Podcast
Questions and Answers
Which condition has the highest risk of osteoradionecrosis?
Which condition has the highest risk of osteoradionecrosis?
What precaution should be taken to minimize complications after radiotherapy?
What precaution should be taken to minimize complications after radiotherapy?
Which indicator suggests the need for tooth extraction in patients about to receive head and neck irradiation?
Which indicator suggests the need for tooth extraction in patients about to receive head and neck irradiation?
In managing dental care for HIV patients, what is a crucial consideration?
In managing dental care for HIV patients, what is a crucial consideration?
Signup and view all the answers
Which factor is NOT a consideration when planning dental procedures for patients on chemotherapy?
Which factor is NOT a consideration when planning dental procedures for patients on chemotherapy?
Signup and view all the answers
What is the recommended period for a drug holiday before restarting Oral Bisphosphonates after treatment?
What is the recommended period for a drug holiday before restarting Oral Bisphosphonates after treatment?
Signup and view all the answers
What is a primary contributing factor to Osteoradionecrosis in the mandible compared to the maxilla?
What is a primary contributing factor to Osteoradionecrosis in the mandible compared to the maxilla?
Signup and view all the answers
Which of the following is NOT part of the recommended management following a surgical procedure in patients with Osteoradionecrosis?
Which of the following is NOT part of the recommended management following a surgical procedure in patients with Osteoradionecrosis?
Signup and view all the answers
What is the initial step in the case treatment sequence for managing Medication-Related Osteonecrosis of the Jaw (MRONJ)?
What is the initial step in the case treatment sequence for managing Medication-Related Osteonecrosis of the Jaw (MRONJ)?
Signup and view all the answers
What is the purpose of Hyperbaric Oxygen (HBO) therapy in the management of Osteoradionecrosis?
What is the purpose of Hyperbaric Oxygen (HBO) therapy in the management of Osteoradionecrosis?
Signup and view all the answers
What is the suggested platelet count threshold for transfusion prior to dental extraction?
What is the suggested platelet count threshold for transfusion prior to dental extraction?
Signup and view all the answers
What is the minimum time frame recommended before initiating radiation therapy for dental extractions?
What is the minimum time frame recommended before initiating radiation therapy for dental extractions?
Signup and view all the answers
In dental care for HIV patients, which of the following is a recommended precaution before a surgical procedure?
In dental care for HIV patients, which of the following is a recommended precaution before a surgical procedure?
Signup and view all the answers
Which of the following symptoms is NOT associated with MRONJ?
Which of the following symptoms is NOT associated with MRONJ?
Signup and view all the answers
What oral health measure should be avoided in patients at risk for Osteoradionecrosis post-radiation therapy?
What oral health measure should be avoided in patients at risk for Osteoradionecrosis post-radiation therapy?
Signup and view all the answers
Which factor increases the risk of Osteoradionecrosis after radiation therapy?
Which factor increases the risk of Osteoradionecrosis after radiation therapy?
Signup and view all the answers
What is the AAOMS recommended drug holiday duration before and after dental procedures?
What is the AAOMS recommended drug holiday duration before and after dental procedures?
Signup and view all the answers
Which is the correct recommendation regarding packing agents during extraction in patients at risk for MRONJ?
Which is the correct recommendation regarding packing agents during extraction in patients at risk for MRONJ?
Signup and view all the answers
Which of the following management strategies can help in the prevention of ONJ in at-risk patients?
Which of the following management strategies can help in the prevention of ONJ in at-risk patients?
Signup and view all the answers
What is the defining feature of MRONJ?
What is the defining feature of MRONJ?
Signup and view all the answers
Which radiographic finding is NOT characteristic of osteoradionecrosis?
Which radiographic finding is NOT characteristic of osteoradionecrosis?
Signup and view all the answers
Study Notes
Evidence and Risk Considerations
- Category X indicates existence of fetal abnormalities and risks in pregnancies; benefits do not justify use of certain medications.
Oncologic Considerations
- Primary goals in cancer treatment include reducing risks of infection and osteoradionecrosis (ORN).
- Increased risk of ORN occurs in:
- Patients with radiation to the posterior mandible
- Those receiving >65 Gy radiation doses
- Smokers
- Patients with a history of traumatic dental procedures, such as extractions.
Dental Management Post-Radiotherapy and Chemotherapy
- Avoid epinephrine to prevent hypovascularity post-radiotherapy.
- Hyperbaric oxygen (HBO) treatment and prophylactic antibiotics are recommended.
- Extractions should be avoided during radiotherapy unless absolutely necessary.
Tooth Extraction Guidelines
- Extractions are indicated for severe dental issues such as:
- Deep pockets (≥6mm), excessive mobility, or drainage of pus.
- Broken, non-restorable, or poorly maintained teeth.
- Associated inflammatory or infectious diseases.
- Emergency situations warrant extraction regardless of conditions.
Chemotherapy Considerations
- Patients exhibit compromised immunity; risk increases over time (notably after 4 years).
- Insufficient data exists to warrant stopping medications due to chemotherapy.
- Oral Bisphosphonates (O.BPs) may require a drug holiday two months prior to surgery; medications not resumed until osseous healing is confirmed.
Osteoradionecrosis (ORN)
- Occurs following surgery or spontaneously in irradiated areas, characterized by non-healing exposed bone more than 6 months post-radiotherapy.
- Predominantly observed in the posterior mandible due to reduced blood supply.
Prevention and Management of ORN
- Dental evaluations should occur at least two weeks before radiotherapy.
- Extractions post-radiotherapy should be avoided, especially in the mandible.
- Maintain optimal oral hygiene, utilize prophylactic antibiotics, and consider plain local anesthetics.
- Hyperbaric oxygen may be beneficial pre- and post-operatively.
- Limit extractions to minimal trauma – use saline irrigation and ensure no bony edges are left exposed.
Guidelines for Postoperative Care
- Employ gentle care with warm saline rinses, chlorhexidine mouthwash, and fluoride gel while avoiding tobacco.
- Schedule follow-ups every three months for monitoring.
AIDS and Extraction Guidelines
- Patients with AIDS define severe immunosuppression; CD4+ count of less than 200 cells/uL necessitates caution.
- Extraction precautions include:
- Timing extractions two weeks prior to starting radiation or chemotherapy.
- Avoiding sharp edges and ensuring primary closure post-extraction.
- Monitoring platelet and white blood cell counts before procedures.
Medication-Related Osteonecrosis of the Jaw (MRONJ)
- Defined by current or prior treatments with antiresorptive or antiangiogenic drugs.
- Characterized by persistent exposed bone for over eight weeks without prior jaw radiation or metastatic disease.
- Symptoms include pain, discomfort, tooth loss, and halitosis.
Management and Prevention of MRONJ
- Prevention strategies report up to a 50% decrease in jaw osteonecrosis when screening is utilized prior to therapy.
- Cessation recommendations for medications vary; some guidelines suggest stopping two months prior to dental procedures, supported by limited evidence.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
