Special care dentistry Flashcards
(4 cards)
Chemotherapy (6mins)
50-year-old patient about to begin chemotherapy for breast cancer.
No idea of need to go to dentist for assessment but oncologist sent her to you as her GDP.
Explain the relevance of dental health for cancer treatment, diagnose a condition of a tooth (gross caries / apical periodontitis from radiographs) and your proposed management.
~ Talk about getting them dentally fit
- chemotherapy outs a toll on your entire body including your teeth
- your GDP sent you to reduce complications in chemotherapy regime by removing sources of infection , making sure your chemotherapy is not interrupted and exacerbation of mucositis
- As chemotherapy increases the chances of infection, delayed healing, ulcers , altered taste , dry mouth , it will contribute to further problems if not dentally fit before chemo
~ Treatment to be carried out
- Full exam and radiographs
- Full PMPR
- remove any teeth of poor prognosis
- impression for soft splint
- Fluoride therapy
- Smooth down sharp teeth
~ Pre-treatment prevention ( this is what is mentioned in the Q)
- OHI
- High fluoride toothpaste
- FV
- Diet advice - no spicy food , acids
- Smoking and alcohol advice if relevant
~ Mid treatment management
- mucositis management (inflammation and ulceration of the mouth soft tissues)
^ Avoid smoking/alcohol/spicy foods , tea , coffee
^ Ice
^ Topical analgesia
^ Saline
^ Sodium bicarbonate mouthwash
^ Remove any potential source of infection
- Candiidosis - antifungals
~ Post treatment palliative care
- more checkups for maintenance
- Prevention
Risks of chemotherapy?
- Altered taste
- Dry mouth
- MRONJ
- Increased caries risk
- Increased perio risk
- Increased candidosis risk
- Increased risk of sialadentitis
- Trismus
What can cause dry mouth from chemotherapy?
- Decreased salivary flow (50-60% ) in first week and further 2-% in the next 5-6 weeks
- Change is salivary consistency and character and increased viscosity / decreased PH
This leads to change in taste preception
It can recover over years but will not return to normal
AWI patient in pain (6mins)
Pt forgetful and confused
Assess capacity and what treatment is required
Provisional treatment plan available by previous dentist as tooth is causing pain
What to do?
- Assess capacity using AWI act 2005 through 2 stages
Stage 1 = is there an impairment or a disturbance in the functioning of the mind? Yes
Stage 2 = can they:
- understand the treatment
- retain information to make a decision
- make a decision
- communicate this decision
- if pt does not have capacity then consider pt best interest
- consider past wishes
- consult with relevant others
- choose lease restrictive option
Ask about welfare guardian or power of attroney
Do pulp extirpation then refer to GDP who have training to complete section 47 for XLA
