Cancer

By Celeste,
and Bri
Definition
● Cancer - neoplastic disease
○ Normal cells → malignant cells

● Classified by tissue involvement

● Second leading cause of death in

the US for adults under 85.
Population affected
● Most common types of cancer
○ Men
■ Prostate
■ Lung
■ Colon and rectum
○ Women
■ Breast
■ Lung
■ Colon and rectum
Risk Factors
● Tobacco - cigarette and
smokeless
● Alcohol - chronic long term
use
● Sunlight - working outside
● Environmental/occupational -
asbestos, radon ect.
● Viruses - Hep C, HPV, Epstein-
Barr
● Socioeconomic - late diagnosis
Diagnostic Criteria
● Discovery of abnormal cell
growth
○ Benign tumor - usually
encapsulated, slow growing
○ Malignant tumor - can
metastasize to different areas
around the body
● How to diagnose
○ Biopsy - the surgical removal of
part of the lesion to study the
types of cells that are present.
■ This determines if the cell
is normal or abnormal
Oral Manifestations
● Enamel erosion - nausea and
vomiting
● Xerostomia - chemotherapy use
● Spontaneous bleeding in the mouth
● Increased bacterial and fungal
infections
● Neurotoxicity - this is a
condition that mimics a toothache
● Osteonecrosis
Risks that may increase oral disease
● Immunosuppression - mores
susceptible to infection
○ More severe response to
biofilm and bacteria
○ Development of yeast
infections in the mouth
○ More susceptible to herpes
infection
Special Considerations During Treatment
● The oncologist should be consulted
in order to know the degree of
immunosuppression of the patient.
● Use of chlorhexidine rinses and
fluorization
● No elective dental treatment should
be carried out during chemotherapy.
ONLY emergency dental care.
● They do not need to be premedicated
difficulties /challenges with homecare
● Fatigue

● Gums bleed easily - Afraid to brush and

floss because of the blood

● Painful to take care of teeth and gums

● Mouth and Jaw Stiffness

Potential Meds
- Bortezomib - proteasome inhibitor
- treats myeloma, mantle cell lymphoma
- Chlorambucil - alkylating agents
- Treats leukemia and lymphoma
- Cyclophosphamide - alkylating agents
- Treats various types of cancer
- Gemcitabine - antimetabolites
- Treats breast, lung, ovarian and pancreatic cancer
- Gleevec - kinase inhibitor
- Treats acute lymphoblastic leukemia and others
Treatment (meds) & potential side effects
● Surgery
● Chemotherapy
○ Alkylating agents, antibiotics,
antimetabolites, plant alkaloids,
steroids/hormones, proteasome inhibitors,
mammalian target of rapamycin inhibitors.
● Radiation therapy
● Hematopoietic cell transplantation
● Hormone therapy
● Vaccine therapy
● Biotherapy
● Targeted therapies
Greatest (worst) side effects come from:
● Chemotherapy
○ Alopecia (hair loss)
○ Myelosuppression (bone marrow
suppression causing a reduction in
blood counts leading to anemia,
leukopenia, and thrombocytopenia.)
○ Immunosuppression (inhibition of
antibody responses resulting from
leukopenia)
○ Nausea, vomiting, and diarrhea
○ Loss of appetite
○ Gastrointestinal mucositis
Side Effects Cont
● Radiation therapy
○ Skin reaction, fatigue, nausea,
vomiting, diarrhea, constipation.
○ With radiation therapy to
esophagus or stomach, pain,
nausea, & dysphagia are common.
● Hematopoietic stem cell
transplantation
○ Red skin rash, severe persistent
diarrhea, jaundice, elevated
liver enzymes, liver tenderness
○ Oral mucositis, xerostomia, viral
and fungal infections: herpes
simplex virus and candida
albicans.
Homecare During Radiation Therapy
● Encourage daily fluoride

● Monitor for trismus

● Exercise jaw 3 times a day

Home Care Considerations

FL mouthwash

Baking soda Bed tray

Considerations for Children: Radiation Therapy
● Extract loose primary teeth
● Remove orthodontic brackets
● Monitor craniofacial
structures for growth and
development
● Encourage daily biofilm
removal
● Daily application of fluoride
● Avoid cariogenic food and
drinks
Motivation and Engagement
● Help the patient understand a routine
schedule of preventive periodontal
scaling, fluoride application, and oral
hygiene assessment by a dental hygienist
contributes to the success of the cancer
treatment.
● THe word cancer is scary and brings fear
and anxiety. Often in a patient’s mind
cancer = death. SO it is important to
provide positive reinforcement and be
creative in helping the patient maintain
optimal oral health.
● Have them bring a friend or family member
to take notes or provide written
instructions.
The Appointment
Documentation

● Diagnosis/treatment dates
● Oncologists name and contact
● Oral assessment
● Oral complications
● Follow up
The Appointment Cont
● Important to teach
patient oral health
information
○ Jaw exercises
○ Avoid sugary foods
○ Avoid spicy and acidic
foods
○ Avoid cancer causing risk
factors such as alcohol and
tobacco
○ Explanations of how to use
saliva substitutes
Barriers to Care
● Financial Hardship
● Unable to receive dental
treatment during cancer
treatment
○ Help them understand the importance
of homecare and how to best manage
their oral health while they are
undergoing cancer treatment.
Dental Observation Perio
● Observed at Dr. Kanter’s
office in Redmond
● Observed Ms. Lindeman RDH
○ The role of the RDH is very
involved in a perio office.
○ They preform SRP’s regularly and
see periomaintanece patients
regularly.
○ It is their goal to get them back
to their regular dentist, but
many patients are more
comfortable seeing the hygienist
at their periodontal office.
Dr. Kanter
● Dental school DDS 1985
○ Case Western Reserve University; Cleveland, Ohio.
● Prosthodontics 1989
○ University of North Carolina; Chapel Hill, North
Carolina Things He
● Periodontics 1979 Performs:
○ University of Washington; Seattle Washington ● Dental Implants
● Gingival grafting
● How long doing implants?
● Cosmetic gingival
○ Restoring implants since 1987
recontouring
○ Placing implants since 1994
● Crown lengthening
● Dual certified specialist, has been a ● Extractions
faculty assistant professor at UW since ● Bone grafting
1989
 Works cited:
Children's Oncology Group, A. (n.d.). Dental Health. Retrieved August 12, 2018, from

https://childrensoncologygroup.org/index.php/sensory/dentalhealth

Choi, N. (2005). 9 Best TMJ Exercises for Pain Relief. Retrieved August 12, 2018, from https://www.healthline.com/health/tmj-

exercises#exercise

Colgate. (2018). Chemotherapy Side Effects on Dental Health. Retrieved August 12, 2018, from https://www.colgate.com/en-us/oral-

health/conditions/cancer/chemotherapy-your-mouth

Darby, Michele Leonardi, Walsh, Margaret M. (Eds.) (2010) Dental Hygine: Theory and Practice St. Louis.

Fred Hutch. (n.d.). Dental health following cancer treatment. Retrieved August 12, 2018, from

https://www.fredhutch.org/content/dam/public/Treatment-Suport/survivorship/Healthy-Links/Dental Health.pdf

Wilkins, Esther M. Wyche, Charlotte J. (2013) Clinical Practice of the Dental Hygienist/ philadelphia : wolters Kluwer Health/ LIppioncott