MEDICALLY COMPROMISED PATIENT HEAD AND NECK By Kayla
MEDICALLY COMPROMISED PATIENT: HEAD AND NECK By: Kayla Garcia & Kelsey Watson
HEAD AND NECK CANCER • Definition: a group of neoplastic diseases in which there is transformation of normal cells into malignant ones. When cancer cells proliferate, the mass of abnormal tissue that is formed enlarges until it takes over the host site. It then sheds cells that spread to distant sites. • Etiology: unknown • Sites for head and neck cancers: oral cavity, pharynx, larynx, Paranasal sinuses and nasal cavity, and salivary glands.
RISK FACTORS • Tobacco use • Preserved or salted foods • Alcohol use • Oral health • Gender • Occupational exposure • Age • Radiation exposure • HPV • Epstein-Barr virus infection • Paan (betel quid). • Ancestry • Maté
TREATMENT • Surgery • Chemotherapy • Radiation therapy • Hematopoietic cell transplantation • Hormone therapy • Vaccine therapy • Biotherapy • Combination (2 or more above)
INDICATIONS AND CONTRAINDICATIONS FOR DENTAL TREATMENT Indications: • Before undergoing cancer treatments • Intensive oral care during therapy have reduced risk for development of oral complications. Contraindications: • Selective dental treatment during cancer therapies • No use of ultrasonic scaler during cancer treatments
IMPACT ON ORAL HEALTH • Severe oral mucositis • Xerostomia • Altered taste buds • Viral infections • Fungal infections • Dental caries • Poor oral hygiene • Trismus • Osteonecrosis of the jaw
PERIODONTAL MANAGEMENT • Frequent recall: for the first 6 months after cancer treatment recall should be every 4 -8 weeks as needed • Saliva substitutes • Ultra-soft tooth brush • Non-alcohol mouth rinse • Fluoride: once daily fluoride gel tray usage • Monitor personal daily oral care Monitor patient for trismus • Check for pain or weakness in masticating muscles • Instruct patient to exercise 3 X a day: opening/closing the mouth as far as possible w/o pain; repeat 20 X • Thor therapy
LOW LEVEL LASER THERAPY (THOR THERAPY) • Thor therapy is indicated for use before and after a dental extraction in a patient who has ever undergone radiation or chemotherapy. • Thor therapy is a quick, painless procedure that boost the oxygen content to the specific site to promote healing and help prevent osteonecrosis of the jaw in patients with cancer of the head and neck. • Now the European Society for Medical Oncology suggests using LLLT to reduce the incidence of oral mucositis and its associated pain, in patients receiving highdose chemotherapy or chemoradiotherapy.
LOW LEVEL LASER THERAPY (THOR THERAPY)
DENTAL HYGIENE CONSIDERATIONS • Premed: none • Patient positioning: choose whatever is most comfortable for the patient • Appointment length: short appointments for stress reduction • Conduct a legitimate head and neck exams on all patients. • Update Medical/Dental History at each appointment • Be there for support and encouragement • Thorough progress notes should include: Ø Cancer diagnosis, type of treatment (start & complete dates) Ø Name of oncologist & contact info, and any consults Ø Oral assesments, patient education Ø Any oral implications Ø Planned follow-up visit & plan of care w/proposed treatment outcomes.
QUESTION #1: The cause of head and neck cancer is the combination usage of alcohol and tobacco. It is also more prevalent in men. A. Both statements are true B. Both statements are false C. The first statement is true. The second statement is false. D. The first statement is false. The second statement is true.
QUESTION #2: How is head and neck cancer treated? A. Surgery B. It depends on the size, location, health of patient, and the treatment objectives. C. Radiation D. Chemotherapy
QUESTION #3: Always consult with the patient’s oncologist before any dental treatment is performed and be sure to write thorough progress notes each time you see the patient. A. Both statements are true B. Both statements are false C. The first statement is true. The second statement is false. D. The first statement is false. The second statement is true.
WORKS CITED "Head and Neck Cancers. " National Cancer Institute. N. p. , n. d. Web. 29 Nov. 2016. "Low Level Laser Therapy (LLLT) Cold Laser - THOR Laser. " Low Level Laser Therapy Comes to Dentistry - THOR Laser. N. p. , n. d. Web. 29 Nov. 2016. "Osteonecrosis of the Jaw. " Osteonecrosis of the Jaw (ONJ). N. p. , n. d. Web. 29 Nov. 2016. Wilkins, Esther M. , and Charlotte J. Wyche. Clinical Practice of the Dental Hygienist. 11 th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013. Print. You. Tube, n. d. Web. 29 Nov. 2016.
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