Oral Management of Oncology Patients requiring Radio/Chemotherapy or bone marrow transplantation

Question 1

Who created these guidelines?

Answer 1

RCS

Question 2

Prior to commencing cancer therapy, when should teeth of dubious prognosis be extracted?

Answer 2

No less than 10 days before. Ideally 3 weeks.

Question 3

Prior to cancer therapy, what should be done for the patient?

Answer 3

• Full oral health assessment and radiographs
• Advise on adverse long and short term side effect
• OHI
• Diet advice
• CHX adjunct if gingival disease
• Definitively restore dental caries
• Remove trauma/polish sharp teeth
• Impressions ready for radiation stents and obturators
• If wearing denture, ensure clean and well adapted to tissue and encourage to leave out
• Extract teeth of poor prognosis
• Discontinue ortho treatment

Question 4

When should antibiotic prophylaxis be considered prior to invasive oral procedures?

Answer 4

If pt has neutropenia (neutrophils less than 2000/mm3) but liase with oncologist

Question 5

What dental problems could increase the risk of infection prior to cancer therapy?

Answer 5

Periodontitis
Caries
Failing restorative work
Ill fitting dentures

Question 6

What can be used for children that are unable to brush their teeth (too sore)?

Answer 6

Oral sponge/gauze as a temporary measure moistened with alcohol free CHX

Question 7

What are the issues with diet in cancer patients and how can this be adressed?

Answer 7

Need a frequent high calorie intake during therapy so increased intake of sugars - leads to dental caries.
Diet advice should not conflict with dieticians advice.
Strategies such as using straws

Question 8

What should be done for the patient during cancer therapy by the dentist?

Answer 8

• OHI - change to soft toothbrush if too sore, dentures cleaned 1xday CHX or dilute sodium hypochlorite
• CHX 0.2% non alcohol if brushing difficult, 2x day 30 mins after brushing
• Reduce caries risk: sugar free medicine, work with dietician, adults = fluoride mouth rinse and 5,000ppm flouride toothpaste
• Look for viral infections (herpes) - prescribed Aciclovir prophylactically after bone marrow transplant
• Look for candidosis - prescribe nystatin oral suspension or miconazole oral gel
• Treat mucositis symptoms
• Treat xerostomia

Question 9

What are the treatments/advice for mucositis?

Answer 9

• Good oral hygiene
• Correcting poorly fitting dentures and sharp teeth
• Difflam (benzydiamine hydrochloride) 0.15% mouthwash
• Oral cooling prior to chemo
• Lidocaine mouthwash
• Zinc supplements

Question 10

What are the treatments/advice for xerostomia?

Answer 10

• Fluoride supplementation
• Lubricating soft tissues
• Pilocarpine
• Stimulation by sugar free chewing gunm
• Saliva substitutes (note some contain animal produce e.g. orthana)
• Frequent sips of water

Question 11

Why are patients at an increased risk of dental caries following cancer therapy?

Answer 11

• Salivary hypofunction/xerostomia
• More cariogenic oral microflora
• Pts choose cariogenic food due to altered tast and difficulty swallowing
• Prescription of cariogenic diet
• Poor OH due to limited opening, psychological
• Presence of enamel defects/dental hypoplasia secondary to radio/chemo in childhood