The dental management of patients who are to or have received radiotherapy pose a great challenge for general dentists. It is very important that we adhere to the established treatment regime to avoid any complications that may occur because of unplanned dental treatments.
Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment.
It is a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal for at least 3 months.
Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment.
It is a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal for at least 3 months.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
Local aneasthesia techniques which are to be performed extraorally when the conventional intraoral approches for local anaesthesia cant be performed.
Very useful for dental Practioners
All you need to know about the gummy smile its causes and examination are included in the powerpoint, how to diagnose gummy smile, its treatment options and cases are presented in the powerpoint.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
Local aneasthesia techniques which are to be performed extraorally when the conventional intraoral approches for local anaesthesia cant be performed.
Very useful for dental Practioners
All you need to know about the gummy smile its causes and examination are included in the powerpoint, how to diagnose gummy smile, its treatment options and cases are presented in the powerpoint.
Classification of peri-implant diseases and condition, implant failures causes, Peri-implant mucositis and its management, Peri-implantitis and its classification, clinical features, Treatment (Surgical and Non-surgical) And management. Implant success rate and conclusion.
Side effects of radiation in head and neck cancerAnagha pachat
this presentation describes how radiation effects normal structures in head and neck region and about the late and acute toxicities which may occur if the radiation exceeds tolerance dose as per QUANTEC
BIOLOGICAL EFFECTS OF Radiation IN DENTISTRY. ppt.pdfSamkeloKhumalo2
Radiation damage to tissue and/or organs depends on the dose of radiation received, or the absorbed dose which is expressed in a unit called the gray (Gy). The potential damage from an absorbed dose depends on the type of radiation and the sensitivity of the different tissues and organs.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 31st publication IJAR 1st name
Similar to Protocol of Dental Treatment in Radiotherapy Indicated Patients.pptx (20)
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
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
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.
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
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
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
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
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
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
