Cancer Patient: What dental options do I have?
This case involves a 41-year-old female, with cancer surgery 3 years ago, no chemo/radio, wants to keep as many teeth as possible...
What options do I have in this case?
11 Comments on Cancer Patient: What dental options do I have?
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mark
10/8/2020
oncology diagnosis?
Mild Poison
10/9/2020
cervical cancer stage 2,all clear since the surgery,but till the surgery she lost around a year ( 2016-2017) lot of blood ,did 6 embolisations to stay alive till found the surgery dr who wanted to operate her...
can bayram
10/9/2020
Rootcanal fillings, periodontal periodic visits and interdental splints i would use to keep the teeth, some areas might need bone graftings and root coverings perhaps.
Good Elixir
10/9/2020
Not knowing if the patient is symptomatic (discomfort, mobility, difficulty chewing.....), somewhat difficult to say; however, the fact that the patient desires to retain her teeth for as long as possible is a good sign...I would highly recommend conservative therapy (operative and endo as required, thorough scaling/root planning and re-evaluation at least every 6 months (if not sooner).... I would probably recommend a prophy every 2 months after the initial S/RP....depending on her current periodontal condition (BOP, purulence), might consider antibiotic therapy concurrent with her initial S/RP..... good luck and hope that you do well!
Mild Poison
10/9/2020
where the bone is really missing it is some mobility, some repetitive infection she had on 13,took rovamycine but infection came back, she s sensitive on antibiotics as she discovered some gastric erosions and at the last rovamycine she had badly itching...
Jere & Peggy Johnson
10/26/2020
Is there a radiologist in the house? Can anyone explain the scattered radiopacities overlying the right parotid region and in the lower lip in the top X-ray? I assume the white (metallic?) FB overlying the right nasal airway is some sort of nose stud.
Carlos Boudet, DDS
10/26/2020
Artifacts, looks like image of radiograph was taken with a flash, maybe with a cellular phone.
Matt Helm DDS
10/27/2020
Dear Ela, IF you are a Dr, you failed miserably in omitting a full case presentation! Ie: what dental problems is the patient facing? Why are you wondering about your options? If you're counting on the principle that "a picture speaks a thousand words", please be advised that this applies to other domains, not clinical dentistry or medicine. In our field we must always present the case particulars, and it is unprofessional to not do so.
As for your solutions/options they should be very straight-forward! Restorations/RCT's as needed, conservative perio treatment along with splinting where warranted. And if you have to actually ask on a case like this, if I were you I would refer the case out, because evidently you have nowhere near the required experience, yet.
Jere & Peggy Johnson
10/27/2020
Carlos, I suppose these white specks must be some sort of artefact because they don't appear on both x-rays, but I can't believe they are due to flashback from a cell phone - unless the computer screen was incredibly filthy!
With regard to the dental care I agree the patient's periodontal state is very poor, and she needs advice from a periodontist plus some routine restorative work, but I don't believe a T1N0M0 cervical carcinoma with no ongoing active treatment is of particular relevance.
Matt Helm - Ela asked for advice, not sarcasm.
Matt Helm DDS
10/28/2020
John, had you read me carefully you would've found my advice in my post. I clearly stated it in the second sentence of the second paragraph: "Restorations/RCT's as needed, conservative perio treatment along with splinting where warranted. "
As for the rest, it wasn't sarcasm, it was criticism of not presenting the case even minimally from a clinical standpoint, i.e: not even outlining the pertinent clinical situation even in broad terms (as a minimum), relying only on the x-ray to tell the story and, perhaps insufficient knowledge and experience for this case. And I do stand by said criticism! The point here is not only to discuss and debate, but also to impart knowledge and teach others. Some of the best and most memorable lessons we ourselves have learned were imparted with 'tough love'. If I have somehow pushed her to follow up on some continuing ed, even if with 'ruffled feathers', I've still done her a favor.
The white spots are indeed artefacts, most likely reflections of the cell phone's flash when the ray was photographed. No, they are not a dirty screen. Notice not all white spots are present on both rays, and those that are present are not identical in size and position. Basic forensics here. But I do agree with you that this patient should be referred to a periodontist in the interest of the patient.
Manosteel
1/6/2021
I think the simpler the better at this point. Conservative dentistry until at least a 5 yr prognosis is favorable and probable. Sometimes these patients are put on IV Bisphosphonates to slow down any bone density problems due to secondary metastatic sites, which would contraindicate implants and bony procedures.
