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Oral Care in Cancer

Patients
ROCHMAN MUJAYANTO, DRG., SP.PM
DEPARTEMEN IPM FKG UNISSULA
TREATMENT ORAL CANCER

 Treatment of Early-Stage Oral Cancer (Stages I and II) :


 Surgery and radiotherapy are widely used for the treatment of
early oral cancer, either as single modalities or in combination.

 Treatment of Locally Advanced Tumors of the Oral Cavity (Stages


III and IV) :
 surgery, radiotherapy with or without chemotherapy
Complications Associated with Surgery

 functional limitations on speech,


 mastication and swallowing,
 damages to the cranial nerves and the resultant neurological problems,
 chronic fistulas,
 healing issues to aesthetic considerations such as severe disfigurement
and prosthetic rehabilitation;
 taking these functional and aesthetic impairments,
 psychological implications,
 the patients’ long-term quality of life could be hampered
Complications Associated with Chemotherapy

 Chemotherapeutic agents have gained a notorious reputation in


damaging not only the malignant cells but also the normal tissue in the
patient’s body.

 The level and the type of toxicity of the treatment greatly depend on :
 the overall immune status of the patient prior to and during
chemotherapy,
 the regimen it self,
 the frequency and the dosage of the treatment,
 the route of administration,
 the type of tumor
 Oral mucositis is an iatrogenic condition  The initial condition is often described as
of erythematous inflammatory changes a burning or tingling sensation making
which tends to occur on buccal and the mouth hypersensitive to foods.
labial surfaces, the ventral surface of the
tongue, the floor of the mouth, and the
soft palate of patients receiving  the condition progresses, eating,
chemotherapy swallowing, and talking become
increasingly difficult

 In the more severe cases, can


compromise the airway leading to
anoxia-induced brain injury and even
death
 mucositis usually starts off with aplasia  In the following 1-2 weeks, a loss of
7–14 days after the initiation of epithelial structure and integrity is
chemotherapy. observed, and severe ulceration
develops

 Clinically, the earliest sign may be


characterized by leukoedema,
appearing as a diffuse, poorly defined
area of milky-white opalescence most
noticeable on the buccal mucosa,
which will disappear upon stretching.
 Intraoral bleeding is another complication
associated with chemotherapy. he bleeding can
be spontaneous, traumatically induced, or efect
from existing pathology  thrombocytopenia
Complications Associated with Radiotherapy

 Orofacial tissues that may be inluenced by head and neck radiotherapy


include salivary glands, taste buds,mucousmembranes, bone and teeth,
the temporomandibular joint (TMJ), and related musculatures.

 The acute efects usually develop early in the radiation treatment period
and persist 2-3 weeks ater completion of treatment, whereas the late
efects may become evident at any time after treatment completion,
ranging from weeks to years
 Xerostomia is perhaps the most commonly reported oral squela among
patients receiving radiotherapy for head and neck cancers.

 Ionizing radiation may cause saliva becomes “scant, sticky, and viscous.”:
 irreversible damage to glandular tissue and loss of salivary luid secretion;
 The progressive glandular atrophy and fibrosis and the reduction in salivary
outlow occur shortly ater the initial exposure to radiation and intensify
there after
 Xerostomia is associated with as little as two or three doses of 2Gy
each, whereas doses greater than 30Gy can usually result in
permanent or semipermanent xerostomia
 Dryness of the mucosa may put the patient
 at risk of oral infections
 dificulties in speech, chewing, and swallowing,
 increase the susceptibility to dental caries
 compromise the mucosal integrity
 Dysgeusia can occur at a rapid rate and be exacerbated at up to an
accumulated dose of 30Gy, then the progress of taste deterioration
would slow down as perception for all four tastes, that is, salty, sweet, sour,
and bitter, approaches zero

 In the majority of the cases, taste acuity is reported to be partially restored


and fully restored 20–60 days and 2–4 months ater radiation therapy,
Treatment

 Mucositis :
 Analgetic & anastetikum mouthwash
 ice chips to the mouth every 30 minutes for prevention and
treatment of oralmucositis in patients undergoing
chemotherapy.
 Bacterial infection :
 a combination of penicillin and metronidazole, followed by routine dental
procedures if necessary
 Oral hygiene practice by gentle brushingwith a sot bristle tooth brush and losing
 using an antimicrobial mouthwash  a chlorhexidine-containingmouthwash is
generally recommended
 Candidiasis :  systemic fluconazole (100–
200mg/day for 2 weeks) for the
 topical antifungal agents are
management of moderate to
commonly prescribed for their
severe infections
lower risk of side efects and drug
interactions
 Clotrimazole troches and nystatin  fluconazole resistant cases,
pastilles are the irst line drugs for itraconazole capsules (200mg/day
mild oropharyngeal candidiasis for 2–4 weeks) or itraconazole oral
solution (200mg/day for 2 weeks)
 Viral Infections  HSV
 Oral prophylaxis can be accomplished with acyclovir at the dose of
200 - 800mg thrice a day or valacyclovir at the dose of 500mg twice a
day

 During treatment, acyclovir may be used intravenously at the dose of


5mg/kg every 8 hours or perorally 200–400mg 3–5 times a day
 Xerostomia
 patient who has dry mouthtotakefrequentsipsofwater(every10minutes)and melt ice chips in
mouth for comfort.
 artiicial saliva spray
 mouth moisturizing gel
 The lips may well be lubricated with petroleum jelly or a lanolin-containing preparation
 Patients should be cautioned against cofee, tea, sot drinks with cafeine, and commercial
mouth rinses with alcohol as they can dehydrate the mouth.
 Alcohol-free mouth rinses are recommended.
 Salivaryl fow rate may be increased by saliva stimulating tablets (SST) and medications like
pilocarpine (Salagen, 5mg, thrice a day)
 use sorbitol- or xylitol-based chewing gum for salivary low stimulation and caries arresting.
 Dysgeusia
 zinc supplementation  the proteins responsible for regulating the taste bud
pores
 vitamin D
 Patients are advised to drink plenty of luids during meal, as such would enable
the dissolution of taste components in the food and facilitate their translocation
to taste buds.
 Food should be chewed slowly and thoroughly to release more lavours and
stimulate saliva production
REFFERENCE

 http://screening.iarc.fr/atlasoral.php
 Epstein_et_al-2012-CA__A_Cancer_Journal_for_Clinicians.pdf
 Lalla et al, Management of Oral Mucositis in Patients with Cancer, Dent
Clin North Am. 2008 January ; 52(1): 61–viii
 Yardimci G, Kutlubay Z, Engin B, Tuzun Y. Precancerous lesions of oral
mucosa. World J Clin Cases 2014; 2(12): 866-872
 Cancer / editors, Hellen Gelband, Prabhat Jha, Rengaswamy
Sankaranarayanan, Susan Horton. 2015
 https://www.hindawi.com/journals/tswj/2014/581795/
Refference

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