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MANIFESTASI KEMOTERAPI DI

RONGGA MULUT

Wilda Hafny Lubis drg MSi

Melakukan Identifikasi & eksploitasi

Kanker

sering

dijumpai

saat ini

Ahli- ahli scince+kemoterapi

Perbedaan biologi sel kanker

Mengembangkan obat dan

kombinasinya

Menghancurkan tumor>dari pada sel normal

Beberapa respons pnk kanker

Terhadap kemoterapi:

1. Untuk penyembuhan kanker

2. Mungkin dapat

menyembuhkan kanker

3. Memperpanjang hidup

4. Tidak respon terhadap kanker

Manifestasi

kemoterapi dapat

dijumpai di rongga

mulut

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Kemoterapi

• Perawatan kanker dengan menggunakan obat- obatan yang

dapat menghancurkan sel kanker, menghentikan berlipat ganda

Disebut obat anti kanker

• Sel normal tumbuh dan mati secara terkontrol

• Sel kanker→ sel tidak normal

•

• Kerusakan sel= efek samping, merusakkan sel normal juga

membelah

membentuk

>tidak terkontrol

Efek samping berpengaruh pada:

• Pembentukan sel darah dalam sumsum

tulang

• Sel dalam saluran cerna (mouth, stomach,

intestines)

• Sistem reproduksi

• Folikel rambut

• Organ vital juga dapat terpengaruh eq.

heart, lung, kidneys, nervous system

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Kemoterapi dapat mempengaruhi pada :…Cont.

• Efek samping tergantung pada tipe dan dosis kemoterapi.

• Recovery time tergantung pada kesehatan

secara umum dan tipe kemoterapi yang diberikan

Beberapa efek samping kemoterapi

Anemia

mengurangi

kemampuan sel

darah merah

Sedikit sel

darah merah

yang membawa

Oksigen

Nafas pendek

Lemah

capek

Nausea

Vomiting

Obat baru

Reduce

this

Pain

Obat KH dapat

merusak syaraf

Rasa terbakar

Mati rasa

Sakit mencucuk

Pada kaki dan

tangan

Kehilangan

rambut

Dapat

mengenai

semua jenis

rambut

Akan tumbuh

kembali setelah

perawatan

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Manifestations in Oral Cavity :

Mukositis and ulceration :

mucosa gastrointestinal rentan

terhadap efek toksik

Infeksi oral: Leucopenia

meningkatnya risiko infeksi ,

pengobatan setelah dilakukan

kultur, mencegah infeksi sistemik

atau septicaemia.

Neurotosik, sakit yang dalam, terus

menerus, bilateral dan seperti

sakit gigi

Xerostomia

Perubahan pengecapan

Manifestation.. Cont..

Perdarahan, pengurangan platelet

( thrombocytopenia )

Perkembangan gigi yang

abnormal

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Pemeriksaan jaringan lunak, keras dan jaringan periodontal

Pasien dengan kelainan haematologi ,mungkin menderita immunosuppression atau thrombocytopenia harus di konsul ke onkologi

Hilangkan daerah infeksi dan iritasi seperti akar gigi , gigi tajam dll.

Jadwal kemoterapi selanjutnya sebaiknya 7-10 hari setelah penyembuhan

Tindakan pre kemoterapi:

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Informasi penting :

Faktor pembekuan Kateter vena central

darah

Tempat kolonisasi bakteri

Komplikasi

haemaragik

terjadi Perlu antibiotic prophylactic

Platelet Neutrophil <

< 50 ribu/mm High risk of infection

and septicaemia

Perawatan Dental / Oral yang harus

diperhatikan

• Teknik menyikat gigi

• Makanan yang tajam

• Berkumur dengan alkohol

• Penggunaan propilaksis

• Pencegahan demineralisasi

• Pasien sering muntah

• Tidak boleh pakai gigi palsu

• Pertahankan oral hygiene

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• Sebelum memulai kemoterapi kanker ,

pada penderita dilakukan evaluasi untuk

mengenali dan menyingkirkan sumber-

sumber infeksi oral yang dapat

memperburuk rangkaian perawatan

kemoterapi

EFFECT OF RADIOTHERAPY

Oral complications of head and neck

radiation 1. Mucositis

- Generalized mucosal erythema ( after initiation of

treatment)

-Desquamation and ulceration

- Extreamly pain, eating nearly impossible

- Sites : buccal, labial and lingual mucosae

- Healing rapidly follows the cessation of radiation

- Mucosal atrophy permanent

- Candidiasis

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2.Xerostomia

- Bacterial colonization of the teeth

- Difficulty of swallowing and managing food

- Plaque formation and debris accumulation

3. Caries radiation

- Rampant caries

Caused by : xerostomia, accelerated

decalcification of irrradiated teeth,

reduced

oral hygiene

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The three major risk factors in the

development of osteoradionecrosis

* Anatomic site of the trauma ------mandible develop necrosis 5 times more

frequently

* Dose of radiation* Dental status of patient ----- patients with

teeth are more likely than edentulous patients

Osteoradionecrosis and extraction

Risk of development of osteoradionecrosis to timing of extraction :

- High risk : extractions during radiation therapy

- Elevated risk : extractions just prior to radiation

therapy

- Lowest risk : !2 mo or more after radiation therapy

Extraction strategy

Pre radiation extraction of actively infected teeth

Extraction done 12 mo or more after radiation therapy are lesser risk

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Oral complications of cancer

cemotheraphy

Factors affecting frequency of development of oral problems

1. Patient related variables

- The younger patient ------ more likely affect

- The type of malignancy----- lymphoma, leukemia : higest

frequency

- Patient with poor oral hygiene and pre existing

odontogenic and periodontal infection -------high risk

Dentist should be work with oncologist to optimize the

2. Therapy related variables* Type of drug

- Antimetabolite ( methotrexate ) ------ mucositis- Alkylating agent ( 5 fluorouracil------ mucositis

- Adriamycin ----- minor salivary gland * Dose of drug administration

* The timing of drug administration

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Oral Complications

Direct Stomatotoxicity

1. Mucositis

- Diffuse ulcerative condition

- Generally on nonkeratinized oral mucosa- Extrem pain

- Erythema and ulceration of some or all mucosal surfaces : typically ginggiva, dorsal surface of

the tongue

- Ulcerative area may appears grayish white with central areas of necrosis

- Self limiting and tends to heal spontaneously in about 14 days

2. Xerostomia

Adriamycin ---- xerostomia

3. NeurotoxicityAlkaloid ----- neurotoxicity ----- odontogenic pain

Symptoms usually disappear with discontinueance

drugs

Indirect Stomatotoxicity

Infection

1. Bacterial infection- Tooth pain, deep caries, sensitivity to percussion

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2. Soft tissue infection

* Ginggiva- Marginal, papillary and attached ginggiva

in patients pre existing periodontal diseases

- Infectious lesions : localized necrotic area

of ginggiva ( similar to ANUG)

- Tends to spread laterally, apically,

large area of ginggiva and mucosa

- Pain, bad taste

- Underlying bone may be exposed

- Bleeding

Mucosa- Ulceration secondary infection

- The center is deeply punched out and contain grayish white necrotic center

- The border of the ulcer may be raised- In leucopenic patients shoul be admitted to the

hospital and treated with intravenous Antibiotic

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Salivary gland infection- Parotid gland --- most frequently affected

- Complain of pain of sudden onset- Unilateral

- The parotid gland may be enlarged and erythemtous

- Pus may be milked from the parotid duct- Fever

- Dry mouthMyelosuppressed patients with salivary gland

infection require hospitalization

Management : cooperation of the dentist, oncologist and infectious disease specialist

2. Fungal infectionIn the myelosuppressed host

Oral Candidiasis

- Raised, white, curdy looking areas

- White necrotic areas may be scraped off, revealing

a raw, bleeding base

- Oral candida infectious may spread to the oesophagus

or lungs ------ dysphagia, febrile

3. Viral infection

- Herpes simplex virus infections---- commissura of the

lips

- Herpes zoster infection

- Recurrent herpes infection

Oral bleeding cause by thrombocytopenia