Pediatric Oncology Flashcards
What dental late affects are noted in patients undergoing remission?
Dental caries
Microdontia
Root malformation
Hypodontia/tooth agenesis
Enamel hypoplasia/Xerostomia/caries
Root thinning/shortening
Osteoradionecrosis
Trismus (fibrosis)
What are risk factors for developing dental anomalies in childhood cancer survivors?
Young age
What is the role of HPV in malignant neoplasms?
HPV-16 and 18 strongly associated with oropharyngeal (70%) cervical, and anal cancers
How does thrombocytopenia present in the oral cavity?
Petechiae/Echymosis, Palatal necrosis, Bleeding gums
How does Acute Myeloid Leukemia present in the oral cavity?
Gingival hyperplasia
When should dentists refer to MDs for evaluation of childhood cancer?
Unexplained fever, joint pain, frequent bruising
Oral tumours are generally benign (90%).
What are the most common malignant oral tumours?
Sarcomas (rhabdomyo-; fibro-) or Lymphomas (e.g. Burkitt’s)
What are signs of oral cancer?
Non-healing ulcer
Lump/thickening
White/red patch on tongue, oral mucosa, etc.
What are some radiographical findings associated with oral cancer?
Irregular bone loss
PDL widening
Infiltration into surrounding structures with displacement or resorption
The role of dentists for cancer patients undergoing treatment
Decrease risk of bloodstream infection
Decrease symptoms associated with mucositis
Improve Oral Health outcomes after cancer treatment
What are parts of pre-cancer therapy dental evaluation?
Address potential sources of infection
Oral health education
What are high priority and low priority dental treatments before cancer therapy?
High: symptomatic, infected teeth
Low: faulty restorations
How is dental health managed for patients undergoing cancer treatment?
Q6mo exam if hematologically stable
Chlorhexidine to reduce bacterial load
Oral stretching for trismus (Radiation Therapy)
Antibiotic Prophylaxis and ANC levels
<1000: defer elective dental treatment
1000-2000: Abx prophylaxis, esp for oral infections
> 2000: normal dental care
Dental care and Thrombocytopenia
> 60,000 normal care, beware of bleeding
<60000 avoid dental procedures, if needed perform at hospital with hem/onc team
Management of mucositis:
Cause: neutropenia
Goal: palliative care + hydration until counts recover
1) Bland mouth rinse
2) Palifermin
3) Prevent with good OH
Management of Dry mouth:
Cause: side effect of radiation
Saliva substitutes
Sugar-free gum/candies
Alcohol-free mouth rinse
Phases of Hematopoietic Stem Cell Transplantation (HCT)
1) High dose chemo/irradiation of bone marrow
2) Transplant
3) Immunosuppression for transplant
How are Phases of HCT managed dentally?
Phase 1: Preconditioning
- remove sources of infection before HCT, else wait 100+ days post HCT
Phase 2: Conditioning (neutropenic)
- avoid elective dental procedures after admission and 30+ days after discharge.
Phase 3: Hematopoietic Recovery
- 30-100+ days post HCT. Defer dental treatment till counts recover
Phase 3: Immune reconstitution
-100+ days post HCT. Normal dental care OK
Summary of dental considerations for HCT patients
1) Take care of all necessary dental treatment before HCT
2) Wait 100+ days post HCT for regular dental care. Defer invasive dental treatment until immune function recovers
What are some oral presentations found in HCT patients?
Mucositis, Dry Mouth, Opportunistic Infections (HSV, fungal), GVHD
How does GVHD present?
Cause: donor T cells attack host
1)Acute: Erythema & Ulcerations
2)Chronic: Lichenoid striations, restricted mouth opening
Pediatric Cancer survival rates?
84+% have 5-year survival rate
but increased mortality compared to rest of US population
Cognitive effects of radiation on cancer survivors
Younger at age of diagnosis = more cognitive problems
What are some factors that affect the risks of late effects after cancer treatment?
Cancer Histology/Sites
Age at Diagnosis
Chemotherapy Dose
Note the overall risk of late effects is high, but the risk of serious life-threatening late effects is low
What is secondary prevention around survivorship?
Early identification and treatment e.g. screening for effects after cancer treatment
What is the survivorship care model at Riley?
3-5 years after treatment, join survivorship clinic for annual risk based screening
Dental late effects in patients undergoing remission:
Dental caries
Microdontia
Root malformation
Hypodontia/tooth agenesis
Enamel hypoplasia/Xerostomia/caries
Root thinning/shortening
Osteoradionecrosis
Trismus (fibrosis)
HPV-16 and 18 are associated with oral cancer. What % survivors are recommended to get the vaccine?
28% (not enough)
Subsequent malignant neoplasms (SMNs) occur in
5-15% of long-term survivors
–> leading cause of nonrecurrence cause of death
HPV is related to which oropharyngeal cancers?
Squamous cell carcinoma
Mucoepidermoid carcinoma
Verrucous carcinoma
Adenocarcinoma
