SPECIAL CARE h+n oncology

Question 1

what is the role of the dental team pre cancer treatment?

Answer 1

remove potential sources of infection so cancer treatment can proceed without delay

Question 2

what are the adjunctive cancer treatments?

Answer 2

radiotherapy
chemotherapy
chemo-radiotherapy

Question 3

what type of radiation does radiotherapy use?

Answer 3

ionising radiation

Question 4

how does radiotherapy target cancer cells?

Answer 4

the ionising radiation kills the DNA of cancer cells
it also destroys healthy cells

Question 5

what glands are sensitive to radiotherapy?

Answer 5

salivary glands

Question 6

what are the types of radiotherapy?

Answer 6

conventional
IMRT
‘rapid arc’

Question 7

what are the general side effects of radiotherapy (exam q)?

Answer 7

fatigue
nausea
burns
pain

Question 8

what are the oral side effects of radiotherapy (exam q)?

Answer 8

mucositis
xerostomia
radiation caries
periodontal disease
dysgeusia/ ageusia
trismus
osteoradionecrosis

Question 9

what is dysgeusia?

Answer 9

loss of one or more taste sensations

Question 10

what is aguesia?

Answer 10

no taste

Question 11

can you recover from dyguesia/ aguesia?

Answer 11

may recover after 9-18 months
may be permanent

Question 12

what treatment may you deliver as a GDP to a pt prior to cancer tx?

Answer 12

xla of hopeless teeth
duraphat toothpaste and varnish
fluoride trays
HPT
therabite
pharmaceuticals
LLLT

Question 13

how does mucositis present?

Answer 13

Grade 0 = No oral mucositis.
Grade 1 = Erythema and soreness.
Grade 2 = Ulcers, able to eat solids.
Grade 3 = Ulcers, requires a liquid diet (due to mucositis)
Grade 4 = Ulcers, alimentation not possible (due to mucositis

Question 14

describe radiation caries?

Answer 14

circumferential pattern of caries on every tooth - aggressive and difficult to treat due to risk of crown fracturing off

Question 15

what taste sensation normally remains intact with dyguesia?

Answer 15

sweet

Question 16

what is a normal measurement of mouth opening?

Answer 16

35-55mm

Question 17

list types of teeth that would be classed as hopeless and in need of xla prior to cancer tx?

Answer 17

gross caries
mobile teeth (grade 2>)
pockets 5mm and greater
periapical pathology
furcation involvement

Question 18

what are the 2 available strengths of duraphat?

Answer 18

2800ppm
5000ppm

Question 19

how would you instruct a pt to use fluoride trays?

Answer 19

fill with duraphat toothpaste or fluoride mousse
minimum 5 min daily wear

Question 20

what devices can help pts trismus?

Answer 20

therabite
‘pat bite’
spatulas

Question 21

what pharmaceuticals can be prescribed to pts post radiation?

Answer 21

pentoxyfylline
vitamin E

Question 22

what is used for the hypoxia theory of ORN?

Answer 22

hyperbaric oxygen

Question 23

explain the hypoxia theory of ORN?

Answer 23

hyperbaric oxygen increases oxygen to damaged bone
promotes healing?
not widely available

Question 24

what is LLLT?

Answer 24

low level laser therapy
currently undergoing trials

Question 25

what should be prescribed to patients undergoing chemotherapy?

Answer 25

duraphat toothpaste and mouthwash

Question 26

what are the 3 types of chemotherapy?

Answer 26

neoadjuvant/ induction chemotherapy (before surgery) adjuvant chemotherapy +/- radiotherapy (after surgery) palliative chemotherapy

Question 27

how does chemotherapy work?

Answer 27

using drugs to kill rapidly dividing cells interferes with mitosis interferes with apoptosis interferes with tumour cell DNA

Question 28

name 3 chemotherapy drugs?

Answer 28

cisplatin cetuximab TPF

Question 29

what are the general side effects of chemotherapy drugs?

Answer 29

fatigue nausea vomiting+diarrhoea skin rash hair loss thrombocytopenia neutropenia

Question 30

what are the oral side effects of chemotherapy drugs?

Answer 30

mucositis infection bleeding temporary zerostomia?

Question 31

what can we do as dental professionals for a pt with mucositis?

Answer 31

soft splints caphosol LLLT? HPT before chemo starts

Question 32

what is caphosol?

Answer 32

Caphosol is a calcium phosphate solution resembling human saliva that is intended to replace the normal ionic and pH balance in the oral cavity. It has been used as a mouth rinse to moisten, lubricate, and clean the oral mucosa, tongue, and throat.

Question 33

what must be checked if XLA is needed during/ soon after chemotherapy?

Answer 33

blood test - FBC, coag screen

Question 34

what is thrombocytopenia?

Answer 34

low platelets = no clotting

Question 35

what is neutropenia?

Answer 35

low neutrophils = immunosuppressed

Question 36

what is HPT?

Answer 36

hygiene based therapy

Question 37

what is pentoxifylline?

Answer 37

vasodilator

Question 38

name a brand of flavour free toothpaste?

Answer 38

oronurse

Question 39

what ingredient in toothpaste can pts who have just had radiotherapy not tend to tolerate?

Answer 39

sodium lauryl sulphate