W1 Oral and Dental complications of Cancer & Radiotherapy

Question 1

What is a potential impact of surgical therapy?

Answer 1

Complete or partial loss of form, function and aesthetics. May involve neck dissection for regional LN metastasis (LN removal).

Question 2

What does radiotherapy do?

Answer 2

Ionizing radiation destroys DNA of malignant and normal cells, avoiding damage to normal cells.

Question 3

How are the effects of radiotherapy reduced?

Answer 3

Multiple short exposures.
Applying beams from many angles.
Avoiding radiosensitive tissues.

Question 4

Name (5) radio sensitive rapidly dividing cells

Answer 4

Tumor cells, mucous/epithelium, taste buds, hair follicles

Question 5

What is the exception that is a non-dividing cell that is radiosensitive?

Answer 5

Salivary glands

Question 6

Name (2) radio-resistant cells

Answer 6

Tumour cells trapped in scar tissue, non-dividing cells (muscles, neurons

Question 7

Name (6) IO short term side effects of radiotherapy?

Answer 7

Mucositis
Severe xerostomia
Dysguesia/dysphagia
Bone marrow suppression
Acute candidosis
Delayed healing

Question 8

What is a side effect of radiotherapy and chemotherapy?

Answer 8

Mucositis, oral ulcers.

GI mucositis

Question 9

Can adjacent metallic filling create more intense mucositis?

Answer 9

Yes, due to fillings scattering radiation.

Question 10

When does oral mucositis occur?

Answer 10

2-3w after radiation

Question 11

What are (3) symptoms of oral mucositis?

Answer 11

• Erythema, ulcers, malnutrtion
• Oral discomfort, pain, bleeding
  Infections

Question 12

What is the management of Oral Mucositis?

Answer 12

Pre-assessment
OHI
Diet modification, not too acidic foods
Artifical saliva products
Lidocain gel
CHX gel (for caries)
Avoiding alcohol

Question 13

How is xerostomnia relevant in chemo/radio therapy?

Answer 13

With the exception of SG not being rapidly dividing, acinar cells are affected, following mucus cells.

Question 14

What are symptoms of xerostomnia?

Answer 14

Radiation caries.
Perio disease
Taste alterations
Discomfort, irritation, trauma, difficulty eating.
Difficulty wearing dentures, and removable appliances.

Question 15

Whats that management for xerostomnia?

Answer 15

↑ h20 intake (sips)
Daily F- app
Drugs: Salagen
Saliva substitues (bicarbonate MR’s)

Question 16

What is the (7) roles of an OHT for management of such pts?

Answer 16

Cancer screening
Comprehensive exam
OHI (preventative strategies)
F- apps
Examin restos and exos
Educate pt on what to expect and how to deal with side effects
Post-therapy FU

Question 17

What are some OHI considerations?

Answer 17

2x per day brushing
Daily F- app
Rinse with Na+ and baking soda
Avoid:
- spicy and hot foods, raw veg, crackers, nuts
- smoking
- sugary snacks
- alcohol MR
 Cold food, drink & ice cream