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Oral Complications during Cancer Therapy: Bacterial Infections

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Highlights

In this Oasis Discussions segment, Dr. Deborah Saunders and Dr. Joel Epstein discuss the management of bacterial infections in oncology patients undergoing treatment. Periodontal and odontogenic infections are commonly found worldwide. However, Periodontal pathogens may cause serious problems in cancer patients. As such, dentists play a crucial role in decontaminating patients and ensuring safe treatments for these patients.

All patients should be examined prior to the cancer treatment. It is important to understand his his/her cancer diagnosis and the type of treatment he/she will be having. The work-up should include:

  • Pretreatment dental treatment to reduce risk
  • Treatment of dental emergencies during active cancer therapy
  • prevention/ongoing dental care following cancer therapy. 
  • Full radiographic examination
  • Full periodontal probing
  • Complete hard/soft tissue examination
  • Sialometry to measure salivary status before radiation
  • Decontamination
  • Oral hygiene instruction

Practitioners must evaluate the patient’s past dental practices along with the current dental status and needs of the patient and look to the potential future dental needs the patient may have. Compliance and oral hygiene status are also important to consider when treatment planning for this patient population.

Head and neck cancer patients must have a stable periodontal condition prior to radiation treatment as it is an indicator for osteoradionecrosis later. As such, it is important to critically evaluate at-risk teeth within the radiation field (pocket depth, attachment loss, caries/restorative status, partially erupted 3rd molars, endodontic lesions). If the teeth have a poor or questionable prognosis, they should be extracted atraumatically with primary closure 1-2 weeks prior to radiation without dressing in the socket.

Cancer patients undergoing chemotherapy may also be candidates for extractions and may require antibiotic coverage depending upon the healing time before chemotherapy begins. If extractions are required between courses of treatment, they should be carried out at the time of blood count recovery. 

Periodontal and odontogenic infections that occur despite efforts to decontaminate and eliminate sources of infection prior to cancer treatment can be managed pharmacologically.

  • 1st line Amoxicillin 500mg po q8h for 7-10 days
  • Alternative Penicillin V 300-600mg po q6h for 7-10 days
  • Alternative Clindamycin 300-450mg po q6h for 7-10 days
  • Known periodontal infection Penicillin & Metronidazole 500mg po q8h for 7-10 days
  • Clavulin 500mg po q8h for 7-10 days
  • Clavulin 875mg po q12 for 7-10 days

Full Presentation (23.44″)

 

2 comments

  1. I have used an antibiotic rinse and spit for 10 yrs now. There are NO systemic effects. It is used as a swish, gargle and spit. Particulate rinses deliver 3000 X the saliva concentration controlling subgingival biofilm s 5-7mm deep, tongue and throat. It eliminates breath odour and has been used by several patients to control mouth ulceration after radiation therapy and to prevent/control MRONJ as it is a bacterial biofiom issue.

  2. I have been using a particular antibiotic rinse, gargle and spit delivery method for ten yrs now. It delivers 3-4 X the MIC to penetrate subgingival biofilms (5-7 mm deep), the tongue and throat biofilms predictably with NO systemic effects. This is useful for preventing by rinsing 4 days before surgery/radiation and continuing during therapy. MRONJ is a biofilm mediated disorder and an antibiotic rinse can prevent and control thus as welll.

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