Treatment of Cancer patients - SDCEP guidance

Question 1

what is a dentist’s role in the treatment of a cancer patient

Answer 1

• part of MDT

- ensure patient is dentally fit prior to beginning Chemo/radiotherapy

Question 2

Priorities of PRE-treatment oral assessment

Answer 2

• OHI (preventative regime)
• fluoride
• removal of poor prog teeth (source of inf/risk of stopping treatment)
• avoid mucocitis exaccerbation

Question 3

Priorities DURING cancer treatment

Answer 3

• managing: Oral ulceration/infection

- emergency treatment

Question 4

What is mucositis

• where is it most likely to affect
• which factors mean patients are more susceptible

Answer 4

inflammation/ulceration of mucous membranes
-high cell turnover rate/highly vascular - soft palate/lateral b of tongue/FoM

• concurrent chemo
• younger
• alcohol
• dental disease
• poor OH

Question 5

Measures to reduce effect of mucositis

Answer 5

• avoid smoking/spicy food/spirits/tea&coffee
• topical analgesics: lignocaine/benzydamine
• saline mw
• tea tree oil mw
• gelclair oral gel
• caphosol mw
• oral cooling: ice

Question 6

SDCEP prescription: Benzydamine SPRAY

Answer 6

Benzydamine oromucosal spray 0.15%

• send: 30ml
• label:4 sprays onto affected area every 1 1/2hrs

Question 7

SDCEP prescription: Benzydamine MW

Answer 7

Benzydamine MW 0.15%

• send: 300ml
• label: Rinse/gargle using 15ml every 1 1/2hr as required

-NO MORE THAN 7 DAY prescription!

Question 8

SDCEP prescription: Lignocaine OINTMENT

-advice given about application

Answer 8

Lignocaine ointment 5%

• send: 15g tube
• label: rub sparingly and gently on affected area, avoid anaesthesising pharynx - choking during eating

Question 9

SDCEP prescription: Lignocaine SPRAY

Answer 9

Lignaocaine spray 10%

• send 50ml
• label: apply as necessary with cotton bud

Question 10

Post treatment care of cancer patients

Answer 10

• Prevention: diet/Fluoride/OHI/trismus/smoking cessation

- monitoring: >checkup frequency/dry mouth management/pros replacement

Question 11

issues arising from xerostomia

Answer 11

• dysphagia
• pros control dificulties
• speech difficulties
• > risk of caries/perio/candidosis/sialadenitis

Question 12

Name some salivary replacements/stimulants

Answer 12

• saliva orthana spray
• biotene oralbalance
• saliva stimulating tablets (SSTs)
• sugar free gum
• water