Goldie Razban DMD Erin Shope DMD MS because of the immunosuppression the patients experience any existing or potential sources of oral dental infections and or soft tissue trauma can compromise the medical treatment ID: 1041332
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1. Pediatric Oral Health in Cancer TherapyGoldie Razban, DMDErin Shope, DMD, MS“…because of the immunosuppression the patients experience, any existing or potential sources of oral/ dental infections and or soft tissue trauma can compromise the medical treatment, leading to morbidity, mortality, and higher hospitalization costs.” - AAPD Guidelines
2. What is the current strategy for assessing oral health of children with new cancer diagnoses?ACBWould you handle these three cases similarly? Differently?
3. MucositisCandidiasisMouth painOral ulcerationsGingival hypertrophyGram negative oral flora transformationSepsisBleedingTaste dysfunctionXerostomiaNeurotoxicityOsteonecrosisTrismusOral Graft Versus Host DiseaseIncreased caries riskImpact on dental developmentEffects on the mouth from immunosuppression, chemo, and/or radiation
4. Oral mucositis definition Oral mucositis (OM) is defined as erythema and/or ulcerations of the oral mucosa secondary to chemotherapy, radiation, or hematopoietic stem cell transplantationIt is one of the most common complications following cancer treatment in children, occurring in approximately 52 to 80% of patientsThe mucosal damage can present with a range of mild atrophy to severe ulcerationsPatients with mucositis can experience severe pain causing pain while eating, drinking, and swallowing affecting the overall quality of life
5. Good oral hygiene can decrease rates of mucositis MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy (2020)
6. Dental clearances1Completed in the hospital or at Eastman Dental Dental examinationTreat all dental needs prior to cancer treatment TreatmentRoutine care along with educationEducation23
7. Compromised oral health : prior to during following cancer therapyDramatically affects:Clinical outcomesQuality of life outcomesDental Oncology Education Program’s: “Oral Health in Cancer Therapy: A Guide for Health Care Professionals”
8. Early, pre-induction, dental intervention: Assures immunosupression is not initiated in the presence of an acute or emerging oral infectionMinimizes oral acute infections during treatment cycles and associated immunosupression Educates child and caregiver as to potential oral complications with cancer therapyEducates child and caregiver importance of and adaptive techniques for oral hygiene during therapy and techniques to maintain hygiene in presence of mucositis / candidiasisDental Oncology Education Program’s: “Oral Health in Cancer Therapy: A Guide for Health Care Professionals”
9. New Cancer DiagnosisClearance Letter & Document in EpicUrgent Dental Treatment (OR) (w/in 24hr)Page Pediatric Dentist on CallRequest Pediatric Dentistry Consult in EpicReferral to Pediatric Dentistry in EpicInpatient Pre-treatment Oral Health Assessment & Radiographs w/in 24 hoursPre-treatment Oral Health Assessment & Radiographs w/in 72 hours at Pediatric Dentistry ClinicNo Potential Dental Sources of Infection/IrritationNo Potential Dental Sources of Infection/Irritation+ Potential Dental Sources of Infection/IrritationCoordinate Dental Care in Future Non-urgent carious lesions/dental issuesCoordinate Dental Care in FutureNon-urgent carious lesions/dental issuesOUTPATIENT:INPATIENT:Daily In-Pt rounds w/ team when acute dental issue presentAssist mucositis / candidiasis / oral pain managementHygienist: as needed
10. Mucositis informational guide Given to families when they are first diagnosedMucositis informational video (7 minute long presentation) Families will watch in the hospital roomOral health educationHands-on demonstrations with dentist and family at the hospitalEducation
11. Inpatient monitoringDaily oral hygieneWHO mucositis scale
12. Daily oral care FLOSSOnly recommended if the patient is skilled at flossing without causing trauma to the gingival tissuesBRUSHTwice daily with a soft nylon brush and fluoridated toothpaste for two minutes(If patient cannot tolerate a soft nylon toothbrush, foam brushes can be used as a replacement soaked in chlorhexidine)MOUTHWASH0.9% saline or sodium bicarbonate mouth rinses four to six times/day PROTECTIONApply lanolin based lubrication on lipsMouth cleaning
13. What are your thoughts…?