Psych/Cancer/Implants Flashcards
What are the 2 most common places for Tumor/Oral Cancer Location/?
- Tongue
- Tonsil
What are some risk factors for oral cancer?
- Tobacco
- Alcohol
- Age
- Sex
- Viral
What are 2 viral risk factors for oral cancer?
Ebstein Barr Virus (Mono)
- Positively linked ot nasopharyngeal cancer
HPV (16, 18, 31, 32)
- Positively linked to oral cancer
- Better prognosis
What does TNM stand for?
- T: Tumor Size
- N: Nodal Involvement
- M: Distant Metastasis
For Tumor Size, describe Tx through T4…
- Tx: Primary tumor cannot be assessed
- TO: No evidence of primary tumor
- T1: Tumor < 2 cm
- T2: Tumor > 2 cm, but < 4 cm
- T3: Tumor > 4 cm
- T4: Tumor of any size that invades adjacent structures
Describe Nodal involvement from NO to N3…
- NO: No palpable node
- N1: Single, homolateral node < 3 cm
- N2: Single, homolateral node 3 - 6 cm, or multiple homolateal nodes, none > 6 cm
- N3: Single or multiple homolateral nodes with one > 6 cm or bilateral nodes or contralateral nodes
For Distant Metastasis, describe MX to M1…
- Mx: Presence of distant spread cannot be assessed
- M0: No distant spread
- M1: Cancer has spread to distant sites outstide the head and neck region
What nodes can you palpate on the head and neck?
What is the first choice treatment for most oral cancers?
Surgery
What is the limiting factor to surgery when removing oral cancer?
- Crtical strucutres of the head and neck
- Can include neck dissection
- Ranges from small excision to large resection
How do Chemotherapy drugs affects cells?
Interfere with mitosis
How is Chemotherapy administered?
IV infusion
What are 3 side effects of Chemotherapy?
- Mucositis
- Leukopenia
- Nausea
What are the 4 types of external beams associated with Radiation Therapy?
- Gamma Rays
- X-Rays
- Protons
- Electrons
What are 3 side effects of Radiation Therapy?
- Xerostomia
- Mucositis
- Muscle Fibrosis
What are the 3 side effects of a radiated mandible after extractions??
- Hypoxic
- Hypocellular
- Hypovascular
When you have a total dose > ____ CGy, you would consider ____________ _____________ therapy…
- 6000 CGy
- Hyperbaric Oxygen Therapy
How much does Hyperbaric Oxygen Therapy reduce incidence of ORN in the mandible?
30% to 5%
What is the dive scheudle for Hyperbaric Oxygen Therapy if total dose > 6000 CGy
- 20 pre-op dives
- 10 post-op dives
What types of disease render Antiresorptive Therapy?
- Osteoporosis
- Pagets Disease
- Bone metastasis of malignancies
- Multiple Myeloma
What are 3 examples of oral BIsphosphonates?
- Fosamax (Alendronate)
- Actonel (Risdronate)
- Boniva (Ibandronate)
What are 4 examples of IV Bisphosphonates?
- Aredia (Pamidronate)
- Boniva (Ibandronate)
- Zometa (Zolendronic Acid)
- Reclast (Zelendronic Acid)
What is Denosumab used to treat?
Antiresorptive Therapy
What does a Cathepsin K inhibitor do like Odanacatib?
What 3 elements MUST YOU HAVE to diagnosis MRONJ?
- Current or previous treament with antiresorptive or antiangiogenic
- Exposed bone or bone that can be probed through an intra/extraoral fistula in the maxillofacial region that has persisted for more than 8 weeks
- No history of radiation therapy to the jaws or obvious mets to bone
What is the percentage of of people getting MRONJ after Osteoporosis treatment?
- AS high as 0.1% spontaneous
- 0.34% following dental extraction
What is the risk of a Cancer patient taking Denosumab (Xgeva) of getting MRONJ?
As high as 13% seen in literature
How do you treat a pt who is clinically normal, asymtomatic who have received antiresorptive therapy?
- Mp treatment beyond routine dental care
- Patient education
How would you treat a patient who is Stage 0 for ARONJ who has no clincal evidence of exposed bone, but presence of non-specific symptoms or clinical and/or radiographic abnormalities?
- Conservative local treatment measures
- Analgesics and antibiotics as indicated
- Communication with prescribing physician
How would you treat a ARONJ Stage 1 pt who has exposed and necrotic bone in patients who are asymptomatic and have no evidence of infection?
- Antimicrobial mouth rinse
- Smooth sharp bone to relieve soft tissue irritation, remove loose sequestra
- Analgesics and antibiotics as indicated
- Clinical follow-up every 3 - 6 months
- Review indications for continued anti-resorptive therapy with prescribing physician
How would you treat a Stager 2 ARONJ pt who has exposed and necrotic bone associated with pain and/or signs of infection in the region of bone exposure with or without purulent drainage?
How would you treat a Stage 3 pt with ARONJ who has exposed and necrotic bone with pain, infection, and at least one of the following: exosure and necrosis extending beyond the local alveolar tissues; radiographic evidence of osteolysis extending to the inferior mandibular border or the maxillary sinus floor; pathologic fracture; oro-antral, oro-nasal or oro-cutaneous communication?
According to the ADA/AAOS - what can you consider in regards to antibiotic prophylaxis for total prosthetic hip and knee repalcements?
You may consider discontinuing the practice of antibiotics prophylaxis for total prostehtic hip and knee joints undergoing routine dental procedures
If you are going to prescribe antibitoics prior to a dental procedure for a patient who has had a Total Joint Replacement, what would you prescribe?
2 gram one hour prior to procedure
- Amoxicillin
- Cephalexin (Keflex)
- Cephradine(Velosef)
