Treating Cancer Patients Flashcards
What is included in pre-assessment of a patient about to undergo cancer treatment?
Full dental assessment - detailed oral hygiene
Fluoride application
Extract teeth with dubious prognosis no less than 10 days before cancer treatment
Dietary advice
Removal of any trauma
Definitively restore carious teeth
Smoking and alcohol advice
Side effects to expect from treatment
Radiographs
What can head and neck cancer treatment have adverse affects on?
Respiration
Mastication
Swallowing
Speech
Taste
Salivary gland function
Mouth opening
What are dental issues patients undergoing cancer treatment can expect?
Oral mucositis
Candida infections
Traumatic ulceration
Reactivation of herpes simplex
Xerostomia
What are some dental issues that can occur following cancer treatment?
Trismus
Dental erosion
Caries
Radiation-induced caries
Periodontal disease
Osteoradionecrosis
What is oral mucositis?
Begins 1-2 weeks after treatment starts
Severe pain and impact on ability to eat
Last until 6 weeks after treatment is complete
What can be advised for prevention and management of oral mucositis?
Mucoadhesive oral rinse (Mugard)
Manuka honey, aloe vera
Good OH will not prevent symptoms but can help it resolve faster
What advice can be given to patients suffering from Xerostomia as a result of cancer treatment?
Stimulation by sugar free gym
Regular sips of water
Saliva replacements - saliva orthana, biotene oral balance gel
What is the advice to give a cancer patient suffering from trismus?
Soft diets
Passive and active stretching exercises and the use of devices for stretching the muscles of mastication
What is osteoradicular necrosis?
An area of exposed bone of at least 3 months duration in an irradiated site and not due to tumour recurrence
How do you prevent ORN from occurring?
XLA teeth of doubtful prognosis in the radiotherapy field
Prevention
Encourage healing with primary closure/sutures where possible No surgical XLAs
XLA’s completed at least 10 days before radiotherapy commences
Why do cancer patients need dental assessment prior to treatment?
Remove poor prognosis teeth prior to patient starting radiotherapy or bisphosphonate therapy to avoid MRONJ or ORN
What effects does chemotherapy have on blood?
Lowers blood cell counts- leading to bleeding problems
Reduces rate at which blood cells are produced - leads to infections lower white blood cells
Lowers platelets
