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Medically Compromised Patient Care

Course Number: 628

Cancer Patients

Oral complications can be common after patients receive chemotherapy or radiation therapy for cancer treatment. Patients may present with oral mucositis, or inflammation and ulceration of the mouth. They may also experience fungal infections, such as candidiasis, or xerostomia (dry mouth) as a result of salivary gland dysfunction. If patients have taken bisphosphonate medication, they may also be at greater risk for osteonecrosis of the jaw (ONJ). Necrosis that is specifically related to head and neck radiation is referred to as osteoradionecrosis of the jaw (ORNJ).

As dental providers, it is possible to provide relief for several of the oral manifestations that can occur in cancer patients. Table 15 lists possible treatments to ease symptoms of mucositis, xerostomia and radiation caries.

Table 15. Treatment for Oral Conditions Related to Cancer (1)
  • Benadryl or viscous lidocaine in milk of magnesia
    • Best treatment to offer relief
    • Requires prescription from oncologist
    • Must be made at compounding pharmacy
    • Called Miracle Mix
  • Alcohol-free mouthrinses (CHX) or Rx antimicrobial agents
  • Maintain hydration (avoid alcohol, soda, & tobacco)
  • Salt and sodium bicarbonate mouthrinse
  • Topical steroids; Orabase; Biotene products; Nystatin
  • Xylimelts
  • Food with liquid
  • Xylitol-based gum
  • Suck ice chips
  • Glycerine & water
  • Saliva substitutes
Radiation Caries (following radiation to head & neck)
  • Education patient concerning risks
  • Motivate them to maintain optimum oral health
  • Frequent dental recall
  • Custom trays for daily fluoride application (for LIFE)
    • 1.1% Neutral sodium
    • 0.4% Stannous fluoride gel
    • Avoid Acidulated Phosphate Fluoride
    • Single, daily brush-on application of 5000 ppm fluoride may be more effective

There are several modifications for dental treatment when caring for cancer patients. First, if the patient is receiving chemo or has an indwelling catheter/port present, consult their oncologist before any dental treatment is performed. The patient may need antibiotic premedication prior to treatment and this should be prescribed by the patient’s oncologist. Also, have the oncology team conduct blood work 24 hours before invasive dental treatment to determine whether the patient’s platelet count, clotting factors, and neutrophil count are sufficient to treat. Treatment must be postponed if the platelet count <50,000 platelets/mm3, abnormal clotting factors are present, or the neutrophil count < 1,000 cells/mm3.

Table 16 provides follow-up questions for cancer patients who are seeking dental care.

Table 16. Follow-Up Questions for Current Cancer Patients Seeking Dental Care1
  • Does your oncologist know you are here today?
  • Did you have lab work done before this appointment? What is you ANC?
  • What type of cancer do you have and what area of the body is affected?
  • May I have permission to contact your oncologist about your treatment?
  • When did/will your oncology treatment start?
  • What type of treatments are you receiving?
  • Has your physician given you any instructions related to having oral health treatment?
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