BDS3 Special Care Dentistry > oncology > Flashcards

oncology Flashcards

(49 cards)

Study These Flashcards
1
Q

if pt tells you reason for teeth being broken should you include in your notes?

A

yes

needs to be clear if known cause as pt can come back with legal claim in months to come

e.g. upper teeth broken during intubation procedure for surgery

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2
Q

omeprazol

A

proton pump inhibitor

reflux

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3
Q

tramadol

A

strong painkiller

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4
Q

citalopram

A

antidepressant

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5
Q

recommended untis of alcohol per week

A

14

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6
Q

how to explain units to pt

A

ask what she is drinking

use drink aware website to show

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7
Q

if pt says they use non-fluoride toothpaste

A

ask why

explain benefits of F - strengthen tooth mineral

not going to give cancer

evidence based - cochrane reviews

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8
Q

is you get a dentally anxious pt how to deal with them

A

ask why they are anxious?

trigger? past experience? anything you can do to help? would they be interested in relaxation techniques?

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9
Q

BPE 2

A

supra gingival plaque and calculus

BOP

<3.5mm pocket

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10
Q

BPE 3

A

probe goes into pocket but black band partially visible 3.5-5.5mm

supragingival plaque and calculus

BOP

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11
Q

managment BPE 2

A

OHI

calculus and overhang removal

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12
Q

management BPE 3

A

6PPC in that sextant after tx

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13
Q

pre cancer therapy dentally fit key

A

remove all potential sources of infection

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14
Q

prevention for pt about to go into chemo

A

enhanced prevention level F - emphasise importance due to dental health risk during chemo (lower immune)

take impressions for F trays and secondary ones incase splint needed if mucositis or ulceration occurs

diet diary to evaluate caries risk and modifications that can be made

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15
Q

radiographic report

A

A

21 and 11 - can see fracture on 21

RCT - adequate down to apex and no voids/air bubbles, 11 GP exposed clinically - could expose to bacteria and saliva - inadequate seal - may need redone

Periapical healthy - OK, PDL ligament widening on mesial 21, not PA lesion on 11 as can see PDL going round tooth

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16
Q

what if you saw this toth in a pt about to go into chemo tx and it has previously been RCT

A

GP exposed risk infection

  • Chemo - extract

If fit and healthy - maybe post crown

  • ferrule? tooth tissue that surround that is able to support post - don’t want flat top
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17
Q

radiographic report

A

A

  • No overlap
  • Can see crowns clearly

Restorations occlusal 16 and 46 amalgams, 47 (composite)

Interproximal caries possible 45 and 46

  • Just into enamel so don’t want to go into (depending on caries risk assessment)

45 likely just into dentine distal xrays 6 months behind

  • When go into 5 assess 6 with probe

White shadow in 17 - pulp stones - calcifications - asymptomatic

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18
Q

radiographic report

A

A old be 2 (as want to see mesial distal entirely)

  • Minimal overlap, Crowns seen
  • likely clearer on clinical screen

37 - secondary caries mesial

36 mesial caries

Gross caries distal 25 and 26

  • Breach pulp - no pain - non-vital
  • extract

Widening PDL 37

Bone loss upper left

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19
Q

chemotherapy aims

A

Kill cancer cells and stop reproducing

Targets specific cells - rapidly dividing cells

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20
Q

side effects chemotherap (10)

Study These Flashcards
A
  • Tired
  • weaken immune system - infection risk
  • Hair loss
  • Nausea/vomitting
  • Reproductive issues
  • Urine issues
  • dry mouth
  • mucositis
  • oral infection
  • haemorrhage

variation

21
Q

mucositis

Study These Flashcards
A

inflammation of mucous membranes

Can vary widly

  • Sometimes cant eat/drink, speak, sleep
    • Take away indpedence

10 days to occur post chemo - 5 days to peak and 5 days to resolve

  • Endless cycle through chemo tx
22
Q

mucositis aids

Study These Flashcards
A

Topical anaesthetic to relieve before eating

  • lidocaines sprays, mouthrinse - can be nippy to apply

Oral hygiene

  • Gauze (muslin cloth) with chlorohexidine/salty water (if too nippy gently) wipe round
  • Soft silk toothbruhses

Mouth rinse - cooling (calcisol)

Oral cooling - ice lolly or suck on ice to help soothe

F trays

  • bumps in retainers to place toothpaste in and prevent rubbing - prevent sore rubbing and apply F
23
Q

grades of mucositis

Study These Flashcards
A

based on side effects

  • 0 (none)
  • I (mild)
  • II (moderate)
  • III (severe)
  • IV (life-threatening)

WHO Oral mucositis grading scale

24
Q

mucositis grade 0

Study These Flashcards
A

no side effects

25
grade I mucositis
oral soreness erythema
26
grade II mucositis
oral erythema ulcers solid diet tolerated
27
grade III mucositis
oral ulcers liquid diet only
28
grade IV mucositis
life-threatening oral alimentation impossible
29
white oral lesion that can be scaped off and removed
fungal - candida | (can leave skin raw/bleed)
30
candida infection type
oppurtunistic takes advantage when immune system low
31
tx for candida
topical antifungals * miconazole gel * nystatin liquid if neither work consider a systemic antifungal (fluconazole) - issue interact with many medications (warfarin etc)
32
what is this lesion can be scraped off
candida infection can occur in cancer tx as immune system down and oppurtunistic infection
33
what is this
cold sores
34
how can cold sores occur due to cancer tx
immunosuppressed so herpes simplex virus can run rampant and cause multiple cold sores
35
tx for herpes simplex caused cold sores
antivital medicatins acyclovir tablets (5 tablets daily for 7 days) if prone to cold sores can be given prophylatically
36
what is this
dry mouth polypharmacy
37
tx for dry mouth
regular sips of plain water saliva replacement - orabalance (SDCEP) some contain gelatin - warn
38
if pt comes in middle of chemotherapy with buccal abscess what are concerns
infection * Spread to blood stream and has weakened immune system due to chemo * can die due to chemo dental infection spread
39
chemotherapy affect on blood cells
Pancytopenia - reduction in all * white blood cells reduced - infection * RBC - anaemic risk * Platelets down - bleeding risk * \< 50 don’t touch not stop bleeding, * \>50 - delicate but should stop bleeding Need FBC before tx
40
tx options for buccal abscess during chemotherapy
* Do nothing - *don't recommend* * Remove the tooth - *platelet and healing issue* * Incise and Drain the abscess - *short term measure - as can come back - wont deal with problem - bleeding and infection risk* * re-RCT - *timely, multiple appointments, lower success rates compared to 1st time* * Antibiotics - *tiding someone over until in a better state to get tx* ## Footnote **Consult oncology team**
41
if pt had cancer tx in past what would you like to know
* what tx they had - radiotherapy, chemotherapy, combination? * where * duration of * any side effects * how long been in remission/no tx plan his tx in future likely if had radiotherapy in past will affect him now
42
radiotherapy of head and neck cancers
radiation hit towards certain points * mask, immobilise head and neck so cant move * got to get through tissues to reach target - side effects on surrounding tisues
43
smoking and alcohol oral cancer link
both individually increase the risk of oral cancer cumulative effect together
44
smoking 3 As
ask - how long? what? considered quitting? advice - health benefits - reduce systemic disease risk act - signpost to specialist cessation services, get pharamacy quit kits
45
report
OPT radiograph - A Caries 37 DO, 17 D * radiation caries - saliva issue, cervical margin region caries (not pit and fissure) 8s weird angle on mandible - close proximity to IAN Severe bone loss lower right (only 48 present) * necrotic bone - Osteoradionecrosis Need reconstruct with bone from femus
46
osteoradionecrosis
death of bone due to radiation - small BV get endoarteritis obliterans - shrink down so not deleiver blood --\> bone death 5 years post radio or longer * Extractions wont heal - gum not close over - infection * Denture wont sit possibly * Lower jaw can fracture as no healthy bone to keep together
47
side effects of head and neck radiotherapy
osteoradionecrosis fibrosis of muscles
48
impact of fibrosis of head and neck muscles
thicker less stretch smaller mouth opening - access harder * OHI and dental care issue
49
importance of dental pre-assessment to cancer tx
can provide tx necessary before unable to as reduced mouth opening OHI and prevention instructions
BDS3 Special Care Dentistry
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