Oncology Tutorial Flashcards
What is the optimal timing for comprehensive dental treatment before a patient starts chemotherapy?
at least 2 weeks before chemotherapy begins to allow adequate healing time.
for complex surgical procedures, 4-6 weeks may be preferable.
List the main pre-chemotherapy dental considerations and prioritization strategy.
- Elimination of acute infection and pain
- Extraction of teeth with poor prognosis
- Treatment of active caries and periodontal disease
- Removal of potential sources of trauma (sharp edges, ill-fitting prostheses)
- Optimization of oral hygiene
- Preventive measures (fluoride application, prescription of high-fluoride toothpastes)
A patient with impending chemotherapy presents with a tooth requiring endodontic therapy. What factors influence your decision between root canal treatment versus extraction?
Time available before chemotherapy begins
Expected severity and duration of immunosuppression
Patient’s existing oral health status
Long-term prognosis of the tooth
Patient’s motivation for oral hygiene and dental care
Alternative restorative options if extraction is chosen
Risk of complications from either procedure
Describe the WHO Oral Mucositis Grading Scale and clinical management approaches for each grade.
Grade 0 (none): No symptoms, routine oral care
Grade I (mild): Oral soreness and erythema; management includes mild analgesics, saline rinses, soft diet
Grade II (moderate): Oral erythema with ulcers but solid diet tolerated; management includes topical anesthetics, protective agents, anti-inflammatory rinses
Grade III (severe): Oral ulcers requiring liquid diet only; management includes stronger pain control, possibly systemic analgesics
Grade IV (life-threatening): Oral alimentation impossible; may require hospitalization, IV hydration, parenteral nutrition, and potent pain management
What are the primary mechanisms by which chemotherapy causes mucositis?
- Direct epithelial cell damage due to chemotherapy’s effect on rapidly dividing cells
- Release of inflammatory cytokines and reactive oxygen species
- Reduced ability to repair damaged mucosal tissue
- Secondary infection of damaged tissues due to immunosuppression
- Altered oral microbiome due to antibiotic use and immune dysfunction
Beyond mucositis, what other oral complications can arise from chemotherapy?
Xerostomia (dry mouth)
Dysgeusia (taste alterations)
Increased risk of opportunistic infections (fungal, viral, bacterial)
Gingival bleeding due to thrombocytopenia
Neurotoxicity causing dental pain or altered sensation
Increased caries risk due to reduced salivary flow and altered diet
Trismus in some cases
Secondary oral malignancies in long-term survivors
How does chemotherapy-induced neutropenia impact dental management decisions?
During neutropenia (typically ANC < 1,000/mm³):
Elective dental procedures should be postponed
Emergent dental care requires antibiotic prophylaxis and possibly platelet transfusions
When ANC < 500/mm³, even routine procedures like probing may be contraindicated
Close coordination with oncologist is essential for lab value monitoring
Patients with fever and dental infection during neutropenia require immediate hospital evaluation
What information would you need to know about previous head and neck radiotherapy to guide dental management?
Total radiation dose received (especially if >60 Gy)
Fields of radiation (which anatomical structures were included)
Time elapsed since radiation treatment
Whether salivary glands were in the radiation field
Use of radiation protective measures (shields, IMRT techniques)
Any previous complications from radiation therapy
Concurrent chemotherapy agents used (which may intensify effects)
Current salivary function
Explain osteoradionecrosis (ORN) and its risk factors in a previously irradiated patient.
ORN is avascular bone necrosis resulting from radiation-induced hypovascular, hypocellular and hypoxic changes. Risk factors include:
Radiation dose >60 Gy
Location of extraction (mandible > maxilla)
Poor oral hygiene
Concomitant alcohol and tobacco use
Nutritional deficiencies
Time since radiation (risk never completely disappears)
Trauma to irradiated bone (extractions, denture irritation)
Pre-existing periodontitis or dental infection
Describe the features of radiation caries and preventive strategies.
Radiation caries features:
Rapid progression
Affects atypical areas (incisal edges, cusp tips)
Circumferential decay pattern around cervical areas
Brown/black discoloration
Multiple teeth affected simultaneously
Preventive strategies:
Daily use of prescription-strength fluoride (5000 ppm)
Custom fluoride trays for daily application
Frequent dental recalls (every 3 months)
Rigorous oral hygiene
Salivary substitutes
Diet modification to reduce cariogenic foods
Consideration of chlorhexidine rinses
Remineralizing agents (calcium phosphate products)
A patient undergoing chemotherapy presents with a dental abscess. What laboratory values would you need to check before providing treatment?
Absolute neutrophil count (ANC) - dental treatment typically safe if >1,000/mm³
Platelet count - values <50,000/mm³ may require platelet transfusion before invasive procedures
Hemoglobin levels - severe anemia may affect wound healing
White blood cell count - indication of immune status
Coagulation studies (PT/INR, PTT) - especially if on anticoagulants
Liver function tests - may affect medication metabolism
Renal function - influences antibiotic choice and dosing
What are the management options for a tooth with a buccal abscess in a patient currently undergoing chemotherapy?
Options depend on hematological status:
If blood counts adequate:
Incision and drainage with antibiotic coverage
Endodontic therapy to relieve pressure
In severe cases, extraction with primary closure and antibiotic prophylaxis
If severely immunocompromised:
Conservative antibiotic therapy
Hospitalization may be required
Consult with oncologist before any invasive procedure
Delay definitive treatment until immune recovery if possible
Consider palliative pulpal extirpation if extraction contraindicated
