NCCN Principles of Dental Evaluation and Managemnt - 07-16-2014 02:13 PM
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.
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.