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Posted: Tue Aug 16, 2005 6:29 pm Post subject: THE ORAL MANAGEMENT OF ONCOLOGY PATIENTS
1) Pathways of Care
A clear pathway of care is necessary to prevent or minimise oral complications.
Following the receipt of a bone marrow transplant and discharge home, children are reviewed to continually monitor the oral condition.
There is an agreed patient-specific minimum period of oral health monitoring post-treatment.
Children are monitored during their period of growth and development.
2) Preventive and Clinical Regimen
The oral cavity is a site where complications frequently develop either as the direct result of the malignancy or as an unwanted effect of treatment.
Prior to Cancer Therapy - at initial diagnosis
It is recommended that:
A comprehensive oral assessment is undertaken.
Detailed oral hygiene instruction with reinforcement and elaboration of diet advice is provided in cooperation with the dietician. 16
Oral hygiene practices are supplemented with the use of a chlorhexidine mouthwash or dental gel , if there is gingival disease diagnosed.
Impressions of the mouth are taken for study casts to construct applicator trays and where appropriate for obturator planning.
Carious teeth that can be restored are stabilised with appropriate restorations.
All sharp teeth and restorations, are suitably adjusted and polished.
The patient is counselled about denture wear during therapy.
Wherever possible, teeth with a dubious prognosis are removed no less than ten days prior to therapy
Orthodontic treatment is discontinued.
During Cancer Therapy
It is recommended that:
The patient receives appropriate support from a dental hygienist.
A high standard of oral hygiene is encouraged (to include denture hygiene).
The use of a chlorhexidine mouthwash, or dental gel, is continued.
Those patients receiving radiotherapy, or total body irradiation prior to bone marrow transplantation, receive a daily fluoride mouthwash to prevent dental caries and promote enamel remineralisation.
Children and adults receiving bone marrow transplants often recieve Acyclovir as a prophylaxis if there is a high risk of viral infections. This is usually prescribed by the oncology team.
Antifungal medication is used following detection of oral candida.
For children this should be used routinely as a prophylaxis.
Every effort should be made to reduce the severity of the mucositis.
Every effort is made to reduce the effect of the xerostomia.
Patients are advised that removable prostheses may be left out of the mouth if there is any evidence of ulceration. They should be examined by a member of the dental team.
When the mouth is too painful for cleaning, the tissues are swabbed with oral sponges.
Certain food, drinks and mouthwashes , which irritate the oral mucosa should be avoided to maintain oral comfort.
Dental treatment is avoided wherever possible during therapy.
2.4 Following Cancer Therapy - Prevention and Monitoring
It is recommended that:
Growth and development should be closely monitored for children.
There is a three months oral hygiene review for as long as the xerostomia continues.
Regular and appropriate oral healthcare monitoring is provided by the designated member of dental staff.
Strategies for dealing with xerostomia continue.
A remineralising solution, such as a fluoride mouthwash continues to be used regularly with confirmation of compliance.
Chlorhexidine gel is applied with applicators every three months.
In the event of trismus, jaw exercises are implemented.
Following Cancer Therapy - Restorative Dental Care
It is recommended that:
In the event of uncontrolled periodontal disease, vigorous treatment is initiated. This may involve identification of atypical pathogens.
Herpes labialis can be a chronic problem. Topical Acyclovir is effective.
Restorations are kept simple ensuring acceptable aesthetics and function.
Dental extractions, if essential, must be performed with appropriate precautions.
Dentures should be avoided wherever possible.
Implant stabilisation of prostheses and obturators may be feasible in some patients.
Following Cancer Therapy - Requirements for Denture Wearers
It is recommended that:
Removable prostheses are left out at night.
Glandosane saliva substitute should be used for edentate patients only.
Antifungals are used if a candidal infection is diagnosed.
Appliance wear is discontinued if the mouth becomes painful. Advice must be sought.
Obturators are reviewed regularly. They may require frequent attention with adjustment or remake.
The Management of Osteoradionecrosis
It is recommended that:
Oral trauma is minimised.
A high standard of oral cleansing is established.
Topical local anaesthetic gel is applied to denuded bone to improve comfort.
High dose systemic antibiotics are prescribed.
In severe cases the use of hyperbaric oxygen therapy may be necessary.
Recent evidence suggests that ultra sound may be helpful.
Surgical excision of necrosed bone with primary closure may become necessary.
Children who have received bone marrow transplants should have a strict follow-up for preventive oral care at four months intervals.
Posted: Tue Aug 16, 2005 6:52 pm Post subject: Caring for HIV child,,,,needs to wait!
Caring for HIV infected child is another thing that merits separate discussion,, which might have to wait for some time. I need to do some editing in that document.
It is to be noted that the above pathway for care..in the previous post and the respective article is applicable for both adults and chlldren. Management when differs age wise of otherwise for children is mentioned wherever applicable.
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