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200910458 200920519

72 year old lady presented to dentist seeking the extraction of the few teeth in her mouth in order to get a set of full dentures , Her medical history revealed breast cancer with metastasis she received radiotherapy , chemotherapy 2 years ago and since then she is on Zometa .

To improve the quality of live for patients with malignant disease, who are receiving cancer therapy that has implications for oral comfort and function, by promoting consistent high standards of oral care through a coordinated team approach

is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis Radiotherapy may be used for curative or adjuvant cancer treatment, palliative and therapeutic treatment. Radiotherapy has several applications in non-malignant conditions Radiotherapy is used for the treatment of malignant tumors (cancer)

Prevent recurrence Recommended (after surgery) when :

cancer larger than 5 cm cancer is found in the lymph nodes

Radiotherapy can be given in 2 main ways :

External beam radiation Brachytherapy (internal radiation)

Mechanism :
Destroy cancer cells and normal cells as well

Fraction :
(5 days/week (Monday to Friday) for about 5 to 6 weeks)

Dermatitis mucosal changes Candidiasis loss of taste salivary gland dysfunction radiation caries soft-tissue necrosis scar tissue formation osteoradionecrosis.

Chemotherapy -The word chemotherapy means the use of any drug (such as aspirin or penicillin) to treat any disease, but to most people chemotherapy refers to drugs used for cancer treatment.
Shortened as Chemo Medically Antineoplastic (anti-cancer) Cytotoxic (cell-killing) .

The most common chemo drugs used for breast cancer : The anthracyclines (doxorubicin/Adriamycin& epirubicin/Ellence) The taxanes ( paclitaxel/Taxol & docetaxel/Taxotere)

Many other chemo drugs are useful in treating women with breast cancer, such as: Platinum agents (cisplatin, carboplatin) Vinorelbine (Navelbine) Capecitabine (Xeloda) Liposomal doxorubicin (Doxil) Gemcitabine (Gemzar) Mitoxantrone Ixabepilone (Ixempra) Albumin-bound paclitaxel (Abraxane) Eribulin (Halaven)

May be used in combination

Bone Marrow Suppression Thrombocytopenia Anemia Nausea Vomiting Alopecia

Mucositis Infections Dental Alterations Xerostomia Bleeding Osteonecrosis

Drug Type: Zoledronic acid or zoledronate is a bisphosphonate derivative What Zometa Is Used For : Hypercalcemia (HCM) multiple myeloma Osteoporosis previous hip fracture How Zometa Is Given : IV (Dose 4.5 mg/5 ml IV injection) No pill Amount : General health or other health problems, type of cancer or condition being treated How Zometa Works :
lowers high blood calcium levels

slowing the breakdown of your bones

ZOMETA is not an anti-cancer therapy.

Adverse effect on kidneys Bone/ joint / muscle pain Nausea & vomiting Numbness Fatigue Fever Eye related SE Headache

Not all SE Predictable Reversible Prevention No Relationship Not to confused with HCM

Osteonecrosis of the Jaw (ONJ) Mucositis Infections Taste changes Dry mouth Pain Tooth decay Gum disease Sores inside your mouth.

Medical team communication ( Dentist, Physician and Oncologist )

Extraction and full denture NOT Recommended . Why ?

Slight chance of ONJ VS Bone metastasis

(Weigh the alternatives !!!)

Zometa affect ! Preventive Rx

Alternative RX :

Fill in spaces of missing teeth Function Stop unwanted movement of remaining teeth Speech Esthetics


Adjunct RX : Fluoride rinse Mouth wash / difflam Saliva substitute Salivary gland protection Frequent oral hygiene recalls Topical antifungal medication Denture hygiene instruction Dietary advice (Simple, functional and acceptable )