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Flashcards in Psych/Cancer/Implants Deck (34)
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1

What are the 2 most common places for Tumor/Oral Cancer Location/?

  • Tongue
  • Tonsil

2

What are some risk factors for oral cancer?

  • Tobacco
  • Alcohol
  • Age
  • Sex
  • Viral

3

What are 2 viral risk factors for oral cancer?

Ebstein Barr Virus (Mono)

  • Positively linked ot nasopharyngeal cancer

HPV (16, 18, 31, 32)

  • Positively linked to oral cancer
  • Better prognosis

4

What does TNM stand for?

  • T: Tumor Size
  • N: Nodal Involvement
  • M: Distant Metastasis

5

For Tumor Size, describe Tx through T4...

  • Tx: Primary tumor cannot be assessed
  • TO: No evidence of primary tumor
  • T1: Tumor < 2 cm
  • T2: Tumor > 2 cm, but < 4 cm
  • T3: Tumor > 4 cm
  • T4: Tumor of any size that invades adjacent structures

6

Describe Nodal involvement from NO to N3...

  • NO: No palpable node
  • N1: Single, homolateral node < 3 cm
  • N2: Single, homolateral node 3 - 6 cm, or multiple homolateal nodes, none > 6 cm
  • N3: Single or multiple homolateral nodes with one > 6 cm or bilateral nodes or contralateral nodes

7

For Distant Metastasis, describe MX to M1...

  • Mx: Presence of distant spread cannot be assessed
  • M0: No distant spread
  • M1: Cancer has spread to distant sites outstide the head and neck region

8

What nodes can you palpate on the head and neck?

9

What is the first choice treatment for most oral cancers?

Surgery

10

What is the limiting factor to surgery when removing oral cancer?

  • Crtical strucutres of the head and neck
  • Can include neck dissection
  • Ranges from small excision to large resection

11

How do Chemotherapy drugs affects cells?

 

Interfere with mitosis

12

How is Chemotherapy administered?

IV infusion

13

What are 3 side effects of Chemotherapy?

  • Mucositis
  • Leukopenia
  • Nausea

14

What are the 4 types of external beams associated with Radiation Therapy?

  1. Gamma Rays
  2. X-Rays
  3. Protons
  4. Electrons

15

What are 3 side effects of Radiation Therapy?

  • Xerostomia
  • Mucositis
  • Muscle Fibrosis

16

What are the 3 side effects of a radiated mandible after extractions??

  • Hypoxic 
  • Hypocellular
  • Hypovascular

17

When you have a total dose > ____ CGy, you would consider ____________ _____________ therapy...

  • 6000 CGy
  • Hyperbaric Oxygen Therapy

18

How much does Hyperbaric Oxygen Therapy reduce incidence of ORN in the mandible?

30% to 5%

19

What is the dive scheudle for Hyperbaric Oxygen Therapy if total dose > 6000 CGy

  • 20 pre-op dives
  • 10 post-op dives

20

What types of disease render Antiresorptive Therapy?

  • Osteoporosis
  • Pagets Disease 
  • Bone metastasis of malignancies
  • Multiple Myeloma

21

What are 3 examples of oral BIsphosphonates?

  • Fosamax (Alendronate)
  • Actonel (Risdronate)
  • Boniva (Ibandronate)

22

What are 4 examples of IV Bisphosphonates?

  • Aredia (Pamidronate)
  • Boniva (Ibandronate)
  • Zometa (Zolendronic Acid)
  • Reclast (Zelendronic Acid)

23

What is Denosumab used to treat?

Antiresorptive Therapy

24

What does a Cathepsin K inhibitor do like Odanacatib?

25

What 3 elements MUST YOU HAVE to diagnosis MRONJ?

  1. Current or previous treament with antiresorptive or antiangiogenic 
  2. Exposed bone or bone that can be probed through an intra/extraoral fistula in the maxillofacial region that has persisted for more than 8 weeks
  3. No history of radiation therapy to the jaws or obvious mets to bone

26

What is the percentage of of people getting MRONJ after Osteoporosis treatment?

  • AS high as 0.1% spontaneous
  • 0.34% following dental extraction

27

What is the risk of a Cancer patient taking Denosumab (Xgeva) of getting MRONJ?

As high as 13% seen in literature

28

How do you treat a pt who is clinically normal, asymtomatic who have received antiresorptive therapy?

  • Mp treatment beyond routine dental care
  • Patient education

29

How would you treat a patient who is Stage 0 for ARONJ who has no clincal evidence of exposed bone, but presence of non-specific symptoms or clinical and/or radiographic abnormalities?

  • Conservative local treatment measures
  • Analgesics and antibiotics as indicated
  • Communication with prescribing physician

30

How would you treat a ARONJ Stage 1 pt who has exposed and necrotic bone in patients who are asymptomatic and have no evidence of infection?

  • Antimicrobial mouth rinse
  • Smooth sharp bone to relieve soft tissue irritation, remove loose sequestra
  • Analgesics and antibiotics as indicated
  • Clinical follow-up every 3 - 6 months
  • Review indications for continued anti-resorptive therapy with prescribing physician

31

How would you treat a Stager 2 ARONJ pt who has exposed and necrotic bone associated with pain and/or signs of infection in the region of bone exposure with or without purulent drainage?

32

How would you treat a Stage 3 pt with ARONJ who has exposed and necrotic bone with pain, infection, and at least one of the following: exosure and necrosis extending beyond the local alveolar tissues; radiographic evidence of osteolysis extending to the inferior mandibular border or the maxillary sinus floor; pathologic fracture; oro-antral, oro-nasal or oro-cutaneous communication?

33

According to the ADA/AAOS - what can you consider in regards to antibiotic prophylaxis for total prosthetic hip and knee repalcements?

You may consider discontinuing the practice of antibiotics prophylaxis for total prostehtic hip and knee joints undergoing routine dental procedures

34

If you are going to prescribe antibitoics prior to a dental procedure for a patient who has had a Total Joint Replacement, what would you prescribe?

2 gram one hour prior to procedure

  • Amoxicillin
  • Cephalexin (Keflex)
  • Cephradine(Velosef)