Article title: Oral complications in children with cancer.
Author(s): Childers, Noel K. et al
Journal: Oral Surgery, Oral Medicine, Oral Pathology
Page #s: pp. 41-47
Year: Jan, 1993
Major topic: Oral complications in children with cancer.
Minor topic(s): NA
Type of Article: Summary of research
Main Purpose: To report the results of a 2.5 yr prospective follow-up study on the incidence of oral complications in 214 pediatric patients with cancer.
Overview of method of research: 214 pediatric cancer patients followed over 2.5 yrs at CH Alabama. Biweekly oral exams. 50 healthy control subjects. Patients grouped into the 12 most common malignant diseases and one group labeled “other”. Oral complications were classified by area, size and description. Mean age of pts was 7.4 y.o.
Key points in the article discussion:
I. In the previous ten yrs, it seems that the incidence of oral complications in cancer patients he decreased.
A. This fact may be due to improved chemotherapeutic an radiation protocols.
II. Certain groups experienced statistically significant increased levels of oral complications.
A. These were patients with solid tumors, sarcomas and the types of malignancies that had poorer prognosis.
B. Typically Pt’s in these more severe groups received more severe treatment… makes sense.
C. Routine dental care shown to reduce effects of oral complications.
III. Within the leukemia group.
A. AML had significantly higher incidence of complications including candidiasis
B. AML considered a “risk group”… especially for candidiasis.
IV. Various complications and top three risk groups
A. Mucositis: Sarcoma, AML, Solid tumors
B. Ulcers: AML, Sarcoma, Solid tumors
C: Candida: AML, Sarcoma, Solid tumors
D. Gingivitis: AML, Leukemia, ALL
Assessment of article: One huge limitation of this study was that they weren’t able to control for different treatment modalities. Also, most of the subjects in this study had deficient oral health care which effected results. Further categorization and research is needed.
Showing posts with label 01/29/2010. Show all posts
Showing posts with label 01/29/2010. Show all posts
Thursday, January 28, 2010
Wednesday, January 27, 2010
Sunday, January 24, 2010
Dental care of the Pediatric Cancer Patient 01/29/2010
Resident: J. Hencler
Date: 01/29/2010
Article title: Dental care of the Pediatric Cancer Patient
Author: Marcio A. da Fonseca, DDS, MS
Journal: Pediatric Dentistry-26:1 Pg 53-57
Major topic: Dental care and the pediatric cancer patient
Type of Article: Literature review
Main Purpose: Dental care recommendations
Key points in the article discussion:
Oral/dental infections may complicate or delay cancer tx. Dental consultation on a newly diagnosed patient should be done asap so enough time is available to complete dental tx before cancer therapy begins.
Take a thorough medical hx and consult with PCP/Oncologist. Antibiotic prophylaxis should be considered due to possible lowered immune state or presence of central line, catheter, or port.
Check patient’s hematologic status. Patients with platelet count <20,000 have increased bleeding risk. Elective dental work should be deferred in patients with absolute neutrophil count <1,000. Routine dental tx can be done when ANC >1,000 and platelet count is >50,000. AB prophylaxis should be considered with ANC between 1000 and 2000. Platelet transfusion should be considered when count is between 40,000 and 75,000. Peak concentration of platelets is reached 45-60 mins after transfusion so dental tx should be conducted at this time if possible. During immune suppression all elective dental tx should be avoided.
Aggressive OH should be conducted throughout cancer tx. Patients with poor OH or PD disease can use chlorhexidine rinses daily. The pediatric cancer patient has high caries risk due to nutritional supplements (high carb), fungal rinses with high sucrose such as nystatin, and frequent vomiting (enamel demin).
Dental tx priorities should be infections, EXTs, PD care and souces of infection before tx of caries, RCT permanent teeth, and replacement of defective restorations. SC/RP before cancer tx begins if time allows and EXTs are favorable over pulp therapy. During immune suppression swelling and purulent exudates may not be observed so radiographic exam is important to determine odontogenic infections.
Fixed ortho and space maintainers should be removed in patients with poor OH. Removable appliances may be worn in the patient with good OH.
Partially erupted molars can be a source of infection due to pericoronitis. Overlying gingival should be excised. Loose primary teeth should be left to exfoliate naturally. EXTs ideally should be completed 3 wks before cancer tx initiation. Osteoradionecrosis risk in patients who have undergone radiation to face and have had EXT is elevated and needs to be addressed.
Patient in maintenance phase and prognosis is good, dental procedures can be done routinely. Must still check blood count and need for AB prophylaxis.
Summary of conclusions: Key to maintaining healthy OH during cancer tx is compliance. It is important to educate parent about importance of oral care to minimize discomfort, a healthy diet, potential cariogenicity of pediatric medications and nutritional supplements, and effects of cancer tx on craniofacial growth and dental development. The role of the pediatric dentist in the hematology/oncology team is a very important one.
Assessment of article: Good article. All information is pertinent and useful to a pediatric dentist in clinical situations.
Date: 01/29/2010
Article title: Dental care of the Pediatric Cancer Patient
Author: Marcio A. da Fonseca, DDS, MS
Journal: Pediatric Dentistry-26:1 Pg 53-57
Major topic: Dental care and the pediatric cancer patient
Type of Article: Literature review
Main Purpose: Dental care recommendations
Key points in the article discussion:
Oral/dental infections may complicate or delay cancer tx. Dental consultation on a newly diagnosed patient should be done asap so enough time is available to complete dental tx before cancer therapy begins.
Take a thorough medical hx and consult with PCP/Oncologist. Antibiotic prophylaxis should be considered due to possible lowered immune state or presence of central line, catheter, or port.
Check patient’s hematologic status. Patients with platelet count <20,000 have increased bleeding risk. Elective dental work should be deferred in patients with absolute neutrophil count <1,000. Routine dental tx can be done when ANC >1,000 and platelet count is >50,000. AB prophylaxis should be considered with ANC between 1000 and 2000. Platelet transfusion should be considered when count is between 40,000 and 75,000. Peak concentration of platelets is reached 45-60 mins after transfusion so dental tx should be conducted at this time if possible. During immune suppression all elective dental tx should be avoided.
Aggressive OH should be conducted throughout cancer tx. Patients with poor OH or PD disease can use chlorhexidine rinses daily. The pediatric cancer patient has high caries risk due to nutritional supplements (high carb), fungal rinses with high sucrose such as nystatin, and frequent vomiting (enamel demin).
Dental tx priorities should be infections, EXTs, PD care and souces of infection before tx of caries, RCT permanent teeth, and replacement of defective restorations. SC/RP before cancer tx begins if time allows and EXTs are favorable over pulp therapy. During immune suppression swelling and purulent exudates may not be observed so radiographic exam is important to determine odontogenic infections.
Fixed ortho and space maintainers should be removed in patients with poor OH. Removable appliances may be worn in the patient with good OH.
Partially erupted molars can be a source of infection due to pericoronitis. Overlying gingival should be excised. Loose primary teeth should be left to exfoliate naturally. EXTs ideally should be completed 3 wks before cancer tx initiation. Osteoradionecrosis risk in patients who have undergone radiation to face and have had EXT is elevated and needs to be addressed.
Patient in maintenance phase and prognosis is good, dental procedures can be done routinely. Must still check blood count and need for AB prophylaxis.
Summary of conclusions: Key to maintaining healthy OH during cancer tx is compliance. It is important to educate parent about importance of oral care to minimize discomfort, a healthy diet, potential cariogenicity of pediatric medications and nutritional supplements, and effects of cancer tx on craniofacial growth and dental development. The role of the pediatric dentist in the hematology/oncology team is a very important one.
Assessment of article: Good article. All information is pertinent and useful to a pediatric dentist in clinical situations.
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