SlideShare a Scribd company logo
1 of 85
Download to read offline
Oral Care for Cancer patients By Renee Anderson, LDH.
Treating Cancer Patients Do you know how to treat a patient who is diagnosed with cancer? What procedures should be done prior to chemotherapy and/or radiation treatments? What treatment can be done during chemotherapy and/or radiation treatments? What to do if oral complications arise during chemotherapy and/radiation treatments?
Cancer Cancer is the uncontrolled growth of abnormal cells in the body.
Chemotherapy Chemotherapy----most chemotherapy drugs cause all dividing cells to die, and since the mucous membranes are composed of rapidly dividing cells, these tissues do not replenish during intense therapy. Mucous membranes form a barrier against infections, and without them the mouth can become inflamed, and opportunistic bacterial, yeast and fungal infections can occur.
Chemotherapy ,[object Object]
Chemo can cause drops in ANC (absolute neutrophil count) which makes it harder to fight off infections.
Low platelet counts means that brushing and flossing can cause bleeding.
In children, development of the teeth can be adversely affected by radiation and intensive chemotherapy protocols.,[object Object]
Prior to Chemotherapy ,[object Object]
Pano and FMX
Periodontal evaluation
Oral exam/cancer screening
Identify and treat existing infections, carious and other compromised teeth, and tissue injury or trauma.
Stabilize or eliminate potential sites of infection.
Conduct a prosthodontic evaluation if indicated. If a removable prosthesis is worn, make sure that it is clean and well adapted to the tissue. Instruct the patient not to wear the prosthesis during treatment, if possible; or at the least, not to wear it at night. ,[object Object]
Schedule oral surgery at least 7 to 10 days before myelosuppressive therapy begins.
Perform oral prophylaxis if indicated.
Smoking cessation!,[object Object]
Chemotherapy The oral complications of chemotherapy depend upon the drugs used, the dosage, the degree of dental disease, and the use of radiation. Chemoradiation therapy carries a significant risk for mucositis.
Consult the oncologist before conducting any oral procedures in patients with hematologic cancers; do not conduct procedures in patients who are immunosuppressed or have thrombocytopenia.
Questions to Ask the Medical Oncologist What is the patient’s complete blood count, including absolute neutrophil and platelet counts?  If an invasive dental procedure needs to be done, are there adequate clotting factors?  Does the patient have a central venous catheter?
What is the scheduled sequence of treatments so that safe dental treatment can be planned?  Is radiation therapy also planned?
Complete Blood Count and  Chemotherapy  ,[object Object]
Anemia (ah-NEE-mee-ah) is the scientific name for a low red blood cell count.
Thrombocytopenia (throm-boh-sy-toh-PEE-nee-ah) is the scientific name for a low platelet count. A low platelet count may cause you to experience bruising or excessive bleeding.,[object Object]
Ask the oncologist to order blood work 24 hours before oral surgery or other invasive procedures. Postpone when
the platelet count is less than 75,000/mm3 or abnormal clotting factors are present
absolute neutrophil count is less than 1,000/mm3, or consider prophylactic antibiotics (www.americanheart.org/presenter.jhtml?identifier=1200000,[object Object]
Due to the lack of saliva, the plaque builds up faster therefore cleanings may be every 2 mos. And check for mouth sores and decay.  (ANC and WBC Count permitting)
Emergency treatment can be done with any hematologic status to remove source of infection,  work with oncologist,  if count under 40,000mm consider platelet replacement.
Use of chlorahexidine prior to treatment and after can help cut down on chance of infection.  (give chairside),[object Object]
During chemo and radiation ,[object Object]
Anti-bacterial mouth rinses
Peridex-  can prevent infections  (alcohol free peridex)
Stains teeth
Taste bad
0.63% Stannous Fluoride--  ask oncologist if can substitute for peridex
Stannous part is anti-microbial
Does not stain teeth
Taste better
Fights cavities
Stanimax,  periomed.,[object Object]
Patients under intense chemo are at risk for fungal and yeast as well as bacterial infections
Nystatin to prevent fungal infections,  can be used to prevent or treat.
Mycostatin or Nilstat rinses-  “swish and swallow” because these infections can be in the throat passage as well as in the mouth.
Mycelex lozenges.
Thrush is the most common mouth infection during chemo.,[object Object]
If toothpaste irritates patients mouth, use a mixture of ½ teaspoon of salt with 4 cups water. Gargle regularly with a solution made up of: 1quart of plain water ½ teaspoon table salt ½ teaspoon baking soda
[object Object]
Identify and treat potential oral problems within the proposed radiation field before radiation treatment begins.
Instruct patients about oral hygiene.
Educate patients on preventing demineralization and dental caries.,[object Object]
During Chemo ,[object Object]
Sores or lesions can occur even in the absence of bacterial or fungal infection, but once there they should be treated with anti-bacterial agents to prevent infection.
Glutamine—helps and lessens mucositis.
Saforis-  a patented, topical, oral suspension of glutamine.
Magic mouth wash- mixture of   benadryl, maalox, nystatin, and lidocaine.
Baking soda and water- aids in healing and neutralizes acid.
Stannous fluoride.
Hot stuff  --Cayenne pepper candy.,[object Object]
Osteonecrosis of the jaw.
Chemo for breast cancer After breast cancer chemo patients may be placed on a estrogen reducer drug femmoren and then on IV bisphosphantates
After chemotherapy ,[object Object]
Once all complications of chemotherapy have resolved, patients may be able to resume their normal dental care schedule. However, if immune function continues to be compromised, determine the patient’s hematologic status before initiating any dental treatment or surgery. This is particularly important to remember for patients who have undergone stem cell transplantation. Ask if the patient has received intravenous bisphosphonate therapy,[object Object]
Head and Neck Radiation Therapy
Radiation Radiation----some people who get radiation to the head/neck (and sometimes chest) areas have redness and soreness in the mouth, a dry mouth, trouble swallowing, changes in taste, or nausea.   Other possible side effects include a loss of taste, earaches, and swelling,  jaw stiffness and jaw bone changes.
Patients receiving radiation therapy to the head and neck are at risk for developing oral complications. Because of the risk of osteonecrosis in irradiated fields, oral surgery should be performed before radiation treatment begins.
Prior to Head/Neck Radiation ,[object Object]
Pano and FMX
Periodontal evaluation
Oral exam/cancer screening
Identify and treat existing infections, carious and other compromised teeth, and tissue injury or trauma.
Stabilize or eliminate potential sites of infection.
Extract teeth in the radiation field that are non-restorable or may pose a future problem to prevent later extraction-induced osteonecrosis.
Conduct a prosthodontic evaluation if indicated. If a removable prosthesis is worn, make sure that it is clean and well adapted to the tissue. Instruct the patient not to wear the prosthesis during treatment, if possible; or at the least, not to wear it at night.
Perform oral prophylaxis if indicated. ,[object Object]
Be sure that the trays cover all tooth structures without irritating the gingival or mucosal tissues. Instruct the patient in home application of fluoride gel.  Several days before radiation therapy begins, the patient should start a daily 10-minute application. Have patients brush with a flouride gel if using trays is difficult.
Allow at least 14 days of healing for any oral surgical procedures. Conduct prosthetic surgery before treatment, since elective surgical procedures are contraindicated on irradiated bone.
Questions to Ask the Radiation Oncologist What parts of the mandible/maxilla and salivary glands are in the field of radiation?  What is the total dose of radiation the patient will receive, and what will be the impact on these areas?  Has the vascularity of the mandible been previously compromised by surgery?
How quickly does the patient need to start radiation treatment?  Will there be induction chemotherapy with the radiation treatment?
During Radiation Therapy Monitor the patient’s oral hygiene. Watch for mucositis and infections. Advise against wearing removable appliances during treatment.
After Radiation Therapy Recall the patient for prophylaxis and home care evaluation every 4 to 8 weeks or as needed for the first 6 months after cancer treatment.  Reinforce the importance of optimal oral hygiene
[object Object]
Consult with the oncology team about use of dentures and other appliances after mucositis subsides. Patients with friable tissues and xerostomia may not be able to wear them again. ,[object Object]
	Amifostine (ethyol)—protects salivary tissues against radiation damage.  Approved for reducing dry mouth. May also reduce mouth sores:   research is ongoing. 	N-acetylcysteine (RK-0202)  -  prevents inflammation due to radiation therapy.

More Related Content

What's hot

Post endodontic restoration/ orthodontic continuing education
Post  endodontic restoration/ orthodontic continuing educationPost  endodontic restoration/ orthodontic continuing education
Post endodontic restoration/ orthodontic continuing educationIndian dental academy
 
Traumatic injuries of teeth
Traumatic injuries of teethTraumatic injuries of teeth
Traumatic injuries of teethChelsea Mareé
 
Cysts and Odontogenic tumors
Cysts and Odontogenic tumorsCysts and Odontogenic tumors
Cysts and Odontogenic tumorsZaher Safadi
 
Molar incisor hypomineralization
Molar incisor  hypomineralization Molar incisor  hypomineralization
Molar incisor hypomineralization Aya Adel
 
Solitary oral ulcers and systemic diseases
Solitary oral ulcers and systemic diseasesSolitary oral ulcers and systemic diseases
Solitary oral ulcers and systemic diseasesDr. Harsh Shah
 
K-oral.m-Normal anatomical-variants
K-oral.m-Normal anatomical-variantsK-oral.m-Normal anatomical-variants
K-oral.m-Normal anatomical-variantsYahya Almoussawy
 
Management of traumatic dental injury of primary teeth
Management of traumatic dental  injury of primary teethManagement of traumatic dental  injury of primary teeth
Management of traumatic dental injury of primary teethDr. Akash Ardeshana
 
What is Xerostomia?
What is Xerostomia?What is Xerostomia?
What is Xerostomia?Dentaid
 
preventive strategies in paediatric dentistry
preventive strategies in paediatric dentistrypreventive strategies in paediatric dentistry
preventive strategies in paediatric dentistryIAU Dent
 
dental management of Git disease patient
 dental management of Git disease patient dental management of Git disease patient
dental management of Git disease patientvidushiKhanna1
 
Dental Crown & Bridges Restores Beautiful Smile & Confidence
Dental Crown & Bridges Restores Beautiful Smile & ConfidenceDental Crown & Bridges Restores Beautiful Smile & Confidence
Dental Crown & Bridges Restores Beautiful Smile & ConfidenceDr. Ace Jovanovski
 
Traumatic injuries of teeth
Traumatic injuries of teethTraumatic injuries of teeth
Traumatic injuries of teethKUMARAVEL SM
 

What's hot (20)

Post endodontic restoration/ orthodontic continuing education
Post  endodontic restoration/ orthodontic continuing educationPost  endodontic restoration/ orthodontic continuing education
Post endodontic restoration/ orthodontic continuing education
 
Traumatic injuries of teeth
Traumatic injuries of teethTraumatic injuries of teeth
Traumatic injuries of teeth
 
Cysts and Odontogenic tumors
Cysts and Odontogenic tumorsCysts and Odontogenic tumors
Cysts and Odontogenic tumors
 
Inlay
InlayInlay
Inlay
 
Leukoplakia
LeukoplakiaLeukoplakia
Leukoplakia
 
Molar incisor hypomineralization
Molar incisor  hypomineralization Molar incisor  hypomineralization
Molar incisor hypomineralization
 
Hall technique
Hall techniqueHall technique
Hall technique
 
Solitary oral ulcers and systemic diseases
Solitary oral ulcers and systemic diseasesSolitary oral ulcers and systemic diseases
Solitary oral ulcers and systemic diseases
 
Space maintainers
Space maintainers Space maintainers
Space maintainers
 
Resin bonded fixed partial denture
Resin bonded fixed partial dentureResin bonded fixed partial denture
Resin bonded fixed partial denture
 
K-oral.m-Normal anatomical-variants
K-oral.m-Normal anatomical-variantsK-oral.m-Normal anatomical-variants
K-oral.m-Normal anatomical-variants
 
Cysts in children
Cysts in childrenCysts in children
Cysts in children
 
Management of traumatic dental injury of primary teeth
Management of traumatic dental  injury of primary teethManagement of traumatic dental  injury of primary teeth
Management of traumatic dental injury of primary teeth
 
What is Xerostomia?
What is Xerostomia?What is Xerostomia?
What is Xerostomia?
 
preventive strategies in paediatric dentistry
preventive strategies in paediatric dentistrypreventive strategies in paediatric dentistry
preventive strategies in paediatric dentistry
 
dental management of Git disease patient
 dental management of Git disease patient dental management of Git disease patient
dental management of Git disease patient
 
NON CARIOUS TOOTH SURFACE LOSS
NON CARIOUS TOOTH SURFACE LOSSNON CARIOUS TOOTH SURFACE LOSS
NON CARIOUS TOOTH SURFACE LOSS
 
Dental Crown & Bridges Restores Beautiful Smile & Confidence
Dental Crown & Bridges Restores Beautiful Smile & ConfidenceDental Crown & Bridges Restores Beautiful Smile & Confidence
Dental Crown & Bridges Restores Beautiful Smile & Confidence
 
Traumatic injuries of teeth
Traumatic injuries of teethTraumatic injuries of teeth
Traumatic injuries of teeth
 
Oral Pathology
Oral PathologyOral Pathology
Oral Pathology
 

Viewers also liked

The Dangers of Tobacco Use in Oral and Systemic Health
The Dangers of Tobacco Use in Oral and Systemic HealthThe Dangers of Tobacco Use in Oral and Systemic Health
The Dangers of Tobacco Use in Oral and Systemic HealthLauryn Tuttle
 
Reconstruction of ca defects (nx power lite)
Reconstruction of ca defects (nx power lite)Reconstruction of ca defects (nx power lite)
Reconstruction of ca defects (nx power lite)Indian dental academy
 
Information about dry mouth syndrome
Information about dry mouth syndromeInformation about dry mouth syndrome
Information about dry mouth syndromenancylopez320
 
Radiation and radiotherapy prosthodontics 2015
Radiation and radiotherapy prosthodontics 2015Radiation and radiotherapy prosthodontics 2015
Radiation and radiotherapy prosthodontics 2015Muaiyed Mahmoud Buzayan
 
Tumors of the oral cavity and oropharynx
Tumors of the oral cavity and oropharynxTumors of the oral cavity and oropharynx
Tumors of the oral cavity and oropharynxSaeed Ullah
 
Oral care for cancer patients power point
Oral care for cancer patients  power pointOral care for cancer patients  power point
Oral care for cancer patients power pointrenee pryor
 
Mucosal Response To Oral Prostheses
Mucosal Response To Oral ProsthesesMucosal Response To Oral Prostheses
Mucosal Response To Oral ProsthesesDr Aaron Sarwal
 
Oral cancer
Oral cancerOral cancer
Oral cancerIAU Dent
 
Oncologic emergencies
Oncologic emergenciesOncologic emergencies
Oncologic emergenciesMohd Hanafi
 
Dental hygiene and oral care
Dental hygiene and oral careDental hygiene and oral care
Dental hygiene and oral careManisha Saxena
 
Oral Mucositis In Cancer Care
Oral Mucositis In Cancer CareOral Mucositis In Cancer Care
Oral Mucositis In Cancer Carefondas vakalis
 

Viewers also liked (20)

The Dangers of Tobacco Use in Oral and Systemic Health
The Dangers of Tobacco Use in Oral and Systemic HealthThe Dangers of Tobacco Use in Oral and Systemic Health
The Dangers of Tobacco Use in Oral and Systemic Health
 
Reconstruction of ca defects (nx power lite)
Reconstruction of ca defects (nx power lite)Reconstruction of ca defects (nx power lite)
Reconstruction of ca defects (nx power lite)
 
Intraoral Prosthetics
Intraoral ProstheticsIntraoral Prosthetics
Intraoral Prosthetics
 
Oral cancer
Oral cancerOral cancer
Oral cancer
 
Information about dry mouth syndrome
Information about dry mouth syndromeInformation about dry mouth syndrome
Information about dry mouth syndrome
 
Oral cancer seminar
Oral cancer seminarOral cancer seminar
Oral cancer seminar
 
Radiation and radiotherapy prosthodontics 2015
Radiation and radiotherapy prosthodontics 2015Radiation and radiotherapy prosthodontics 2015
Radiation and radiotherapy prosthodontics 2015
 
Tumors of the oral cavity and oropharynx
Tumors of the oral cavity and oropharynxTumors of the oral cavity and oropharynx
Tumors of the oral cavity and oropharynx
 
Epidemiology of Oral Cancer
Epidemiology of Oral Cancer Epidemiology of Oral Cancer
Epidemiology of Oral Cancer
 
Oral care for cancer patients power point
Oral care for cancer patients  power pointOral care for cancer patients  power point
Oral care for cancer patients power point
 
Mucosal Response To Oral Prostheses
Mucosal Response To Oral ProsthesesMucosal Response To Oral Prostheses
Mucosal Response To Oral Prostheses
 
Oncologic emergencies
Oncologic emergenciesOncologic emergencies
Oncologic emergencies
 
Maxillofacial prosthodontics
Maxillofacial prosthodonticsMaxillofacial prosthodontics
Maxillofacial prosthodontics
 
Oral cancers
Oral cancersOral cancers
Oral cancers
 
Oral Cancer
Oral CancerOral Cancer
Oral Cancer
 
Oral cancer
Oral cancerOral cancer
Oral cancer
 
Oncologic emergencies
Oncologic emergenciesOncologic emergencies
Oncologic emergencies
 
Oral cancer
Oral cancerOral cancer
Oral cancer
 
Dental hygiene and oral care
Dental hygiene and oral careDental hygiene and oral care
Dental hygiene and oral care
 
Oral Mucositis In Cancer Care
Oral Mucositis In Cancer CareOral Mucositis In Cancer Care
Oral Mucositis In Cancer Care
 

Similar to Oral care for cancer patients power point

Dental management of children under chemotherapy
Dental management of children under chemotherapyDental management of children under chemotherapy
Dental management of children under chemotherapyRiwa Kobrosli
 
Management of oral problem in Palliative care setting
Management of oral problem in Palliative care setting Management of oral problem in Palliative care setting
Management of oral problem in Palliative care setting jenishaadhikari
 
dental management of chemotherapy patients
dental management of chemotherapy patients  dental management of chemotherapy patients
dental management of chemotherapy patients Eman Hassona
 
oral management of chemotherapy and radiation
oral management of chemotherapy and radiation oral management of chemotherapy and radiation
oral management of chemotherapy and radiation Eman Hassona
 
ORAL MEDICINE AND PHARMACOLOGY.docx
ORAL MEDICINE AND PHARMACOLOGY.docxORAL MEDICINE AND PHARMACOLOGY.docx
ORAL MEDICINE AND PHARMACOLOGY.docxFaryal Saeed Abdal
 
Pre Radiotherapy Dental Management
Pre Radiotherapy Dental ManagementPre Radiotherapy Dental Management
Pre Radiotherapy Dental ManagementWendy Jeng
 
Medically compromised pedo .docx
Medically compromised pedo .docxMedically compromised pedo .docx
Medically compromised pedo .docxssuser3fdc1f1
 
"Management of the Patient Irradiated for Head and Neck Cancer"
"Management of the Patient Irradiated for Head and Neck Cancer""Management of the Patient Irradiated for Head and Neck Cancer"
"Management of the Patient Irradiated for Head and Neck Cancer"Jansen Calibo
 
Infective endocarditis
Infective endocarditisInfective endocarditis
Infective endocarditisUnni Krishna
 
Oral care of patients undergoing chemotherapy and
Oral care of patients undergoing chemotherapy andOral care of patients undergoing chemotherapy and
Oral care of patients undergoing chemotherapy andAlaa AlQutub
 
Orthodontics and medical disorders
Orthodontics and medical disordersOrthodontics and medical disorders
Orthodontics and medical disordersMaherFouda1
 
Diagnosis and treatment planning of Removable Partial Denture
Diagnosis and treatment planning of Removable Partial Denture Diagnosis and treatment planning of Removable Partial Denture
Diagnosis and treatment planning of Removable Partial Denture dwijk
 
Dental considerations for management of medically compromised 2018
Dental considerations for management of medically compromised 2018Dental considerations for management of medically compromised 2018
Dental considerations for management of medically compromised 2018Cairo university
 
Antibiotics in dentistry
Antibiotics in dentistryAntibiotics in dentistry
Antibiotics in dentistryUzair86
 
DISORDERS OF THE ORAL CAVITY
DISORDERS OF THE ORAL CAVITYDISORDERS OF THE ORAL CAVITY
DISORDERS OF THE ORAL CAVITYRamya569989
 
The minimal intervention dentistry
The minimal intervention dentistryThe minimal intervention dentistry
The minimal intervention dentistryParth Thakkar
 

Similar to Oral care for cancer patients power point (20)

Dental management of children under chemotherapy
Dental management of children under chemotherapyDental management of children under chemotherapy
Dental management of children under chemotherapy
 
Management of oral problem in Palliative care setting
Management of oral problem in Palliative care setting Management of oral problem in Palliative care setting
Management of oral problem in Palliative care setting
 
dental management of chemotherapy patients
dental management of chemotherapy patients  dental management of chemotherapy patients
dental management of chemotherapy patients
 
oral management of chemotherapy and radiation
oral management of chemotherapy and radiation oral management of chemotherapy and radiation
oral management of chemotherapy and radiation
 
ORAL MEDICINE AND PHARMACOLOGY.docx
ORAL MEDICINE AND PHARMACOLOGY.docxORAL MEDICINE AND PHARMACOLOGY.docx
ORAL MEDICINE AND PHARMACOLOGY.docx
 
medically compromised patients
medically compromised patientsmedically compromised patients
medically compromised patients
 
medically compromised patients
medically compromised patientsmedically compromised patients
medically compromised patients
 
Pre Radiotherapy Dental Management
Pre Radiotherapy Dental ManagementPre Radiotherapy Dental Management
Pre Radiotherapy Dental Management
 
Medically compromised pedo .docx
Medically compromised pedo .docxMedically compromised pedo .docx
Medically compromised pedo .docx
 
"Management of the Patient Irradiated for Head and Neck Cancer"
"Management of the Patient Irradiated for Head and Neck Cancer""Management of the Patient Irradiated for Head and Neck Cancer"
"Management of the Patient Irradiated for Head and Neck Cancer"
 
Infective endocarditis
Infective endocarditisInfective endocarditis
Infective endocarditis
 
Oral care of patients undergoing chemotherapy and
Oral care of patients undergoing chemotherapy andOral care of patients undergoing chemotherapy and
Oral care of patients undergoing chemotherapy and
 
Orthodontics and medical disorders
Orthodontics and medical disordersOrthodontics and medical disorders
Orthodontics and medical disorders
 
Diagnosis and treatment planning of Removable Partial Denture
Diagnosis and treatment planning of Removable Partial Denture Diagnosis and treatment planning of Removable Partial Denture
Diagnosis and treatment planning of Removable Partial Denture
 
Dental considerations for management of medically compromised 2018
Dental considerations for management of medically compromised 2018Dental considerations for management of medically compromised 2018
Dental considerations for management of medically compromised 2018
 
Antibiotics in dentistry
Antibiotics in dentistryAntibiotics in dentistry
Antibiotics in dentistry
 
DISORDERS OF THE ORAL CAVITY
DISORDERS OF THE ORAL CAVITYDISORDERS OF THE ORAL CAVITY
DISORDERS OF THE ORAL CAVITY
 
MRONJ
MRONJMRONJ
MRONJ
 
The minimal intervention dentistry
The minimal intervention dentistryThe minimal intervention dentistry
The minimal intervention dentistry
 
chemotherapy
chemotherapychemotherapy
chemotherapy
 

Recently uploaded

Bone Marrow Biopsy Needle in Hematology Diagnostics
Bone Marrow Biopsy Needle in Hematology DiagnosticsBone Marrow Biopsy Needle in Hematology Diagnostics
Bone Marrow Biopsy Needle in Hematology DiagnosticsNanchang Kindly Meditech
 
How to Choose the Right IV Catheter Needle
How to Choose the Right IV Catheter NeedleHow to Choose the Right IV Catheter Needle
How to Choose the Right IV Catheter NeedleNanchang Kindly Meditech
 
Shock Continuum - Sara Crager - TBS24.pdf
Shock Continuum - Sara Crager - TBS24.pdfShock Continuum - Sara Crager - TBS24.pdf
Shock Continuum - Sara Crager - TBS24.pdfscanFOAM
 
Musculoskeletal disorders: Osteoarthritis,.pptx
Musculoskeletal disorders: Osteoarthritis,.pptxMusculoskeletal disorders: Osteoarthritis,.pptx
Musculoskeletal disorders: Osteoarthritis,.pptxraviapr7
 
Rheumatoid arthritis - Musculoskeletal disorders.ppt
Rheumatoid arthritis - Musculoskeletal disorders.pptRheumatoid arthritis - Musculoskeletal disorders.ppt
Rheumatoid arthritis - Musculoskeletal disorders.pptraviapr7
 
Regulations are Crippling Precision Medicine.pdf
Regulations are Crippling Precision Medicine.pdfRegulations are Crippling Precision Medicine.pdf
Regulations are Crippling Precision Medicine.pdfJasper Colin
 
Challenges and Potential Solutions for Improving Health Technology Assessment...
Challenges and Potential Solutions for Improving Health Technology Assessment...Challenges and Potential Solutions for Improving Health Technology Assessment...
Challenges and Potential Solutions for Improving Health Technology Assessment...Canadian Cancer Survivor Network
 
SCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna ThakurSCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna ThakurSapna Thakur
 
liver, Biliary, & pancreatic secretions.pptx
liver, Biliary, & pancreatic  secretions.pptxliver, Biliary, & pancreatic  secretions.pptx
liver, Biliary, & pancreatic secretions.pptxDr.Nusrat Tariq
 
Hip Joint Biomechanics & its Kinetics and Kinematics
Hip Joint Biomechanics & its Kinetics and KinematicsHip Joint Biomechanics & its Kinetics and Kinematics
Hip Joint Biomechanics & its Kinetics and KinematicsRishiRajgude
 
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfSGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfHongBiThi1
 
Dissociative and Conversion Disorder and its associated types
Dissociative and Conversion Disorder and its associated typesDissociative and Conversion Disorder and its associated types
Dissociative and Conversion Disorder and its associated typesProf. (Dr.) Rahul Sharma
 
Systemic Lupus Erythematosus -SLE PT2.ppt
Systemic  Lupus  Erythematosus -SLE PT2.pptSystemic  Lupus  Erythematosus -SLE PT2.ppt
Systemic Lupus Erythematosus -SLE PT2.pptraviapr7
 
Abnormal uterine bleeding- Prof.HHY.pptx
Abnormal uterine bleeding- Prof.HHY.pptxAbnormal uterine bleeding- Prof.HHY.pptx
Abnormal uterine bleeding- Prof.HHY.pptxKyawMyoHtet10
 
Breast Cancer and its types, signs and symptoms
Breast Cancer and its types, signs and symptomsBreast Cancer and its types, signs and symptoms
Breast Cancer and its types, signs and symptomsnthanuja0331
 
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)MohamadAlhes
 
World-Health-Day-2024-My-Health-My-Right.pptx
World-Health-Day-2024-My-Health-My-Right.pptxWorld-Health-Day-2024-My-Health-My-Right.pptx
World-Health-Day-2024-My-Health-My-Right.pptxEx WHO/USAID
 
Vata-Rakta vyadhi nidana
Vata-Rakta vyadhi nidana Vata-Rakta vyadhi nidana
Vata-Rakta vyadhi nidana Jay Gondaliya
 
Somatoform Disorder, somatic symptoms and other types
Somatoform Disorder, somatic symptoms and other typesSomatoform Disorder, somatic symptoms and other types
Somatoform Disorder, somatic symptoms and other typesProf. (Dr.) Rahul Sharma
 

Recently uploaded (20)

Bone Marrow Biopsy Needle in Hematology Diagnostics
Bone Marrow Biopsy Needle in Hematology DiagnosticsBone Marrow Biopsy Needle in Hematology Diagnostics
Bone Marrow Biopsy Needle in Hematology Diagnostics
 
How to Choose the Right IV Catheter Needle
How to Choose the Right IV Catheter NeedleHow to Choose the Right IV Catheter Needle
How to Choose the Right IV Catheter Needle
 
Shock Continuum - Sara Crager - TBS24.pdf
Shock Continuum - Sara Crager - TBS24.pdfShock Continuum - Sara Crager - TBS24.pdf
Shock Continuum - Sara Crager - TBS24.pdf
 
Musculoskeletal disorders: Osteoarthritis,.pptx
Musculoskeletal disorders: Osteoarthritis,.pptxMusculoskeletal disorders: Osteoarthritis,.pptx
Musculoskeletal disorders: Osteoarthritis,.pptx
 
Rheumatoid arthritis - Musculoskeletal disorders.ppt
Rheumatoid arthritis - Musculoskeletal disorders.pptRheumatoid arthritis - Musculoskeletal disorders.ppt
Rheumatoid arthritis - Musculoskeletal disorders.ppt
 
Regulations are Crippling Precision Medicine.pdf
Regulations are Crippling Precision Medicine.pdfRegulations are Crippling Precision Medicine.pdf
Regulations are Crippling Precision Medicine.pdf
 
Challenges and Potential Solutions for Improving Health Technology Assessment...
Challenges and Potential Solutions for Improving Health Technology Assessment...Challenges and Potential Solutions for Improving Health Technology Assessment...
Challenges and Potential Solutions for Improving Health Technology Assessment...
 
SCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna ThakurSCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
 
Finite Therapy, Infinite Possibilities in CLL: Exploring the Rapid Emergence ...
Finite Therapy, Infinite Possibilities in CLL: Exploring the Rapid Emergence ...Finite Therapy, Infinite Possibilities in CLL: Exploring the Rapid Emergence ...
Finite Therapy, Infinite Possibilities in CLL: Exploring the Rapid Emergence ...
 
liver, Biliary, & pancreatic secretions.pptx
liver, Biliary, & pancreatic  secretions.pptxliver, Biliary, & pancreatic  secretions.pptx
liver, Biliary, & pancreatic secretions.pptx
 
Hip Joint Biomechanics & its Kinetics and Kinematics
Hip Joint Biomechanics & its Kinetics and KinematicsHip Joint Biomechanics & its Kinetics and Kinematics
Hip Joint Biomechanics & its Kinetics and Kinematics
 
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfSGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
 
Dissociative and Conversion Disorder and its associated types
Dissociative and Conversion Disorder and its associated typesDissociative and Conversion Disorder and its associated types
Dissociative and Conversion Disorder and its associated types
 
Systemic Lupus Erythematosus -SLE PT2.ppt
Systemic  Lupus  Erythematosus -SLE PT2.pptSystemic  Lupus  Erythematosus -SLE PT2.ppt
Systemic Lupus Erythematosus -SLE PT2.ppt
 
Abnormal uterine bleeding- Prof.HHY.pptx
Abnormal uterine bleeding- Prof.HHY.pptxAbnormal uterine bleeding- Prof.HHY.pptx
Abnormal uterine bleeding- Prof.HHY.pptx
 
Breast Cancer and its types, signs and symptoms
Breast Cancer and its types, signs and symptomsBreast Cancer and its types, signs and symptoms
Breast Cancer and its types, signs and symptoms
 
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
 
World-Health-Day-2024-My-Health-My-Right.pptx
World-Health-Day-2024-My-Health-My-Right.pptxWorld-Health-Day-2024-My-Health-My-Right.pptx
World-Health-Day-2024-My-Health-My-Right.pptx
 
Vata-Rakta vyadhi nidana
Vata-Rakta vyadhi nidana Vata-Rakta vyadhi nidana
Vata-Rakta vyadhi nidana
 
Somatoform Disorder, somatic symptoms and other types
Somatoform Disorder, somatic symptoms and other typesSomatoform Disorder, somatic symptoms and other types
Somatoform Disorder, somatic symptoms and other types
 

Oral care for cancer patients power point

  • 1. Oral Care for Cancer patients By Renee Anderson, LDH.
  • 2. Treating Cancer Patients Do you know how to treat a patient who is diagnosed with cancer? What procedures should be done prior to chemotherapy and/or radiation treatments? What treatment can be done during chemotherapy and/or radiation treatments? What to do if oral complications arise during chemotherapy and/radiation treatments?
  • 3. Cancer Cancer is the uncontrolled growth of abnormal cells in the body.
  • 4. Chemotherapy Chemotherapy----most chemotherapy drugs cause all dividing cells to die, and since the mucous membranes are composed of rapidly dividing cells, these tissues do not replenish during intense therapy. Mucous membranes form a barrier against infections, and without them the mouth can become inflamed, and opportunistic bacterial, yeast and fungal infections can occur.
  • 5.
  • 6. Chemo can cause drops in ANC (absolute neutrophil count) which makes it harder to fight off infections.
  • 7. Low platelet counts means that brushing and flossing can cause bleeding.
  • 8.
  • 9.
  • 13. Identify and treat existing infections, carious and other compromised teeth, and tissue injury or trauma.
  • 14. Stabilize or eliminate potential sites of infection.
  • 15.
  • 16. Schedule oral surgery at least 7 to 10 days before myelosuppressive therapy begins.
  • 17. Perform oral prophylaxis if indicated.
  • 18.
  • 19. Chemotherapy The oral complications of chemotherapy depend upon the drugs used, the dosage, the degree of dental disease, and the use of radiation. Chemoradiation therapy carries a significant risk for mucositis.
  • 20. Consult the oncologist before conducting any oral procedures in patients with hematologic cancers; do not conduct procedures in patients who are immunosuppressed or have thrombocytopenia.
  • 21. Questions to Ask the Medical Oncologist What is the patient’s complete blood count, including absolute neutrophil and platelet counts? If an invasive dental procedure needs to be done, are there adequate clotting factors? Does the patient have a central venous catheter?
  • 22. What is the scheduled sequence of treatments so that safe dental treatment can be planned? Is radiation therapy also planned?
  • 23.
  • 24. Anemia (ah-NEE-mee-ah) is the scientific name for a low red blood cell count.
  • 25.
  • 26. Ask the oncologist to order blood work 24 hours before oral surgery or other invasive procedures. Postpone when
  • 27. the platelet count is less than 75,000/mm3 or abnormal clotting factors are present
  • 28.
  • 29. Due to the lack of saliva, the plaque builds up faster therefore cleanings may be every 2 mos. And check for mouth sores and decay. (ANC and WBC Count permitting)
  • 30. Emergency treatment can be done with any hematologic status to remove source of infection, work with oncologist, if count under 40,000mm consider platelet replacement.
  • 31.
  • 32.
  • 34. Peridex- can prevent infections (alcohol free peridex)
  • 37. 0.63% Stannous Fluoride-- ask oncologist if can substitute for peridex
  • 38. Stannous part is anti-microbial
  • 42.
  • 43. Patients under intense chemo are at risk for fungal and yeast as well as bacterial infections
  • 44. Nystatin to prevent fungal infections, can be used to prevent or treat.
  • 45. Mycostatin or Nilstat rinses- “swish and swallow” because these infections can be in the throat passage as well as in the mouth.
  • 47.
  • 48. If toothpaste irritates patients mouth, use a mixture of ½ teaspoon of salt with 4 cups water. Gargle regularly with a solution made up of: 1quart of plain water ½ teaspoon table salt ½ teaspoon baking soda
  • 49.
  • 50. Identify and treat potential oral problems within the proposed radiation field before radiation treatment begins.
  • 51. Instruct patients about oral hygiene.
  • 52.
  • 53.
  • 54. Sores or lesions can occur even in the absence of bacterial or fungal infection, but once there they should be treated with anti-bacterial agents to prevent infection.
  • 56. Saforis- a patented, topical, oral suspension of glutamine.
  • 57. Magic mouth wash- mixture of benadryl, maalox, nystatin, and lidocaine.
  • 58. Baking soda and water- aids in healing and neutralizes acid.
  • 60.
  • 62. Chemo for breast cancer After breast cancer chemo patients may be placed on a estrogen reducer drug femmoren and then on IV bisphosphantates
  • 63.
  • 64.
  • 65. Head and Neck Radiation Therapy
  • 66. Radiation Radiation----some people who get radiation to the head/neck (and sometimes chest) areas have redness and soreness in the mouth, a dry mouth, trouble swallowing, changes in taste, or nausea. Other possible side effects include a loss of taste, earaches, and swelling, jaw stiffness and jaw bone changes.
  • 67. Patients receiving radiation therapy to the head and neck are at risk for developing oral complications. Because of the risk of osteonecrosis in irradiated fields, oral surgery should be performed before radiation treatment begins.
  • 68.
  • 72. Identify and treat existing infections, carious and other compromised teeth, and tissue injury or trauma.
  • 73. Stabilize or eliminate potential sites of infection.
  • 74. Extract teeth in the radiation field that are non-restorable or may pose a future problem to prevent later extraction-induced osteonecrosis.
  • 75. Conduct a prosthodontic evaluation if indicated. If a removable prosthesis is worn, make sure that it is clean and well adapted to the tissue. Instruct the patient not to wear the prosthesis during treatment, if possible; or at the least, not to wear it at night.
  • 76.
  • 77. Be sure that the trays cover all tooth structures without irritating the gingival or mucosal tissues. Instruct the patient in home application of fluoride gel. Several days before radiation therapy begins, the patient should start a daily 10-minute application. Have patients brush with a flouride gel if using trays is difficult.
  • 78. Allow at least 14 days of healing for any oral surgical procedures. Conduct prosthetic surgery before treatment, since elective surgical procedures are contraindicated on irradiated bone.
  • 79. Questions to Ask the Radiation Oncologist What parts of the mandible/maxilla and salivary glands are in the field of radiation? What is the total dose of radiation the patient will receive, and what will be the impact on these areas? Has the vascularity of the mandible been previously compromised by surgery?
  • 80. How quickly does the patient need to start radiation treatment? Will there be induction chemotherapy with the radiation treatment?
  • 81. During Radiation Therapy Monitor the patient’s oral hygiene. Watch for mucositis and infections. Advise against wearing removable appliances during treatment.
  • 82. After Radiation Therapy Recall the patient for prophylaxis and home care evaluation every 4 to 8 weeks or as needed for the first 6 months after cancer treatment. Reinforce the importance of optimal oral hygiene
  • 83.
  • 84.
  • 85. Amifostine (ethyol)—protects salivary tissues against radiation damage. Approved for reducing dry mouth. May also reduce mouth sores: research is ongoing. N-acetylcysteine (RK-0202) - prevents inflammation due to radiation therapy.
  • 86. What are the common side effects of radiation Reduced resistance to bacterial, viral or fungal infections which allows them to become opportunistic Dry mouth/ altered taste sensations-including a burning sensation Sore/stiff jaw Damage to tooth enamel Swallowing difficulties
  • 87.
  • 88. Trismus/tissue fibrosis: Instruct the patient on stretching exercises for the jaw to prevent or reduce the severity of fibrosis.
  • 89.
  • 90. Follow instructions for fluoride gel applications. Avoid mouthwashes containing alcohol. Rinse the mouth several times a day with a baking soda and salt solution, followed by a plain water rinse. Use ¼ teaspoon each of baking soda and salt in 1 quart of warm water.
  • 91. Try the following if dry mouth is a problem: Sip water frequently. Suck ice chips or use sugar-free gum or candy. Use saliva substitute spray or gel or a prescribed saliva stimulant if appropriate. Avoid glycerin swabs.
  • 92. Exercise the jaw muscles three times a day to prevent and treat jaw stiffness from radiation treatment. Avoid candy, gum, and soda unless they are sugar-free. Avoid spicy or acidic foods, toothpicks, tobacco products, and alcohol.
  • 93. Taste changes: Refer to a dietitian. Etched enamel: Advise the patient to rinse the mouth with water and baking soda solution after vomiting to protect enamel.
  • 94. Special Care for Children Children receiving chemotherapy and/or radiation therapy are at risk for the same oral complications as adults. Other actions to consider in managing pediatric patients include the following:
  • 95.
  • 96. Remove orthodontic bands and brackets if highly stomatotoxic chemotherapy is planned or if the appliances will be in the radiation field.
  • 97.
  • 98.
  • 99. Consult the oncologist about scheduling dental treatment.
  • 100. Schedule oral surgery at least 7 to 10 days before myelosuppressive therapy begins.
  • 101. Prevent tooth demineralization and radiation caries:
  • 102. Instruct the patient in home application of fluoride gel (not fluoride rinses).
  • 103.
  • 104. Monitor the patient’s oral health for plaque control, tooth demineralization, dental caries, and infection.
  • 105.
  • 106. What is mucositis? Mucositis refers to the breakdown of mouth tissues. It can range in severity from a red sore mouth and gums to open sores in the mouth. Chemotherapy and radiation therapy kill not only cancer cells, but other rapidly dividing cells including the lining of the mouth and throat.
  • 107. Oral mucositis leads to several problems: Pain Nutritional problems/inability to eat Increased risk of infection due to open sores in the mucosa
  • 108.
  • 109. Blood in the mouth
  • 110. Sores in the mouth or on the gums or tongue
  • 111. Soreness or pain in the mouth or throat
  • 113. Feeling of dryness, mild burning or pain when eating food
  • 114. Soft, whitish patches or pus in the mouth or on the tongue
  • 115.
  • 116. Course of a mouth sore Not everyone undergoing treatment for cancer develops mouth sores. 1st day of treatment ---no noticeable change, but injury is beginning to accumulate. 3-5 days after treatment---damage to genetic material in mouth cells, soft tissue starts to feel warm. 7-10 days after treatment---Inflammation and sores appear.
  • 117. During treatment period---sores can become painful and infected. Eating and swallowing can become difficult. 2-9 weeks after treatment---sores heal and disappear.
  • 118.
  • 119. (2) Painful ulceration with pseudomembrane formation and, in the case of myelosuppressive treatment, potentially life-threatening sepsis, requiring antimicrobial therapy. Pain is often of such intensity as to require treatment with parenteral opiate analgesics.
  • 120.
  • 121.
  • 122. Patients receiving chemotherapy or radiation to the chest/head/neck area should have their mouths checked daily for redness, sores, or signs of infection.
  • 123.
  • 124. Pain Control --Ibuprofen (such as motrin) or acetaminophen(tylenol) for mild pain. --over-the –counter anesthetics, such as xylocaine, anbesol, or orajel. --Difflam- benzydamine mouthwash is a local anesthetic ---Gelclair- an oral gel designed to coat and soothe mouth sores by forming a protective barrier in the mouth. Gelclair contains 3 key ingredients: one to coat raw tissue with protective film, a second to moisten and lubricate the tissues and licorice root extract for flavoring. RX only.
  • 125.
  • 126. Opiates (ex. morphine)—are an important tool for controlling pain and not something to be shunned or feared.
  • 127. Pills
  • 130.
  • 131. Opiates (ex. morphine)—are an important tool for controlling pain and not something to be shunned or feared.
  • 132. Pills
  • 135.
  • 136. Oral Care Do’s Use an ultra-soft bristle toothbrush after meals and a bedtime. Use gauze or washcloth if patient has difficulty swallowing or ANC or WBC counts are low.
  • 137. Oral Care Don’ts No mouthwashes with alcohol No dental floss if counts below 40,000 No lemon or glycerine swabs No hard or medium toothbrushes No petroleum based products for lip care because they can promote infection Do not use water pik during treatment
  • 138. Oral Care Don’ts No mouthwashes with alcohol No dental floss if counts below 40,000 No lemon or glycerine swabs No hard or medium toothbrushes No petroleum based products for lip care because they can promote infection Do not use water pik during treatment
  • 139.
  • 140. Include foods high in protein in the diet
  • 141. Avoid hot, spicy or acidic foods, alcohol, hard or coarse foods (crusty bread, chips, crackers), soda.
  • 142. Do not smoke cigarettes, cigars or pipes.
  • 143. Do not use smokeless tobacco (chewing tobacco or snuff)
  • 144. Let food cool to room temperature
  • 145.
  • 153. Cooked meats pureed in blender, with gravy or broth added
  • 156. Salty or spicy foods
  • 159. Drinks with caffeine or alcohol
  • 163.
  • 164.
  • 165. Because of the risk of osteonecrosis, principally in the mandible, patients should avoid invasive surgical procedures, including extractions that involve irradiated bone. If an invasive procedure is required, use of antibiotics and hyperbaric oxygen therapy before and after surgery should be considered.
  • 166.
  • 167. Dentists should closely monitor children who have received radiation to craniofacial and dental structures for abnormal growth and development.
  • 168.
  • 169. Mouth sores can be extremely painful, cause malnutrition, delay cancer treatments and can cause serious infections.
  • 170. The oral cavity usually goes back to normal after chemotherapy, but has life long complications after head and neck radiation treatments.
  • 171.
  • 172. Dental extractions, root plane and scales, should be done 10days to 2 wks prior to chemotherapy or radiation treatments.
  • 173. Pain management is very important to patient recovery.
  • 174.
  • 175. The patient Do not lecture the patient on oral care. This patient already has a lot on their mind. New instructions to follow every day and may not physically be able to get up and brush properly!! Encourage good oral hygiene. Have a written instruction sheet Give booklet from cancer care.
  • 176. Web sites http://www.nidcr.nih.gov/OralHealth/Topics/CancerTreatment/OralComplicationsCancerOral.htm American Oncology Nursing Association Customer.service@ons.org OncoLink Abranson Centre Cancer Centre University of Pensylvania http://www.oncolink.com National Cancer institute website, www.cancer.gov http://www.nursing.upenn.edu http://www.cancer.org/docroot/MBC/content... http://www.cancerbackup.org.uk/resourcessupport/symptomssideeffects/mouthcare/chemotherapy http://ONJ.net.org /fosamax
  • 177.
  • 178. Eilers J. nursing intrventions and supportive care for the prevention and treatment of oral mucositis associated with cancer treatment, Oncology nursing forum online 31(4suppl):13-23 2004 July.
  • 179.

Editor's Notes

  1. Over 1,500,000 new cases of cancer were diagnosed in 2010!!!! Chances are pretty good you will provide care to someone with cancer. So hopefully you will remember some of what we talk about today.Some pt’s will not be able to have dental tx during cancer tx. Most will, but it is up to the oncologist.The patient benefits if their dental team is knowledgeable about cancer treatments since many times the mouth is affected.
  2. This is why people going through chemo loss their hair (rapidly dividing cells), fingernails are very britel, and vomit a lot. GI tract (rapidly dividing cells)
  3. With low ANC if pt get an oral infection or even just a sore without infection it can lead to bacteria getting into the blood stream and the body cannot fight off infection, and they may have to stop their chemo tx. Until infection is gone and then restart the chemo process
  4. If pt. is going to have a bisphosphanate drug, then you would not want to do an extraction that could cause osteonecrosis.If denture or partial is rubbing and causing sores it should not be worn due to a sore could cause an infection that the body cannot fight.
  5. Myelosuppressive therapy is any form of tx that is aimed at slowing down the rate of blood cell production.
  6. These are questions to ask if a pt comes in and needs tx. During chemo. Remember you may need to clean teeth every 2-3 mos. Also you may need to do emergency tx. If tooth becomes infected during chemo, you have to get rid of the infection due to ANC. Work with oncologist.
  7. The oncologist will do blood work 24 hrs. prior to dental work and will work with dentist.
  8. This is for routine prophy’s.
  9. Stannous fluoride comes in flavors. Mint , cinnamon, tropical. May aggravate some tissue. Some pt. cannot toerate the taste of chlorhexidine and may not use it as recommended. Ask oncologist if pt. can use stannous fluoride instead if it does not irritate the tissue.
  10. Some oncologist will give nystatin as a preventive measure , some will only give after infection has started.
  11. Salt helps with healing of mouth sores while the baking soda nuetralizes the acids.
  12. Change this slide
  13. Saforis or L-glutamine reduces inflammation. May reduce severity of mouth sores and amount of pain medication needed.Magic mouth wash has soothing, anti-fungal and numbing agents and anti acid to reduce acids.
  14. Aredia and zometa are just 2 IV bisphosphonates related to ONJ ONJ can also be caused by long term steroid use, diabetes, old age, idiopathic, Is exposed bone that has to last more than 8 weeks. 1 in 100,000 can get it from oral bisphosphonates. IV is 10 times greater than oral.
  15. So, regular dental visits, check complete blood count, ask about bisphosphonates.
  16. This is also important for the dental team to know that if your patient comes in for a dental emergency that these are common side affects and most will go away after radiation treatment is over.
  17. Xerostomia will make it difficult to wear C/C and may cause rubbing.If denture or partial is rubbing and causing sores it should not be worn due to a sore could cause an infection that the body cannot fight.
  18. The vascularity is what causes ONJ. If the isn’t blood flow to the bone it dies.
  19. Cleocin is a good antibiotic for bone infections.
  20. These are drugs on the horizon. Still in clinical trials.
  21. For stiff jaw. Pt. can do jaw exercises such as opening and closing 20 times 2-3 times a day to help loosen up.
  22. The most rapid dividing cells are in the bone marrow,(why body can not fight off infection as easy) hair folicals (loss of hair), and GI tract, (causing diarrhea and mucositis).
  23. Some patients will have to be hospitalized and put on IV’s for nutrition.
  24. Myelosuppressive chemo effects bone marrow and thus the body cannot fight off infection.
  25. Hospitals have their own protocol for checking patients mouths during treatments. If a patient has a fever then it is likely that they have an infection. Contact the oncologist.
  26. You can relieve mouth pain by sucking ice chips when the chemotherapy drug is most concentrated in the body. This technique, called cryotherapy, works by decreasing blood flow to the cells in the mouth, reducing exposure to the drug and decreasing the risk of developing mouth sores.
  27. Stage 1
  28. Opiates—some people think they will become addicted and will not take as needed. This are usually given for Stage 2 oral mucositis.
  29. Opiates—some people think they will become addicted and will not take as needed. This are usually given for Stage 2 oral mucositis.
  30. Smoking and tobacco cause mouth sores to worsen and affect healing.
  31. Soothing foods. Vs acidic, and foods that cause trauma to the tissue
  32. Now some study’s show hyperbaric oxygen may not help
  33. All dentist and dental hygienist should be doing oral cancer screenings. Use of Vizilite?