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10 Cards in this Set

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External Radiation mechanism
Cobalt-60

Doesn't damage DNA or RNA directly, but splits H2O into free radicals

Typical treatment is 200cGy/rad 5 days a week for 6-9wks
- 5000-7600 cGy for SCCa
- 3000-4500 cGy for Lymphoma
Brachytherapy
Interstitial radiation using seeds or needles of 192iridium
- Directly in tissue and emits continuous energy
- More damage to tumor and normal tissue
Three dimensional conformal radiotherapy
- Used in patients with SCCa that can't be treated with surgery
- Usually treated with Chemo Cetuximab
- Moves around more and delivers more radiation to tumor and less to surrounding normal tissue
Succeptability of cells to radiation
- Germinal and Lymphoreticular cells are most vulnerable
- Endothelial cells and fibroblasts intermediate
- Muscle and nerve cells are most resistant
Three-H tissue
Injured vascular and Fibroblastic cells are not replaced by viable daughter cells
- Hypocellular
- Hypovascular
- Hypoxic

- Tissue is at risk of nonhealing if wounded or injured even years after treatment
Salivary stimulating drugs
Civimiline and Pilocarpine
Radiation Complications
- Caries and pulpal necrosis of teeth in beam path
- Xerostomia
- Taste Alteration: Zinc might help
- Dysphagia: Usually late and long term complication
- Trismus due to fibrosis of massetter or medial pterygoid
- Carotid Atheroma
- Osteoradionecrosis: Wait atleast 21 days or 14min after extraction to begin radiation
Golden Window
3-4mths after radiotherapy when followup invasive procedures can be done without hyperbaric oxygen
- Hyperbaric oxygen stimulates angiogenesis in three H tissue
Dental care for chemo patients
17-20 days after tx when patient feels up to it
- Granulocyte count greater than 2000 cells
- Platelet count greater than 50,000
- If indwelling catheter present, must pre-medicate with AHA regimen
Chemo complications
Neurotoxicity - Especially with Vincristine and Vinblastine
- Can affect teeth and resemble irreversible pulpitis