BAN quiz 5

betel nut chewing

increases cancer risk by ~9 times, causes submucous fibrosis

radiation dose/location and when treatment starts

critical information for dentist

tooth loss, salivary dysfunction, caries, gingival recession

complications after radiation

bland rinses, topical anesthetics, NSAIDs, Opiods

treeatment of radiation induced mucositis

>30Gy

at what dose of radiation is salivary dysfunction permanent

cairies, candidiasis, altered function, decreased comfort

consequences of dry mouth/salivary dysfunction

25Gy to single or 20Gy to both

recommended dose of radiation to parotid glands to avoid salivary dysfunction

hydration,saline rinse, stimulatnts (sugar free), topical agents, rx topical sprays

conservative management of salivary dysfunction and dry mouth

pilocarpine (salagen)

sialagogue used for radiation induced dry mouth

50 Gy

above what level of radiation is there a risk of Osteoradionecrosis (ORN)

OSCC/OPSCC

type of cancer that requires the most radiation

injury, surgery, EXT, infection

risk factors of osteoradionecrosis

hyperbaric oxygen

therapy used to enhance healing and reduce the risk of osteoradionecrosis by increasing oxygen supply to tissues.

hyperbaric oxygen

BEFORE to EXT what treatment is NOT recommened

total 70 Gy, 2 Gy/visit for 7 weeks

conventional dose of radiation to gross tumor

60 Gy, 2Gy/visit for 6 weeks

post op (adjuvant) radiation dose

refer to oral surgery, prophylactic pentoxifylline and tocopherol

what should be done when EXT is unavoidable in pt with osteoradionecrosis risk

mylohyoid ridge on lingual side of mandible

most common site of osteoradionecrosis

acute iritis, narrow angle glaucoma, uncontrolled asthma

contraindications to sialagogues

clotimazole and nystatin

topical antifungals

caries (high sugar content)

risk of antifungals

osteoradionecrosis (ORN)

exposed and irritated bone as a result of vascular damage from radiation

2 weeks

healing time AFTER EXT BEFORE radiation

root fracture, severe bone loss, endo infection w/ questionable prognosis

in what condition requires EXT of tooth prior to radiation

fewer teeth, salivary dysfunction, bad oral hygiene, prior untreated caries, probing ≥5-6mm

risk factors for tooth loss due to radiation therapy

mucositis, salivary dysfunction, mucosal infection, pain, taste dysfunction

ACUTE oral complications of radiation therapy

salivary dysfunction, osteoradionecrosis, neuropathic pain, periodontal disease, fibrosis/trismus

chronic oral complications of radiation therapy

until therapy is complete and tissue regenerates

how long does mucositis caused by radiation persist

fanconi anemia

inherited AR disorder that affects bone marrow, leading to decreased production of blood cells and increased cancer risk by 500-700x

decreasing, decreased tobacco use

what is the current trend of SMOKING RELATED oral squamous cell carcinoma prevalence and why?

HPV

cause of majority of OROPHARYNGEAL TUMORS

painful ulcer, loose teeth, ill-fitting dentures, bleeding gums

clinical presentation of oral cancer

based on tumor, nodes and metastases (TMN)

how are oral cancers staged

oral squamous cell carcinoma

the term “oral cancer” usually reefers to what type of cancer

ventrolateral tongue and floor of mouth

most common locations for OSCC (oral squamous cell carcinoma)

persistent ulcers, rolled borders, hardness, irregular shape

what clinical findings would raise concern for OSCC/OPSCC

root resorption, irregular radiolucency, punch out radiolucencies, bony expansion, numbness

clinical findings that would raise concern for bony cancers

leukemic gingivitis, bleeding, aphthous, lymphadenopathy

clinical findings that would raise concern for hematologic cancers

tobacco, alcohol, betel/areca nut

major common MODIFIABLE risk factors for oral cancer

age, immunosuppression, genetic disorders

non-modifiable risk factors for cancer

HPV induced oropharyngeal squamous cell carcinoma (OPSCC)

most rapidly increasing cancer diagnosis in men

tonsillar crypts and base of tongue

location of HPV OPSCC

HPV OPSCC has better survival

how does survival of HPV OPSCC compare to tobacco induced OSCCs

most oral manifestations are not malignant

important thing to remember about HPV

HPV 16

Which HPV has highest risk of developing into OPSCC?

NO

does a positive HPV-16 salivary screening mean that the patient will develop OPSCC

vaccination

prevention of HPV OPSCC

dysphagia, odynophagia (pain when swallowing), unilateral ear pain, neck mass

signs and symptoms of OPSCC

any lymph node involvement is at least stage III

how does lymph node involvement affect staging of OSCC

biopsy

required to make a diagnosis of oral cancer

proliferative leukoplakia, erythroplakia, non-homogenous leukoplakia, leukoplakia, oral lichen planus

Rank oral pre-malignant lesions (OPML) from highest to lowest risk for transformation to OSCC

leukoplakia

most common OPML

lateral tongue and floor of mouth

high risk sites of leukoplakia

erythroplakia

a red patch that cannot be classified as another condition, associated with a higher risk of malignant transformation than leukoplakia

proliferative verrucous leukoplakia (PVL)

much higher malignancy risk than both erythroplakia and localized leukoplakia (malignant transformation 70-100%)

agressive and frequent surgical interventions, monitor for recurrence

treatment of proliferative verrucous leukoplakia (PVL)

premalignant abnormal growth

what does oral epithelial dysplasia mean on biopsy report

NO

does a negative biopsy mean that the lesion will always be benign