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Orodental management of the patient with head and neck cancer Paul C. Lopez, DDS, MD Michigan Oral & Maxillofacial Surgeons Disclosures • Employed by Michigan Oral Surgeons -salary/wage -partnership interest • I certify, to the best of my knowledge, I am not included in the Office of The Inspector General's List of Excluded Individuals/Entities, and have not been debarred, excluded or otherwise ineligible to participate in any Federal healthcare program. • I receive no monetary compensation for this talk and have no promotional interests. • In this presentation, you may see commercial products. I have no interest in promotion of these products. What once was will no longer be. • With a diagnosis of H&N cancer come multiple challenges • Understanding the disease • Understanding its management • Understanding the impending impact of the disease itself and the therapies employed • Navigating successfully through these changes • Cure can seem worse than the disease The Multiple Treatment Modalities of H&N Cancer • • • • • surgery chemo rads combo tx palliation The Multiple Treatment Modalities of H&N Cancer • • Not only the disease, but, the very treatment chosen can cause injury and dysfunction to involved (and neighboring) tissue The aerodigestive tract has a myriad of vital functions not only for survival, but, also involving QOL Primary and collateral damage • The disease or its treatment can involve a composite of tissue • Tongue, teeth, salivary glands, the facial and masticatory muscles, skin, jaws, oral mucosa, taste buds • This results in affected ability with eating, speech, nonverbal communication, infections, dental caries, limited mouth opening, appearance Primary and collateral damage • Understanding the ensuing potential complications of disease or treatment is important to be able to prepare for, or even obviate, some of them Interventions matter. • Pre-treatment evaluation and planning • Maintenance during cancer treatment • Management of post-treatment sequelae Pre-treatment evaluation and planning • Referral to dentist • Patient education • effects on salivary glands (xerostomia), risk of caries, muscles (trismus) • Patient Eval and Tx Planning • hygiene instruction • restorations • extractions (14-day lead time to rads) • Fabrication of silicone guards tandartsplein.nl After Pre-radiation Therapy Oral Evaluation Protocol, University of Michigan Hospital Dentistry • Pre-treatment evaluation and planning • Maintenance during cancer treatment • Management of post-treatment sequelae Maintenance during cancer treatment • Most difficult time to maintain goal • compromised ability during hospital stays • compromised access to hygiene products during hospital stays • Problem-focused exams with DDS to address problems early (not often practical) • Pre-treatment evaluation and planning • Maintenance during cancer treatment • Management of post-treatment sequelae Management of Post-treatment Sequelae • Schedule recall visits with short recall at first (Q 4weeks, Q 3-4 months) with gradual normalization • Focus on education, hygiene, management of symptoms (fluoride, sialogogues, physiotherapy, etc) • Establishment of a new, acceptable "normal" oral health state Summary • Not only the disease, but the treatment impacts can be severe in H&N Ca • Patients with H&N Ca need intensive education on orodental health considerations PRIOR TO CANCER TREATMENT • Formal evaluation and treatment is critical to limiting complications associated with treatment for the patient with H&N Ca References • Hashim D, Sartori S, Brennan P, Curado MP, Wünsch-Filho V, Divaris K, Olshan AF, Zevallos JP, Winn DM, Franceschi S, Castellsagué X, Lissowska J, Rudnai P, Matsuo K, Morgenstern H, Chen C, Vaughan TL, Hofmann JN, D'Souza G, Haddad RI, Wu H, Lee YC, Hashibe M, Vecchia CL, Boffetta P. The role of oral hygiene in head and neck cancer: results from International Head and Neck Cancer Epidemiology (INHANCE) consortium. Ann Oncol. 2016 Aug;27(8):1619-25 • Murdoch-Kinch CA, Zwetchkenbaum S. Dental Managment of the Heand and Neck Cancer Patient treated with radiation therapy. J Mich Dent Assoc. 2011 Jul;93(7):28-37. • Cooper JS, Fu K, Marks J, Silverman S. Late effects of radiation therapy in the head and neck region. Int J Radiat Oncol Biol Phys 1995: 31:1141-64 • Driezen s, Brown LR, Daly TE, Drane JB. Prevention of xerostomia-related dental caries in irradiated patients. J Dent Res 1977;56:99-104 • Schiodt M, Hermund NU. Management of oral disease prior to radiation therapy. Support Care Cancer 2002; 10:40-3. • Bruins HH, Jolly DE, Koole R. Preradiation dental extraction decisions in patients with head and neck cancer. Oral Surg Oral MedOral Pathol Pral Radiol Endod 1999;88:406-12 Thanks for your attention! [email protected] 19