SPECIAL CARE h+n oncology Flashcards
what is the role of the dental team pre cancer treatment?
remove potential sources of infection so cancer treatment can proceed without delay
what are the adjunctive cancer treatments?
radiotherapy
chemotherapy
chemo-radiotherapy
what type of radiation does radiotherapy use?
ionising radiation
how does radiotherapy target cancer cells?
the ionising radiation kills the DNA of cancer cells
it also destroys healthy cells
what glands are sensitive to radiotherapy?
salivary glands
what are the types of radiotherapy?
conventional
IMRT
‘rapid arc’
what are the general side effects of radiotherapy (exam q)?
fatigue
nausea
burns
pain
what are the oral side effects of radiotherapy (exam q)?
mucositis
xerostomia
radiation caries
periodontal disease
dysgeusia/ ageusia
trismus
osteoradionecrosis
what is dysgeusia?
loss of one or more taste sensations
what is aguesia?
no taste
can you recover from dyguesia/ aguesia?
may recover after 9-18 months
may be permanent
what treatment may you deliver as a GDP to a pt prior to cancer tx?
xla of hopeless teeth
duraphat toothpaste and varnish
fluoride trays
HPT
therabite
pharmaceuticals
LLLT
how does mucositis present?
Grade 0 = No oral mucositis.
Grade 1 = Erythema and soreness.
Grade 2 = Ulcers, able to eat solids.
Grade 3 = Ulcers, requires a liquid diet (due to mucositis)
Grade 4 = Ulcers, alimentation not possible (due to mucositis
describe radiation caries?
circumferential pattern of caries on every tooth - aggressive and difficult to treat due to risk of crown fracturing off
what taste sensation normally remains intact with dyguesia?
sweet
what is a normal measurement of mouth opening?
35-55mm
list types of teeth that would be classed as hopeless and in need of xla prior to cancer tx?
gross caries
mobile teeth (grade 2>)
pockets 5mm and greater
periapical pathology
furcation involvement
what are the 2 available strengths of duraphat?
2800ppm
5000ppm
how would you instruct a pt to use fluoride trays?
fill with duraphat toothpaste or fluoride mousse
minimum 5 min daily wear
what devices can help pts trismus?
therabite
‘pat bite’
spatulas
what pharmaceuticals can be prescribed to pts post radiation?
pentoxyfylline
vitamin E
what is used for the hypoxia theory of ORN?
hyperbaric oxygen
explain the hypoxia theory of ORN?
hyperbaric oxygen increases oxygen to damaged bone
promotes healing?
not widely available
what is LLLT?
low level laser therapy
currently undergoing trials
what should be prescribed to patients undergoing chemotherapy?
duraphat toothpaste and mouthwash
what are the 3 types of chemotherapy?
neoadjuvant/ induction chemotherapy (before surgery)
adjuvant chemotherapy +/- radiotherapy (after surgery)
palliative chemotherapy
how does chemotherapy work?
using drugs to kill rapidly dividing cells
interferes with mitosis
interferes with apoptosis
interferes with tumour cell DNA
name 3 chemotherapy drugs?
cisplatin
cetuximab
TPF
what are the general side effects of chemotherapy drugs?
fatigue
nausea
vomiting+diarrhoea
skin rash
hair loss
thrombocytopenia
neutropenia
what are the oral side effects of chemotherapy drugs?
mucositis
infection
bleeding
temporary zerostomia?
what can we do as dental professionals for a pt with mucositis?
soft splints
caphosol
LLLT?
HPT before chemo starts
what is caphosol?
Caphosol is a calcium phosphate solution resembling human saliva that is intended to replace the normal ionic and pH balance in the oral cavity. It has been used as a mouth rinse to moisten, lubricate, and clean the oral mucosa, tongue, and throat.
what must be checked if XLA is needed during/ soon after chemotherapy?
blood test - FBC, coag screen
what is thrombocytopenia?
low platelets = no clotting
what is neutropenia?
low neutrophils = immunosuppressed
what is HPT?
hygiene based therapy
what is pentoxifylline?
vasodilator
name a brand of flavour free toothpaste?
oronurse
what ingredient in toothpaste can pts who have just had radiotherapy not tend to tolerate?
sodium lauryl sulphate
