Special Care: Oncology Flashcards
What is our role in pre-assessment and treatment before a patient has cancer treatment? (5)
assess the patient and carry out the necessary dental treatment in order to remove disease and potential disease (dentally fit) before the patient starts their cancer treatment - must be radical to prevent interruption of cancer treatment
emphasise oral hygiene instruction to maintain a disease free mouth and prevent worsening Mucositis
emphasise prevention
start fluoride therapy
plan rehabilitation
What are the oral side effects of radiotherapy? (6)
Ulceration and Mucositis
fibrosis of muscles and tissues = truisms
dry mouth from damage to the salivary glands = dental caries and denture retention problems
osteoradionecrosis from endarteritis
infections
caries - incisal edges and cervical
how does Mucositis impact the patients mouth?
pain means that the patient struggles to carry out oral hygiene
How can we manage Mucositis?
Avoid;
smoking, spirits, spice, tea/coffee and mouthwash (not prescribed)
use; topical lignocaine gel ice chips saline mouthwash sodium bicarbonate mouthwash
How can we PREVENT Mucositis?
Aloe vera
Amifostine (radio protective agent)
low level laser light (children)
Manuka honey
chlorhexidine
cryotherapy
keratinocyte growth factor
how do we commonly treat Mucositis?
low level laser light theory and morphine
What occurs after damage to the salivary glands during radiotherapy?
xerostomia from;
saliva increasing in viscosity
saliva pH drops = acidic
What are the impacts of xerostomia?
Difficulty with; mastication and swallowing denture retention speaking altered taste
increased;
caries
periodontal d
sialadenitis
What kind/pattern of caries is usually found after radiation?
Cervical/smooth surface caries
caries on the incisai edge
What occurs in osteoradionecrosis?
endarteritis obliterans - damage to the blood vessels supplying the bone
(commonly mandible)
How can we manage the dentition of those with osteoradionecrosis?
remove teeth with poor prognosis before treatment
emphasise prevention
if having to remove teeth prescribe vitamin E for 6 weeks before
when assessing a patient for dental treatment before they have cancer treatment what should we know?
start date of therapy
what kind of therapy radio/chemo - what type of chemo
How long before cancer treatment should we extract a tooth?
10-14 days
should we carry out ends treatment before cancer treatment? why?
no
requires lots of appointments - short window before treatment
60% success = possible need for retreatment
assess caries risk
What are the side effects of chemotherapy on the whole body ? (6)
anaemia from reduction in RBC
low WBC
low platelets
Reduced neutrophils
nausea and vomiting
hair loss
how long after chemotherapy do cell counts start to drop?
10-14 days
when is best to treat a patient after they have had chemo? why?
Always liaise with the oncologist
anytime 21 days after chemo has been given - cell counts start to rise again
what level should neutrophils be to allow us to treat the patient?
> 1
what is important to remember in patients with breast cancer?
Commonly metastasises to the bone - so they might also be on bisphosphonates = high risk for MRONJ
What are the risk factors for head and neck cancer?
Smoking alcohol (both = synergistic) HPV Sunlight Pre existing mucosal abnormalities
What dose of radiotherapy increases the chance of osteoradionecrosis?
50 - 60
what are the oral side effects of chemo therapy? (6)
– Xerostomia – from damage to the salivary glands
– Mucositis – atrophy of the mucosa (ulceration)
– Gingivitis from defective haemostasis
_ Gingival enlargement & haemorrhage
– Prone to infection (fungal, bacterial and viral)
– Vinchristine used in chemo can cause trismus and jaw pain
