthwash
- Dental caries risk moderation
- Viral infection treatment and prevention
- Fungal infection treatment and prevention
- Mucositis treatment and prevention
- Xerostomia management
- Dietary advice
What dental care advice should be given to oncology patients after their active treatment phase (Maintenance)
- Dental caries risk
- Gingival/periodontal risk
- Prevention and fluoride
- Xerostomia management
- Limited mouth opening
When does RCEng recommend that an oncology patient is assessed prior to commencement of their active treatment?
One month prior
What Oral hygiene routine should be recommended for children undertaking oncology treatment.
Age 0-10
Age 10-16
Age 16+
Age 0-10: 1350-1500ppm fluoride tp. Age>8 should also encourage fluoride mw.
Age >10 with ACTIVE caries should have prescription tp given: 2800ppm for age 10-16. 5000ppm for >16y.
Explain the justification for caries management plans in children with oncology ie what teeth would be removed and contraindicated treatment
-Mobile teeth or those of questionable prognosis should be XLA
-Pulp therapy is contra-indicated in oncology patients.
-Minimally traumatic XLAs
-10 days minimum healing period post XLAs
How long between completion of active oncology treatment should orthodontic treatment be restarted?
Orthodontic appliances should be removed prior to commencement of active treatment and should wait 2 years
What can be used to manage Chemotherapy induced mucositis in Oncology patients
- PBM (LED/laser)
- Intensive oral hygiene
- Removal of trauma sources such as poorly fitting dentures
- Use of analgesics such as Difflam
- Oral cooling?
- ?zinc supplements
A FBC is recommended prior to any dental treatment, how long is the acceptable period prior to the commencement of treatment that is adequate.
24-48hrs prior to commencement of treatment
What factors make a patient more likely to suffer from ORN
The total radiation dose exceeded 60Gy
The dose fraction was large with a high number of fractions.
There is local trauma as the result of a tooth extraction (especially
mandibular extractions), uncontrolled periodontal disease or an ill
fitting prosthesis.
The person is immunodeficient.
The person is malnourished
Describe the criteria that can stage ORN
Stage 0, I, II, III
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, verified by imaging
techniques, along with skin fistulas and infection with addition of potential or actual pathological fracture. Radiological evidence of bone necrosis within the radiation field, where tumour recurrence has been excluded.
