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PaulB Offline OP
Patient Advocate (old timer, 2000 posts)
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Patient Advocate (old timer, 2000 posts)

Joined: Jul 2012
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Below are the New 2014 NCCN Head and Neck Cancer Guidelines for "Principles of Dental Evaluation and Management." It can be seen in its entirety in version 2.2014 (only).

Goals of Pre-RT Dental/Oral Evaluation:

1. Patient education, both oral and written, regarding oral and dental complications of RT and need for compliance with preventive protocols.

* Effect on Salivary glands:
> Dry mouth strategies
. Increaee hydration
. Salivary substitutes-eg, calcium phosphate containing solutions, gels containing Lysozyme. Lactoferrin and peroxide.
. Alcohol Free Mouthwash
. Salivary stimulation eg, Xylitol chewing gum, sorbitol/makic Acid Lozenges or Xylitol losengesb
. Cholinergic agonists - Pilocerpine cevimeline

> Dental Carries Prevention
. Diet Counceking
. High potency topical fluoride-continue long term after therapy
. Daily 1.1% NaF gel or SNF2, brush on or custom made dental trays or daily 1.1% dentifrice or fluoride varnish, three times a year,
. Calcium Phosphate saliva rinse

> regular frequent Dental evaluation to detect dental disease
. Effect on bone in irritated field

> Need for pre-RT Dental Evaluation and determine need for dental extractions.
. If Yes, should be completed at least 2 weeks prior to the start of RT
. Long term prognosis of teeth and patient motivation should be considered.
. Need to contact dental oncology if any future extractions or surgery in irritated field.

> Effect on Macsticatory muscles
. Prevention of Trismus
. Maintain range of motion
* tongue blades and gentle stretching
* Custom mouth opening devises for rehabilitation of trismus and jaw motion

2. Examination and Assessment of Patient with Treatmnt Plan

. Complete oral and head and neck examination, inc,using radiographicsof all teeth
. Existing Peridontal and dental conditions
. Radiographicsof evidence of Peridontal and dental conditions
> Oral hygiene
>Past dental history
> Patirnt motivation and compliance

. Treatmnt Plan
> Eliminate potential sources of Infection
> Extractions at least two weeks before start of RT
> Treatmnt of active dental carries, Peridontal disease
> Silicone guards to minimize back scatter, if patient has
any metl restoration
> Prescribe potent topical fluoride for daily use. Duration to be determined by periodic carries risk assessment over time.
> Return visit for reevaluation and reinforcement of Preventive Protocol, during, last week of RT
> Evaluation for oral condition and treat appropriately with agents.

Goals of Dental Management during cancer Treatment
1. Manage Xerostomia
2. Prevent Trismus of Macsticatory muscles
3. Evaluation for Oral Candidiosis and treat as clinically indicated

Goals of Dental Management Post Treatmnt
1. Manage Xerostomia
2. Prevent and Managemnt of Trismus
3. Prevent and dental carries
4. Prevent post radiation osteonecrosus
5. Prevent and Manage oral Candidiosis

Dental recall visit interval based on risk, at least once every 6 months, or more frequently for those with Xerostomia, or those with new carries, lesions following radiotherapy.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Jan 2013
Posts: 1,291
Likes: 1
Patient Advocate (1000+ posts)
Offline
Patient Advocate (1000+ posts)

Joined: Jan 2013
Posts: 1,291
Likes: 1
Thanks Paul.

For those wanting to read the whole doc here you go

This is a great addition to the guidelines. Seems like it should have been there years ago; better late than never I guess.


Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
Joined: Jul 2012
Posts: 3,267
Likes: 1
PaulB Offline OP
Patient Advocate (old timer, 2000 posts)
OP Offline
Patient Advocate (old timer, 2000 posts)

Joined: Jul 2012
Posts: 3,267
Likes: 1
Thanks Don. I couldn't post the 2.2014 link that let everyone in automatically without registering? 2013 is not a problem, and is floating around. Could have saved me some typing lol.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs







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