Oral Cancer Protocols for Patients Undergoing Cancer Therapy
You will receive 2 credit(s) of continuing education credit upon successful completion of this course.

The purpose of this course is to educate dentists in the care and treatment of cancer patients and their families. One of the authors (JP) is a six-year cancer survivor of squamous cell carcinoma; many of these clinical suggestions are based on his experiences. In joint effort with Loyola university, Cardinal Bernadin Cancer Center, a restrospective study makes up the remainder of the recommended approaches and products and their effective uses.

Kathryn Gilliam, RDH, BA
Kathryn Gilliam, RDH, BA, is an active clinical dental hygienist, a performance coach, an author and a speaker. Kathryn is a contributor to numerous dental industry publications including The Journal of the Academy Of General Dentistry, RDH, Dentistry Today, and Hygiene Mastery Magazine.

A graduate of both the University of Nebraska and the University of Texas, Kathryn combines her experience as a clinical dental hygienist with strong leadership and business knowledge to create successful...
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James Pavlatos, DDS

Dr. James Pavlatos is a diplomate of the International Congress of Oral Implantologists and The American Society of Osseointegration; as well as an Associate Fellow of the American Academy of Implant Dentistry; Fellow of the American College of Oral Implantology; and Fellow member of the Illinois State Dental Society.

He is President of the Illinois Implant Study Club; former faculty; Loyola School of Dentistry; member of the Academy of General Dentistry; guest lecturer at Osteomed Corporation...

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Learning Objectives:

Upon completion of this course, participants should be able to:

  1. Have a better understanding of pre-cancer treatment dental care
  2. Know the oral protocols for patients with cancer
  3. Understand how to reduce caries in patients with cancer

One of the authors (JP) is a six-year cancer survivor of squamous cell carcinoma; many of these clinical suggestions are based on his experiences. In joint effort with Loyola university, Cardinal Bernadin Cancer Center, a restrospective study makes up the remainder of the recommended approaches and products and their effective uses.

ADA CERP Disclosure: The author of this Continuing Education Activity receives ongoing financial consideration from DrBicuspid.com for preparation of these CE course materials.   Author has disclosed that they do not have any real or perceived conflict of interest in preparing this educational activity, nor does this activity discuss any unlabeled or unapproved drug or device.

  1. Introduction
  2. Phase I: Pre-cancer Treatment Dental Examination
  3. Pre-cancer treatment dental appointment No.1
  4. Pre-cancer treatment dental appointment No. 2
  5. Phase II: Dental treatment during cancer therapy
  6. Chemotherapy-induced complications
  7. Management of Mucositis
  8. Management of Mucositis Continued
  9. Mucositis-Associated Infection
  10. Viral Infection
  11. Mucositis
  12. Dysgeusia
  13. Xerostomia
  14. Prevention of Xerostomia
  15. Candidiasis
  16. Depression
  17. Dental care after surgery for head and neck cancer
  18. Phase III: Dental care following active cancer therapy
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  10. Ramirez-Amador V, Silverman S Jr, mayer P, Tyler M, Quivey J. Candidal colonization and oral candidiasis in patients undergoing oral and pharyngeal radiation therapy. Oral Surg Oral med Oral Pathol Oral Radiol Endod 1997;84:149-153.
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  12. Rosengren B, Wulff L, Carlsson E, Carlsson J, Montelius A, Russell K, Grusell E. backscatter at tissue-titanium interfaces. Analysis of biologic effects from 60Co and protons. Acta Oncology 1995;34:859-866
  13. Melian E, Fatyga M, Lam P, Steinberg M, Reddy SP, Petruzzelli GJ, Glasgow GP. Effect of metal reconstruction plates on cobalt-60 dose distribution: A predictive formula and clinical implications. Int J Radiat Oncol Biol Phys 1999;44:725-730
  14. Li XA, Chu JC, Chen W, Zusag T. Dose enhancement by a thin foil of high-Z material: A Monte Carlo study. Med Phys 1999;26:1245-1251
  15. Nadrowitz R, Feyerabend T. Backscatter dose from metallic materials due to obliquely incident high-energy photon beams. Med Phys 2001;28:959-965
  16. Fleming TJ, Rambach SC. A tongue-shielding radiation stent. J Prosthet Dent 1983;49:389-392
  17. Das U, kahm FM. Backscatter dose perturbation at high atomic number interfaces in megavoltage photon beams. Medical Physics 1989;16:367-375.
  18. Scrimger JW. Backscatter from high atomic number materials in high energy photon beams. Radiology 1977;124:815-817
  19. Gibbs FA, Palos B, Goffinet DR. The metal/tissue interface effect in irradiation of the oral cavity. Radiology 1976;119:705-707
  20. Tatcher M, Kuten A, Helman J, Laufer D. Perturbation of cobalt 60 radiation doses by metal objects implanted during oral and axillofacial surgery. J Oral maxillofac Surg 1984;42:108-110
  21. Sauer O. Calculation of does distributions in the vicinity of high-Z interfaces for photon beams. Med Phys 1995;22:1685-1690
  22. Reitemeier B, Reitemeier G, Schmidt A, Schaal W, Blochberger P, Lehmann D, Hermann T. Evaluation of a device for attenuation of electron release from dental restorations ina therapeutic radiation field. J Prosthet Dent 2002;87:323-327
  23. Fuller CD, Diaz I, Cavanaugh SX, Eng TY. In vivo dose perturbation effects of metallic dental alloys during head and neck irradiation with intensity modulated radiation therapy. Oral Oncol 2004;40:645-648
  24. Thilmann C, Adamietz IA, Rahn R, Mose S, Saran F, Schopohl B, Bottcher HD. [The In-vivo determination of dosage intensification due to dental alloys in the therapeutic irradiation of the oral cavity] [article in German]. Strahlenther Onkol 1995;171:468-472
  25. Thilmann C, Adamietz IA, Ramm U, Rahn R, Mose S, Saran F, Bottcher HD. In-vivo dose increase in the presence of dental alloys during 60Co Gamma-ray therapy of the oral cavity. Med Dosim 1996;21:149-154
  26. Farahani M, Eichmiller FC, McLaughlin WL. Measurement of absorbed doses near metal and dental material interfaces irradiated by x and gamma-ray therapy beams. Phys Ned Biol 1990;35:369-385
  27. Schratter-Sehn AU, Schmidt WF, Keilhauser R, Langer H, karcher KH. [The prevention of mucosal lesions during oropharyngeal irradiation with a dental-fillinf shield] [article in German]. Stranlenther Onkol 1992;168:35-38
  28. Wang R, Boyle A. A convenient method for guarding against localized mucositis during radiation therapy. J Prosthodont 1994;3:198-201
  29. Wang RR, Pillai K, Jones PK. In vitro backscattering from implant material during radiotherapy. J Prosthet Dent 1996;75:626-632
  30. Ravikumar M, Ravichandran R, Supe SS. Forward scatter dose effect at metallic interfaces irradiated by X and gamma ray therapy beams. Stranhlenther Onkol 2004;180:173-178
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  32. Eating hints for cancer patients: Before, during and after treatment. Bethesda, MD: National Institute of Health; 1998
    Haveman CW. Xerostomia management in the head and neck radiation patient. Texas Dent J 2004;6:121
  33. What is trismus? Available at: http://www.oralcancerfoundation.org/dental/trismus.htm. Accessed on April 20, 2007
  34. Buchblinder D, Currivan RB, Kaplan AJ, Urken ML. Mobilization regimens for the prevention of jaw hypomobility in the radiated patient: A comparison of three techniques. J Oral Maxillofac Surg 1993;51:863-867
  35. Available at: http://www.healthline.com/galecontent/prophylactic-antibiotic-premedication. Accessed May 2008
  36. Drug Information. Available at: http://www.mayoclinic.com/health/drug-information/DrugHerbIndex. Accessed may 2008


Release date: January 2, 2012
Review date: January 1, 2016
Expiration date: December 31, 2018
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