Download Orodental management of the Patient with HN cancer

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.
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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
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surgery
chemo
rads
combo tx
palliation
The Multiple Treatment Modalities of H&N
Cancer
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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
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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
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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.
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Pre-treatment evaluation and planning
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Maintenance during cancer treatment
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Management of post-treatment sequelae
Pre-treatment evaluation and planning
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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
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Pre-treatment evaluation and planning
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Maintenance during cancer treatment
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Management of post-treatment sequelae
Maintenance during cancer treatment
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Most difficult time to maintain goal
• compromised ability during hospital stays
• compromised access to hygiene products during hospital stays
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Problem-focused exams with DDS to address
problems early (not often practical)
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Pre-treatment evaluation and planning
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Maintenance during cancer treatment
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Management of post-treatment sequelae
Management of Post-treatment Sequelae
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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
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Not only the disease, but the treatment impacts
can be severe in H&N Ca
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Patients with H&N Ca need intensive education
on orodental health considerations PRIOR TO
CANCER TREATMENT
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Formal evaluation and treatment is critical to
limiting complications associated with treatment
for the patient with H&N Ca
References
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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
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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.
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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
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Driezen s, Brown LR, Daly TE, Drane JB. Prevention of xerostomia-related dental caries in
irradiated patients. J Dent Res 1977;56:99-104
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Schiodt M, Hermund NU. Management of oral disease prior to radiation therapy. Support
Care Cancer 2002; 10:40-3.
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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]
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