MANIFESTASI KEMOTERAPI DI RONGGA MULUT

12/3/2010
MANIFESTASI KEMOTERAPI DI
RONGGA MULUT
Wilda Hafny Lubis drg MSi
Kanker
sering
dijumpai
saat ini
Ahli- ahli scince+kemoterapi
Melakukan Identifikasi & eksploitasi
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
1
12/3/2010
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
membelah
• Sel kanker→ sel tidak normal
>tidak terkontrol
membentuk
•
• Kerusakan sel= efek samping, merusakkan sel normal juga
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
2
12/3/2010
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
Pain
Obat KH dapat
merusak syaraf
Obat baru
Rasa terbakar
Reduce
this
Mati rasa
Sakit mencucuk
Pada kaki dan
tangan
Kehilangan
rambut
Dapat
mengenai
semua jenis
rambut
Akan tumbuh
kembali setelah
perawatan
3
12/3/2010
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
4
12/3/2010
Tindakan pre kemoterapi:
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
5
12/3/2010
Informasi penting :
Faktor pembekuan
darah
Kateter vena central
Tempat kolonisasi bakteri
Komplikasi
haemaragik
terjadi
Platelet
< 50 ribu/mm
Perlu antibiotic prophylactic
Neutrophil <
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
6
12/3/2010
• Sebelum memulai kemoterapi kanker ,
pada penderita dilakukan evaluasi untuk
mengenali dan menyingkirkan sumbersumber 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
7
12/3/2010
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
8
12/3/2010
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
9
12/3/2010
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
10
12/3/2010
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. Neurotoxicity
Alkaloid ----- neurotoxicity ----- odontogenic pain
Symptoms usually disappear with
discontinueance
drugs
Indirect Stomatotoxicity
Infection
1. Bacterial infection
- Tooth pain, deep caries, sensitivity to percussion
11
12/3/2010
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
12
12/3/2010
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 mouth
Myelosuppressed patients with salivary gland
infection require hospitalization
Management : cooperation of the dentist,
oncologist and infectious disease specialist
2. Fungal infection
In 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
13