Oral Complications Associated with Radiation and Chemotherapy

Question 1

An abnormal growth of cells which tend
to proliferate in an uncontrolled way
and, in some cases, to metastasize
(spread).

Answer 1

Cancer

Question 2

T/F: Decreased alcohol and tobacco use has has a
significant effect on the incidence of SSC in the oral
cavity

Answer 2

True

Question 3

What is the number 1 risk factor for oropharyhgeal cancer?

Answer 3

HPV

Question 4

Which HPV types are associated with oropharyngeal SCC?

Answer 4

HPV 16 and 18

Question 5

Does HPV cancers occur early or later in life?

Answer 5

Earlier: 40-59 yrs

Question 6

THE ONLY WAY TO 
DEFINITIVELY
DIAGNOSE ORAL
PATHOLOGY
IS WITH A
\_\_\_\_\_\_

Answer 6

BIOPSY

Question 7

All the tissue between the portals receives the same

dose

Answer 7

Fixed beam radiation

Question 8

 A constantly moving beam administers different
amounts of radiation to the tissues
 The tumor receives the highest amount of
radiation.
 Minimal amounts of radiation are applied to vital
structures. (spinal cord, salivary glands)

Answer 8

Intensity Modulated Radiation

Therapy

Question 9

 The application of radiation therapy in smaller
consecutive doses to minimize the lethal effects and limit
the side effects of the therapy.
 The dose is usually administered 5 times a week for 5 to
7 consecutive weeks.

Answer 9

Fractionation

Question 10

What are the 5 Rs of fractionation?

Answer 10

 Repair
 Redistribution
 Repopulation
 Reoxygenation 
 Radiosensitivity

Question 11

What radiation complication is the biggest issue in pts?

Answer 11

Xerostomia and dental caries

Question 12

Hypofunction can occur when exposed radiation

doses as low as ___ Gy

Answer 12

25 Gy

Question 13

Are Serous glands or mucous glands more sensitive to radiation?

Answer 13

Serous

Question 14

Do dental caries progress more quickly or slower in radiation pts?

Answer 14

Quicker

Question 15

 Sugar alcohol originally derived from birch trees
 Commercially produced from corn cobs (xylan)
 Caries causing bacteria are unable to metabolize it
 Ingesting 6-8 grams daily can decreased caries
 Frequency of use more important than quantity
 Available as a packaged sweetener or in gums, mints,
candies and oral rinses

Answer 15

Xylitol

Question 16

 Cholinergic agonist

 5-10mg tid
 Max dose 30mg/day
 May take 12 weeks to see results

• Affects bp and HR
• Best tx for xerostomia

Answer 16

 Pilocarpine hydrochloride

Question 17

 Oral mucosa exposed to radiation becomes
edematous, erythematous, and ulcerated.
 The condition can be extremely painful and cause
issues with mastication and swallowing.
 The signs and symptoms often arise after the
second week of therapy and may last a few weeks
after the completion of treatment

Answer 17

Mucositis

Question 18

 Mild Pain
 Maintain oral hygiene
 Use bland oral rinses
 Baking soda/water
 With/without salt
 Use topical oral pain management
 Caphosol
 Magic Mouthwash
 Viscous lidocaine, Maalox, diphenhydramine
 With/without nystatin
 Mild analgesics (OTC)

 Moderate pain
 Addition of moderate strength opioids
 Hydrocodone and oxycodone
 Altered diet (soft)

 Severe pain
 Addition of strong opioids
 Oxycodone, morphine, oxymorphone
 May need nasogastric or PEG tube

Answer 18

Mucositis tx

Question 19

 Viscous lidocaine, Maalox, diphenhydramine

 With/without nystatin

Answer 19

Magic Mouthwash

Question 20

 Radiation results in vascular changes in the bone
limiting the blood supply and the ability to heal
after trauma or extractions
 Associated with radiation doses above 50 Gy
 More common with the mandible

Answer 20

ORn

Question 21

What Gy of radiation are associated with ORN?

Answer 21

50 Gy

Question 22

Is ORN more common in mand or max?

Answer 22

Mand

Question 23

Stage ___ ORN
 No exposed bone, but pt. is symptomatic
 Radiographic changes may be present
 Treatment
 Periodic monitoring
 Systemic management (antibiotics and pain meds)

Answer 23

0

Question 24

Stage ___ ORN

 Bone is exposed, asymptomatic, no infection present
 Treatment:
 Monitor closely for 8 weeks
 If no changes, continue to monitor quarterly
 Meticulous home care
 Antimicrobial oral rinses
 Remove loose sequestra if present

Answer 24

 Stage 1:

Question 25

Stage ___ ORN ```  Exposed bone with associated pain  Purulent exudate may be present  Treatment:  Same treatment as Stage 1  Addition of systemic antibiotics(Penicillin, Clindamycin, Doxycycline)  Superficial debridement to relieve soft tissue irritation  Possible hyperbaric oxygen therapy? ```

Answer 25

 Stage 2:

Question 26

Stage ___ ORN ```  Exposed bone with pain and one of the following:  Pathologic fracture  Extra-oral fistula  Necrotic lesion extends to the inferior border  Treatment:  Surgical debridement or resection  Antibiotic therapy  Possible hyperbaric oxygen? ```

Answer 26

 Stage 3:

Question 27

 Primarily occurs when the pterygoid region is irradiated  Usually noticed near the completion of radiation therapy  Radiation may cause spasms or fibrosis of the TMJ and muscles of mastication resulting in a limited range of motion  The effects of trismus usually are not permanent, but may last for several months after the completion of radiation therapy  Treatment:  Warm, moist heat  Massage  Physical therapy  Tongue depressors  TheraBite  Dynasplint

Answer 27

Trismus

Question 28

Permanent taste loss may occur with a cumulative dose | of ___ Gy.

Answer 28

60 Gy

Question 29

Wait __-__ months after the completion of radiation to | fabricate dentures and RPDs

Answer 29

6-9 months

Question 30

 a form of cancer treatment that involves taking one or more of a type of drug that interferes with the DNA (genes) of fast-growing cells. These drugs are further subdivided into specific classes such as alkylating agents, antimetabolites, anthracyclines, and topoisomerase inhibitors.

Answer 30

Chemotherapy

Question 31

Effects of ______: ```  Immune system suppression  Mucositis  Xerostomia  Bleeding  Hypogeusia/Dysgeusia ```

Answer 31

Chemotherapy

Question 32

T/F: Avoid any dental treatment if possible during | chemotherapy

Answer 32

True

Question 33

Pts usually reach their “nadir”(lowest blood counts) __-___ | days after a course of chemo

Answer 33

7-14 days

Question 34

T/F: If treatment is needed, blood counts are usually best just prior to their next course of chemo

Answer 34

True

Question 35

What do you want ANC count to be for OS in chemo pts?

Answer 35

Above 1000

Question 36

What do you want platelet count to be for OS in chemo pts?

Answer 36

>75,000

Question 37

 Chemotherapy is used to destroy the bone marrow  Hematopoietic stem cells are then transplanted to repopulate the bone marrow

Answer 37

Bone marrow transplant

Question 38

 The pts own bone marrow or stem cells are removed | and preserved for transplantation.

Answer 38

Autologous

Question 39

 Bone marrow or stem cells from a HLA (Human leukocyte antigen) matched individual are used for transplantation.

Answer 39

Allogeneic

Question 40

 Bone marrow or stem cells from an identical twin are | used for transplantation.

Answer 40

Syngeneic

Question 41

How long do you want to wait to do any routine dental care after a bone. marrow transplant?

Answer 41

1 year

Question 42

 Occurs primarily with allogeneic transplants  Treatment involves severe immunosuppression  Oral manifestations:  Mucositis  Infections (bacterial, fungal, viral)  Mucosal atrophy  Xerostomia

Answer 42

Graft versus host disease