Oral Care after Oral Cancer

1
Oral Care after Oral Cancer

• Catherine Waldron RDH
• Dental Hygiene Tutor
• Dublin Dental School and Hospital

2
Oral Cancer The Patients Journey

• Cancer Diagnosis
• Pre-treatment Dental Management
• Cancer Therapy
• Surgery
• Chemotherapy
• Radiotherapy
• Combination
• Post Treatment Dental Management

3
Pre Treatment Dental Management

• Restorations / Extractions
• Oral Hygiene Programme
• Debridement
• Diet Advice
• Use of Fluoride Trays
• Smoking Cessation

Prevention is better than cure
4
Surgery
5
Trismus - Limited Opening

• 5 - 38 prevalence
• Site of Cancer
• Surgery
• Radiation of TMJ or Medial Pterygoid Muscle

• Plast Reconstr Surg. 2006 Jul118(1)102-7

6
Exercise/ Physiotherapy
7
Radiotherapy / Chemotherapy

• Side Effects
• Mucositis
• Dry Mouth
• Radiation Caries
• Osteoradionecrosis

8
Mucositis

• 83 of HNC patients develop mucositis
• 29 developed severe mucositis

Vera Lionch M, et Al Oral mucositis in
patients undergoing radiation treatment for head
and neck carcinoma
Cancer. 2006 Jan 15106(2)329-36
9
Dry Mouth

• Reduced Flow
• Thick / Stringy
• Loss of taste
• Difficulty swallowing
• Speech
• Recovery depends on site and dose of Rx

10
Patients Primary Complaint

• Patient Preference in the Management of Radiation
  Induced Dry Mouth

• Mac Carthy D, and C Waldron. School of Dental
  Science,
• Faculty of Health Sciences, Trinity College,
  Dublin, Ireland

11
Most Helpful for Dry MouthFirst Choice
65
11
5
4
1
9
5
12
Saliva Substitutes
13
Radiation Caries

• Mild

• Severe

14
Radiation Caries

• 1999

15
Unmonitored Dry Mouth

• 1999

• 2002

16
Use of Fluoride

• Fluoride /
• Chlorhexidine
• Regime
• each alternate
• day for 10-15
• minutes in
• dental trays

17
Osteoradionecrosis

• Superficial Debridement
• Oral Saline Irrigation
• Antibiotics for secondary infection

18
Summary

• Pre Cancer Treatment Assessment
• Regular Dental / Dental Hygiene Visits
• Tailored Oral Hygiene and Diet Advice
• Use of Fluoride Trays
• Smoking / Alcohol Cessation Programmes

19
Acknowledgement

• Dr Denise MacCarthy
• Consultant in Restorative Dentistry and
  Periodontology
• Dublin Dental School and Hospital,
• Trinity College, Dublin.