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BDS3 Special Care Dentistry > oncology > Flashcards

oncology Flashcards

1
Q

if pt tells you reason for teeth being broken should you include in your notes?

A

yes

needs to be clear if known cause as pt can come back with legal claim in months to come

e.g. upper teeth broken during intubation procedure for surgery

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2
Q

omeprazol

A

proton pump inhibitor

reflux

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3
Q

tramadol

A

strong painkiller

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4
Q

citalopram

A

antidepressant

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5
Q

recommended untis of alcohol per week

A

14

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6
Q

how to explain units to pt

A

ask what she is drinking

use drink aware website to show

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7
Q

if pt says they use non-fluoride toothpaste

A

ask why

explain benefits of F - strengthen tooth mineral

not going to give cancer

evidence based - cochrane reviews

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8
Q

is you get a dentally anxious pt how to deal with them

A

ask why they are anxious?

trigger? past experience? anything you can do to help? would they be interested in relaxation techniques?

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9
Q

BPE 2

A

supra gingival plaque and calculus

BOP

<3.5mm pocket

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10
Q

BPE 3

A

probe goes into pocket but black band partially visible 3.5-5.5mm

supragingival plaque and calculus

BOP

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11
Q

managment BPE 2

A

OHI

calculus and overhang removal

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12
Q

management BPE 3

A

6PPC in that sextant after tx

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13
Q

pre cancer therapy dentally fit key

A

remove all potential sources of infection

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14
Q

prevention for pt about to go into chemo

A

enhanced prevention level F - emphasise importance due to dental health risk during chemo (lower immune)

take impressions for F trays and secondary ones incase splint needed if mucositis or ulceration occurs

diet diary to evaluate caries risk and modifications that can be made

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15
Q

radiographic report

A

A

21 and 11 - can see fracture on 21

RCT - adequate down to apex and no voids/air bubbles, 11 GP exposed clinically - could expose to bacteria and saliva - inadequate seal - may need redone

Periapical healthy - OK, PDL ligament widening on mesial 21, not PA lesion on 11 as can see PDL going round tooth

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16
Q

what if you saw this toth in a pt about to go into chemo tx and it has previously been RCT

A

GP exposed risk infection

  • Chemo - extract

If fit and healthy - maybe post crown

  • ferrule? tooth tissue that surround that is able to support post - don’t want flat top
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17
Q

radiographic report

A

A

  • No overlap
  • Can see crowns clearly

Restorations occlusal 16 and 46 amalgams, 47 (composite)

Interproximal caries possible 45 and 46

  • Just into enamel so don’t want to go into (depending on caries risk assessment)

45 likely just into dentine distal xrays 6 months behind

  • When go into 5 assess 6 with probe

White shadow in 17 - pulp stones - calcifications - asymptomatic

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18
Q

radiographic report

A

A old be 2 (as want to see mesial distal entirely)

  • Minimal overlap, Crowns seen
  • likely clearer on clinical screen

37 - secondary caries mesial

36 mesial caries

Gross caries distal 25 and 26

  • Breach pulp - no pain - non-vital
  • extract

Widening PDL 37

Bone loss upper left

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19
Q

chemotherapy aims

A

Kill cancer cells and stop reproducing

Targets specific cells - rapidly dividing cells

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20
Q

side effects chemotherap (10)

A
  • Tired
  • weaken immune system - infection risk
  • Hair loss
  • Nausea/vomitting
  • Reproductive issues
  • Urine issues
  • dry mouth
  • mucositis
  • oral infection
  • haemorrhage

variation

21
Q

mucositis

A

inflammation of mucous membranes

Can vary widly

  • Sometimes cant eat/drink, speak, sleep
    • Take away indpedence

10 days to occur post chemo - 5 days to peak and 5 days to resolve

  • Endless cycle through chemo tx
22
Q

mucositis aids

A

Topical anaesthetic to relieve before eating

  • lidocaines sprays, mouthrinse - can be nippy to apply

Oral hygiene

  • Gauze (muslin cloth) with chlorohexidine/salty water (if too nippy gently) wipe round
  • Soft silk toothbruhses

Mouth rinse - cooling (calcisol)

Oral cooling - ice lolly or suck on ice to help soothe

F trays

  • bumps in retainers to place toothpaste in and prevent rubbing - prevent sore rubbing and apply F
23
Q

grades of mucositis

A

based on side effects

  • 0 (none)
  • I (mild)
  • II (moderate)
  • III (severe)
  • IV (life-threatening)

WHO Oral mucositis grading scale

24
Q

mucositis grade 0

A

no side effects

25
Q

grade I mucositis

A

oral soreness

erythema

26
Q

grade II mucositis

A

oral erythema

ulcers

solid diet tolerated

27
Q

grade III mucositis

A

oral ulcers

liquid diet only

28
Q

grade IV mucositis

A

life-threatening

oral alimentation impossible

29
Q

white oral lesion that can be scaped off and removed

A

fungal - candida

(can leave skin raw/bleed)

30
Q

candida infection type

A

oppurtunistic

takes advantage when immune system low

31
Q

tx for candida

A

topical antifungals

  • miconazole gel
  • nystatin liquid

if neither work consider a systemic antifungal (fluconazole) - issue interact with many medications (warfarin etc)

32
Q

what is this lesion

can be scraped off

A

candida infection

can occur in cancer tx as immune system down and oppurtunistic infection

33
Q

what is this

A

cold sores

34
Q

how can cold sores occur due to cancer tx

A

immunosuppressed so herpes simplex virus can run rampant and cause multiple cold sores

35
Q

tx for herpes simplex caused cold sores

A

antivital medicatins

acyclovir tablets (5 tablets daily for 7 days)

if prone to cold sores can be given prophylatically

36
Q

what is this

A

dry mouth

polypharmacy

37
Q

tx for dry mouth

A

regular sips of plain water

saliva replacement - orabalance (SDCEP)

some contain gelatin - warn

38
Q

if pt comes in middle of chemotherapy with buccal abscess

what are concerns

A

infection

  • Spread to blood stream and has weakened immune system due to chemo
    • can die due to chemo dental infection spread
39
Q

chemotherapy affect on blood cells

A

Pancytopenia - reduction in all

  • white blood cells reduced - infection
  • RBC - anaemic risk
  • Platelets down - bleeding risk
    • < 50 don’t touch not stop bleeding,
    • >50 - delicate but should stop bleeding

Need FBC before tx

40
Q

tx options for buccal abscess during chemotherapy

A
  • Do nothing - don’t recommend
  • Remove the tooth - platelet and healing issue
  • Incise and Drain the abscess - short term measure - as can come back - wont deal with problem - bleeding and infection risk
  • re-RCT - timely, multiple appointments, lower success rates compared to 1st time
  • Antibiotics - tiding someone over until in a better state to get tx

Consult oncology team

41
Q

if pt had cancer tx in past what would you like to know

A
  • what tx they had - radiotherapy, chemotherapy, combination?
  • where
  • duration of
  • any side effects
  • how long been in remission/no tx

plan his tx in future

likely if had radiotherapy in past will affect him now

42
Q

radiotherapy of head and neck cancers

A

radiation hit towards certain points

  • mask, immobilise head and neck so cant move
  • got to get through tissues to reach target - side effects on surrounding tisues
43
Q

smoking and alcohol oral cancer link

A

both individually increase the risk of oral cancer

cumulative effect together

44
Q

smoking 3 As

A

ask - how long? what? considered quitting?

advice - health benefits - reduce systemic disease risk

act - signpost to specialist cessation services, get pharamacy quit kits

45
Q

report

A

OPT radiograph - A

Caries 37 DO, 17 D

  • radiation caries - saliva issue, cervical margin region caries (not pit and fissure)

8s weird angle on mandible - close proximity to IAN

Severe bone loss lower right (only 48 present)

  • necrotic bone - Osteoradionecrosis

Need reconstruct with bone from femus

46
Q

osteoradionecrosis

A

death of bone due to radiation - small BV get endoarteritis obliterans - shrink down so not deleiver blood –> bone death

5 years post radio or longer

  • Extractions wont heal - gum not close over - infection
  • Denture wont sit possibly
  • Lower jaw can fracture as no healthy bone to keep together
47
Q

side effects of head and neck radiotherapy

A

osteoradionecrosis

fibrosis of muscles

48
Q

impact of fibrosis of head and neck muscles

A

thicker

less stretch

smaller mouth opening - access harder

  • OHI and dental care issue
49
Q

importance of dental pre-assessment to cancer tx

A

can provide tx necessary before unable to as reduced mouth opening

OHI and prevention instructions

BDS3 Special Care Dentistry (21 decks)

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