Oral aspects of cancer care

Question 1

what are the oral effects of radiotherapy?

Answer 1

• damage of healthy tissues as well as cancerous
• ulceration/mucositis
• salivary glands/xerosotmia
• radiation caries & periodontal disease
• infections (ie candidiasis)
• loss of taste
• dysphagia
• osteoradionecrosis

Question 2

what are the aims of local treatment?

Answer 2

protect local area 
relieve pain 
reduce inflammation 
OR 
control secondary infection

Question 3

define mucositis?

Answer 3

inflammation of the mucosa

Question 4

what will mucositis look like?

Answer 4

white/yellow fibrinous slough often with ulceration & bleeding

unpleasant odour

Question 5

what will patient complain about with mucositis?

Answer 5

painful to eat, speak and swallow

inability to tolerate prosthesis

Question 6

is mucositis a portal for microbial entry?

Answer 6

yes

Question 7

when is mucositis likely to heal completely?

Answer 7

2-3 weeks post completion cancer therapy

Question 8

how to manage mucositis? 8 points

Answer 8

• SOFT toothbrush with F toothpaste
• chlorhexidine mouthwash if toothbrush comprimised
• hydrogen peroxide dilute mouthwash for short term
• gauze or sponge application of mouthwash
• topical analgesics or anti-inflammatory rinses, gels or ointments may be applied prior to eating
• soft, bland non-cariogenic diet at low temperature is advised
• alcohol and tobacco must be avoided

Question 9

how many days after the beginning of treatment would you expect a reduction in serous gland production?

Answer 9

3-4 days

Question 10

what does this reduction in serous gland production lead to?

Answer 10

• increased susceptibility to candidal/viral infections
• increased risk of demineralisation
• mastication and swallowing impaired
• dry friable mucosa (difficulty in tolerating prosthesis)

Question 11

what is the oral management of xerostomia?

Answer 11

• pilocarpine therapy
• saliva substitutes (preferably with fluoride)
• water atomiser and ice chips can be soothing
• avoid dry foods and sucking on sugary sweets
• chewing sugar free gum
• humidifiers

Question 12

where will radiation caries occur mostly?

Answer 12

on exposed root surfaces

Question 13

where do these radiation caries lesions spread to?

Answer 13

will encircle the neck of the teeth

Question 14

is radiation caries directly related to radiation?

Answer 14

no, still multifactorial

Question 15

oral management of radiation caries?

Answer 15

Intensify prevention measures

• daily fluoride application m/w or 2800ppm TP
• non-cariogenic diet
• saliva substitute

Question 16

name two anti-fungal treatments?

Answer 16

• niconazole (spray or tablet)
• daktarin gel

(try to make sure these are sugar free)