Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Protocol of Dental Treatment in Radiotherapy Indicated Patients.pptx
Similar to Protocol of Dental Treatment in Radiotherapy Indicated Patients.pptx (20)
Recently uploaded
Recently uploaded (20)
Protocol of Dental Treatment in Radiotherapy Indicated Patients.pptx
- 1. Protocol of Dental Treatment in Radiotherapy Indicated Patients Dr. Hoor-E-Jannath Prity OSD (Additional), DGHS DDS Non-Resident Sylhet MAG Osmani Medical College
- 2. OUTLINE Radiotherapy History Mechanism Types Dosage Oral manifestations of radiotherapy Management Hyperbaric Oxygen Therapy Tooth extraction after radiotherapy Conclusion
- 3. RADIOTHERAPY Radiation therapy, or radiotherapy, is a type of cancer treatment in which cancerous cells in the body are killed by exposing them to ionizing radiation, such as X-rays, gamma rays, high- energy electrons or heavy particles under expert supervision
- 4. HISTORY As the properties were still unknown, he decided to call it ‘X-ray’ Wilhelm Roentgen discovered X-rays in 1895- accidentally-while testing whether cathode rays could pass through glass
- 5. USES OF X-RAYS Diagnostic use • Roentgen quickly found that X-rays would pass through human tissue too, rendering the bones and tissue beneath visible Therapeutic use • Shortly after the discovery of X-ray the first observations on the therapeutic effects of this newly discovered radiation were published.
- 6. RADIATION TO RADIOTHERAPY In 1896, radiotherapy was first applied for therapeutic purpose in Chicago. A breast cancer patient with ulceration was reportedly treated with radiotherapy under the guidance of Emil Grubbe.
- 7. HOW RADIOTHERAPY WORKS Radiation therapy uses particles or waves moving at a high frequency to damage the DNA of the cancer cells If the DNA required for mitosis and replication is damaged, the cells are unable to replicate as usual and the growth of a cancerous tumor is inhibited.
- 8. TYPES OF RADIOTHERAPY Two Types External Beam Radiotherapy/ Teletherapy Internal or Brachytherapy
- 9. TELETHERAPY Given by external beam Uses electromagnetic radiation or particulate components
- 10. TELETHERAPY Mainly used in the treatment of malignancy of the bladder, brain, breast, cervix, larynx, lung, prostate Also used as a palliative therapy to treat symptoms of the advanced stage malignancy patients
- 11. BRACHYTHERAPY
- 12. BRACHYTHERAPY The source is placed in small sealed vials called implants To treat tumours of head and neck, prostate, cervix, ovary, breast, and perianal and pelvic regions.
- 13. RADIOTHERAPY DOSAGE Fractionation The schedule on which the radiation dose is delivered The total dose is divided into smaller doses, or fractions The amount of radiation given measured in centigray or cGy A fraction is given each day and repeated over many days to add up to the total dose of radiation.
- 14. Fractionation Daily doses range from 180cGy to 200cGy. Given once a day, 5 days a week. Given over 6-7 weeks. Standard radiotherapy doses typically range from 4500 to 6000 cGy for the treatment of breast, head, and neck cancers.
- 15. ORAL MANIFESTATIONS OF RADIOTHERAPY The “Three H” principle of irradiated tissue described by Marx (1983)
- 16. MUCOSITIS Occurs when the radiation field involves the oral mucosa
- 17. HYPOGEUSIA Damage to taste buds Recovery starts at 2-4 months Permanent with >6000 cGy radiation
- 18. Damage to major salivary glands, salivary secretions diminish within a week of radiotherapy Perio dontal diseas e Caries Oral candida infection Acute ascending sialadenitis XEROSTOMIA
- 21. OSTEORADIONECROSIS Most serious late complication of therapeutic radiotherapy for head and neck cancer An exposure of nonviable, nonhealing, non-septic lesion in irradiated bone, which fails to heal without intervention
- 22. OSTEORADIONECROSIS Etiology Dependent on the radiation dose- approximately 6500- 7000 or greater or in excess of 0.55 uGy/hour Radiation particularly to the floor of the mouth and mandible • Extraction in 60-89% cases • Trauma Triggering factors
- 24. OSTEORADIONECROSIS Severe, deep, boring pain for weeks or months Swelling of face when infection develops Fetid odor Exposed bone with intra or extraoral fistulae Trismus Soft tissue abscesses and persistent draining sinuses Pyrexia Pathological fracture
- 25. OSTEORADIONECROSIS • An area of denuded bone on alveolar process • Sloughing of mucosa • Slow sequestration If extrac tion is the cause
- 26. OSTEORADIONECROSIS Little change in early stage Radiolucent area with indefinite nonscleroti c borders Occasional areas of radiopacity with bony sequestrum Sequestra and involucra occur late or not at all
- 28. TRISMUS Radiotherapy Progressive endarteritis of affected tissues with reduction in blood supply Fibrosis of the masticatory muscles
- 29. DENTAL DEFECTS Hypoplasia Delayed Eruption Due to irradiation to developing teeth
- 31. BEFORE RADI0THERAPY Oral hygiene instructions Preventive dental care – application of topical fluoride- 0.4% stannous fluoride gel/ 1% acidulated flurophosphates gel for 15 mins twice a day for 2 weeks Restorative procedures Saliva substitutes- pilocarpine 5mg 3 times daily beginning 1 hour prior to the first radiation dose and continuing life-long Periodontal Therapy
- 32. BEFORE RADI0THERAPY Teeth that cannot be restored by endodontic treatment Teeth with periapical lesions Periodontal pockets over 5- 6mm Furcation involvementof grade 2 Grade 2 mobility or more Retained roots
- 33. BEFORE RADI0THERAPY Extractions done 2 - 3weeks prior to the radiotherapy Hospitalization and removal of teeth in one session under antibiotic cover Unerupted and deeply buried teeth left in situ
- 34. BEFORE RADI0THERAPY Alveoloplasty to allow proper wound closure Interdental septa ground off, sharp bony margins removed No bone left exposed
- 35. DURING RADIOTHERAPY • Warm normal saline m/w • Lignocaine viscous 2% Mucositis • 0.2% CHX m/w • Regular toothbrushing and flossing Oral Hygiene • Jaw opening exercises Trismus • Brush-on gel or custom tray twice daily for 15 minutes Topical Fluoride
- 36. AFTER RADIOTHERAPY Avoidance of dentures for some time after therapy Maintenance of oral hygiene Application of topical fluoride Saliva substitutes
- 37. AFTER RADIOTHERAPY • Scaling • Measurement of periodontal pocket depth • Plaque index Every 6 months • Radiographic examination Every 12 months
- 38. AFTER RADIOTHERAPY Postirradiation Pulpitis Restoration Endodontic treatment • no instrumentation beyond the apex • done under antibiotic prophylaxis
- 40. AFTER RADIOTHERAPY Golden Window Period Within the first 4 months (4-6 weeks) after radiation Tooth extraction can be done without the need for HBO Tissues would have recovered from the hyperaemia and inflammation Tissues would not have pronounced 3H
- 41. EXTRCTION AFTER RADIOTHERAPY Prophylactic antibiotics Raising the periosteum as little as possible Minimal trauma Removing sharp bony edges Careful suturing
- 42. Hyperbaric Oxygen Therapy Mono-place chamber pressurized with O2 Multi-place chamber pressurized with air (with O2 mask/hood/head tent/endotracheal tube) Patients inhales 100% humidified oxygen in an absolute pressure chamber at 1.5 atm or greater, intermittently almost daily
- 43. EXTRACTION AFTER RADIOTHERAPY • 20-30 dives before extraction • 10 dives after extraction • Humidified pure O2 • 2-2.5 atm absolute pressure • 90-120 min each session • Once a day Prophylactic Hyperbaric Oxygen Therapy
- 44. Effects of HBOT • Limit ischemic damage, cell death, & inflammation • Promotes collagen synthesis & angiognesis Delivery of oxygen to hypoperfused tissues • Aids in oxygen dependent killing of bacteria Generation of oxygen free radicals • Decreases tissue edema Vasoconstriction
- 45. Uses of HBOT
- 46. Side Efffects of HBOT Exposure to HBO leads to an increase in the amount of dissolved oxygen and also reactive oxygen species (ROS) in the blood. Production of oxygen free radicals, which lead to lipid peroxidation and tissue damage. Barotrauma Central nervous system (CNS) toxicity Pulmonary oxygen toxicity Ocular side effects
- 48. PENTOXIFYLINE Tri-substituted methylxanthine derivative chemically designated as 1-(5-oxohexyl)-3,7- dimethylxanthine anti-tumor necrosis factor (tnf)-α effect increases erythrocyte flexibility vasodilates inhibits inflammatory reactions inhibits human dermal fibroblast proliferation and extracellular matrix production
- 49. TOCOPHEROL Vitamin E Scavenges the reactive oxygen species generated during oxidative stress that escape the activity Protects cell membranes against lipid peroxidation Partly inhibits tgf-ß1 and procollagen gene expression
- 51. CONCLUSION The patients who are indicated for or received radiotherapy in the head and neck region pose a great challenge for the dental surgeons. It is very important that a dental surgeon adheres to the established protocol of treatment while dealing with such patients. Any deviation from the described treatment regime may lead to devastating consequences. The goal of a dental surgeon should be to provide preventive and supportive care before and during radiotherapy and to deliver treatment in such a way that it minimizes the risk of such complications.
- 52. REFERENCES • Malik NA, (2021), Textbook of Oral and Maxillofacial Surgery, (Edition 5), Jaypee Brothers Medical Publishers Pvt. Limited, ISBN 9352705785, 9789352705788 • Anjum K, Sarkar AD, (2020), “Guidelines for Extraction in Irradiated Patients”, IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), e-ISSN: 2279-0853, p- ISSN: 2279-0861.Volume 19, Issue 7 Ser.2 (July. 2020), PP 27-31 • Gianfaldoni S, Gianfaldoni R, Wollina U, Lotti J, Tchernev G, Lotti T, (2017), “An Overview on Radiotherapy: From Its History to Its Current Applications in Dermatology”, Open Access Maced J Med Sci , v.5(4); 2017 Jul 25 PMC5535674
- 53. REFERENCES • Fu Q, Duan R, Sun Y, Li Q, (2022), «Hyperbaric oxygen therapy for healthy aging: From mechanisms to therapeutics”, Redox Biology, Volume 53, July 2022, 102352, https://doi.org/10.1016/j.redox.2022.102352 • https://www.news-medical.net/health/Radiation-Therapy- Mechanism.aspx
- 54. THANK YOU