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3rd Year > SC-oncology > Flashcards

SC-oncology Flashcards

1
Q

What are the dental priorities before cancer treatment begins?

A

Preventative regime

Reduce treatment complications

Reduce post treatment complications.

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2
Q

How do we reduce treatment complications?

A

Make the patient dentally fit.

Avoid exacerbation of mucositis.

We don’t want dental treatments interupting scheduled chemotherapy.

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3
Q

At what granuloycte count should we use antibiotic prophylaxis with treatment?

A

<2

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4
Q

How do we reduce post treatment complications?

A

Remove teeth with an uncertain longterm prognosis

Institute a preventative regime

Plan rehabilitation

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5
Q

What information should you ask about a patient’s previous cancer treatments?

A

What cancer treatment did they have?

Were there any complications.

If it was radiotherapy (field and the dose)

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6
Q

What Dental treatment do you provide during cancer treatment?

A
  • Prevention.
  • Dry mouth management
  • Removing plaque retentive factors
  • Remove any risk of haemorrhage (e.g. smoothing over sharp cusps or restorations)
  • EMERGENCY TREATMENT.
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7
Q

What is this oncology treatment side effect and how do we treat it?

A

This is traumatic ulceration caused by the opposite teeth during treatment.

This is treated using a soft splint.

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8
Q

What is this and how do we treat it?

A

Radiographic or chemotherapy induced ulceration.

It is very painful.

Treated with opiod based analgesia and avoiding exacerbating factors.

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9
Q

What is mucositis?

A

Pain and Inflammation of the mucosa

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10
Q

How do we grade mucositis?

A

0-4

0- none

1- mild (oral soreness and erythema)

2-moderate (oral erythema, ulceration, can tolerate a solid diet)

3-severe (ulceration and liquid diet only)

4-life threatening (Unable to eat at all)

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11
Q

How can we prevent mucositis?

A

Good oral hygiene.

Chlorohexidine- to prevent plaque build up and further inflammation.

Cyrotherapy- using ice to cut off little blood vessels to prevent ulcer formation.

Alovera.

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12
Q

How can we treat mucositis?

A

Topical:

Lignocaine (provides pain relief when eating)

Saline mouthwash

Sodium bicarbonate

Gelclair (acts as a protective film for the mucosa)

Other:

Low level light therapy (works well in children)

Morphine.

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13
Q

What effect does cancer treatment have on the mucosa?

A
  • ulceration
  • Mucositis
  • Herpes simplex
  • Oral candidiasis.
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14
Q

What is shown in this clinical image and how do you treat it?

A

Reactivation of Herpes Simplex-

There is painful oral ucleration with sudden onset.

It i snomrally more extensive, slow healing and aggressive.

Pain comes before the ulcers appear.

Treat with acylovir 5% cream for 5 days.

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15
Q

Discuss the effect of cancer treatment on the muscles and connective tissues?

A

It can cause fibrosis of the muscles of mastication leading to trismus.

This restricts access to the mouth and is irreversible.

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16
Q

How does Cancer treatment affect the salivary glands?

A

salivary flow is reduced by 50% in the first week and by 20% over the next 6 weeks.

Treatment changes the saliva consistency (increased viscosity which decreases pH)

Once cancer treatment ends:

Chemotherapy- the salivary flow will return but not to normal.

Radiography-can permanently damage the salivary glands.

17
Q

How can cancer treatment affect the teeth?

A

caries due to:
Xerostomia

Radiation induced (Prevalent on the smooth surfaces of the teeth and the necks of the teeth)

Restorations will not last, they will dry out and fall off.

The caries will eventually become circumferential and the teeth will fall out.

18
Q

How do we manage dental problems in a cancer patient?

A

OHI

scaling and root planing

Modern caries management

We want to avoid extraction:

  • could retain the roots instead
  • Autraumatic extraction if we have to- no flaps
19
Q

How could cancer treatment impact bone and how can we prevent this?

A

Osteoradionecrosis:
Knowing which teeth are in the field of radiography and removing any of poor prognosis (so we dont need to extract after treatment)

Complete any neccessary extractions 10 days prior to radiotherapy (to give it a chance of healing.

20
Q

Discuss the short term effects of chemotherapy?

A
  • Bone marrow suppression
    • Risk of infection
    • Defective haemostasis
  • Cytotoxic
    • Can cause mucositis and decreased salivary gland function
  • Neurological (trismus and jaw pain)
21
Q

Discuss the long term effects of chemotherapy?

A
  • On teeth developing during treatment
    • Roots not fully developing
    • hypodontia
    • Microdontia
    • Crown hyperplasia.
  • Dry mouth
22
Q

What is the Nadir point?

A

This is the point 2 weeks after chemotherapy starts when the patient’s cell count is at its lowest. (patient is at highest risk)

You avoid treating the patient at this point at all costs.

23
Q

What is the main concern about treatment doing radiotherapy?

A

Osteoradionecrosis.

we remove any teeth of variable prognosis prior to radiotherapy to prevent extractions during or after treatment.

We want to avoid extractions. (decoronate and leave the roots)

24
Q

How is breast cancer relevant to dental treatment?

A

The breast cancer metastases commonly spread to bone. Therefore, the patient may then recieve biphosphonate treatment (MRONJ)

25
Q

What is the typical caries pattern in head and neck cancer patients?

A

Cusp tips

Incisal edges

Cervical margins

26
Q

What is leukaemia ?

A

A cancer of the white blood cells, which continue to divide but not mature. These fill up the bone marrow and stop it from making healthy cells.

This affects the body’s protection increasing infection risk.

27
Q

What treatments can the GDP do when the patient is in maintenance?

A

Fissure sealant

fluoride varnish

Checkups.

28
Q

Where does patient dental treatment take place when the patient is in remission?

A

GDP.

29
Q

What is multiple myeloma and how do we treat it?

A

Multiple myelom is a cancer originating in the bone marrow affecting plasma cells.

It is treated using bisphosphonates.

3rd Year (63 decks)

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