Special Care: Oncology

Question 1

What is our role in pre-assessment and treatment before a patient has cancer treatment? (5)

Answer 1

assess the patient and carry out the necessary dental treatment in order to remove disease and potential disease (dentally fit) before the patient starts their cancer treatment - must be radical to prevent interruption of cancer treatment

emphasise oral hygiene instruction to maintain a disease free mouth and prevent worsening Mucositis

emphasise prevention

start fluoride therapy

plan rehabilitation

Question 2

What are the oral side effects of radiotherapy? (6)

Answer 2

Ulceration and Mucositis

fibrosis of muscles and tissues = truisms

dry mouth from damage to the salivary glands = dental caries and denture retention problems

osteoradionecrosis from endarteritis

infections

caries - incisal edges and cervical

Question 3

how does Mucositis impact the patients mouth?

Answer 3

pain means that the patient struggles to carry out oral hygiene

Question 4

How can we manage Mucositis?

Answer 4

Avoid;
smoking, spirits, spice, tea/coffee and mouthwash (not prescribed)

use;
topical lignocaine gel 
ice chips 
saline mouthwash 
sodium bicarbonate mouthwash

Question 5

How can we PREVENT Mucositis?

Answer 5

Aloe vera

Amifostine (radio protective agent)

low level laser light (children)

Manuka honey

chlorhexidine

cryotherapy

keratinocyte growth factor

Question 6

how do we commonly treat Mucositis?

Answer 6

low level laser light theory and morphine

Question 7

What occurs after damage to the salivary glands during radiotherapy?

Answer 7

xerostomia from;

saliva increasing in viscosity
saliva pH drops = acidic

Question 8

What are the impacts of xerostomia?

Answer 8

Difficulty with;
mastication and swallowing 
denture retention
speaking 
altered taste 

increased;
caries
periodontal d
sialadenitis

Question 9

What kind/pattern of caries is usually found after radiation?

Answer 9

Cervical/smooth surface caries

caries on the incisai edge

Question 10

What occurs in osteoradionecrosis?

Answer 10

endarteritis obliterans - damage to the blood vessels supplying the bone

(commonly mandible)

Question 11

How can we manage the dentition of those with osteoradionecrosis?

Answer 11

remove teeth with poor prognosis before treatment

emphasise prevention

if having to remove teeth prescribe vitamin E for 6 weeks before

Question 12

when assessing a patient for dental treatment before they have cancer treatment what should we know?

Answer 12

start date of therapy

what kind of therapy radio/chemo - what type of chemo

Question 13

How long before cancer treatment should we extract a tooth?

Answer 13

10-14 days

Question 14

should we carry out ends treatment before cancer treatment? why?

Answer 14

no

requires lots of appointments - short window before treatment

60% success = possible need for retreatment

assess caries risk

Question 15

What are the side effects of chemotherapy on the whole body ? (6)

Answer 15

anaemia from reduction in RBC
low WBC
low platelets
Reduced neutrophils

nausea and vomiting
hair loss

Question 16

how long after chemotherapy do cell counts start to drop?

Answer 16

10-14 days

Question 17

when is best to treat a patient after they have had chemo? why?

Answer 17

Always liaise with the oncologist

anytime 21 days after chemo has been given - cell counts start to rise again

Question 18

what level should neutrophils be to allow us to treat the patient?

Answer 18

> 1

Question 19

what is important to remember in patients with breast cancer?

Answer 19

Commonly metastasises to the bone - so they might also be on bisphosphonates = high risk for MRONJ

Question 20

What are the risk factors for head and neck cancer?

Answer 20

Smoking 
alcohol 
(both = synergistic) 
HPV
Sunlight 
Pre existing mucosal abnormalities

Question 21

What dose of radiotherapy increases the chance of osteoradionecrosis?

Answer 21

50 - 60

Question 22

what are the oral side effects of chemo therapy? (6)

Answer 22

– Xerostomia – from damage to the salivary glands

– Mucositis – atrophy of the mucosa (ulceration)

– Gingivitis from defective haemostasis

_ Gingival enlargement & haemorrhage

– Prone to infection (fungal, bacterial and viral)

– Vinchristine used in chemo can cause trismus and jaw pain