oral rehabilitation of oral cancer survivors.

1. Good
Afternoon.

2. Comprehensive
Rehabilitation Care
for Oral Cancer
Survivors

3. Contents
Introduction
What is rehabilitation
Stages of rehabilitation
Role of oral physician
Current barriers
Conclusion

5. Rehabilitation
It refers to a process aimed at enabling
persons with disabilities to achieve and
maintain their optimal physical, sensory,
intellectual, psychiatric and/or social
functional levels.

6. Physical
therapist
Occupational
therapist
Physician
Oral cancer
survivor
Speech
therapist
Nutritionist
Prosthetist-
orthotist
Rehabilitation
nurse
Psychologist

7. Principles of Rehabilitation
Initial Diagnosis and Treatment Planning.
Dentition should be Preserved.
Fundamental Principles of Prosthodontics along with Philosophy
of Preventive Dentistry and Conservative Dentistry.
Surgery before Prosthetic Rehabilitation.
Multidisciplinary Care.

8. Preventive
rehabilitation
therapy
Restorative
rehabilitation
therapy
Supportive
rehabilitation
therapy
Palliative
rehabilitation
therapy
Stages of
Rehabilitation

9. Role of
Oral Physician
in Rehabilitation
of Oral Cancer
Survivors

10. Preventive Rehabilitation Therapy
• GOAL: Attempts to prevent avoidable deterioration in
function.
 Pretreatment dental evaluation and prophylactic
dental care.
 Dental extractions must be accomplished before
minimum 1 month prior to radiation
therapy.
To prevent:
OSTEORADIONECROSIS

11.  Due to positioning of many oral tumors- Salivary Glands
are exposed to Therapeutic Radiation.
 Salivary glands are exquisitely sensitive to radiation.
Localization of
radiation dose
Radioprotectors
Radiosensitizers
Radiation mitigators

12. • Amifostine
• Nitroxides (tempol)
• Cysteine and cysteamine
• Other anti oxidants( lipoic acid, vitamin A, C and E, superoxide
dismutase)
• Novel radioprotectors– tetracycline and fluoroquinolones
Radioprotectors
• Hyperbaric oxygen
• Carbogen
• Nicotinamide
• Metronidazole and its analogs
• Radiosensitizing nucleosides( 5- Fluorouracil, bromodeoxyuridine.
Fludarbine)
• Novel radiosensitizers- paclitaxel, docetaxel, irinotecan)
Radiosensitizers
• Palifermin
• Halofuginone
• TGF- beta
• Keratinocyte growth factor
• ACE inhibitor( Captopril, ramipril)
• COX- 2 inhibitors/ NSAIDS ( ibuprofen, asprin, celecoxib)
Radiation Mitigators

13.  Topical fluoride application for prevention of dental
caries.
 Oral hygiene maintenance protocol.
To prevent:
Radiation caries

14. Restorative rehabilitation therapy
 GOAL: Aim to return patients to a previous level of
function.
 The reconstruction plan uses the skills of the
prosthodontist and oral surgeon.

15. Role of Stem Cells
in Restorative
Rehabilitation
Immuno-
Reconstruction
Restores bone
marrow and immune
system following
radio and
chemotherapy
Tissue Regeneration
Long lasting
replication,
differentiation and
multilineage potential
As Delivery Vehicles
Cell based carrier for
drug delivery for gene
therapy

16. Supportive rehabilitation therapy
 GOAL : Focus on maximizing functioning, independence
and participation in meaningful activities.
 Exercises
 Physiotherapy
 Xerostomia
Thera Bite jaw
motion System

17. Hydration
of the
mucosal
membrane
by frequent
intake of
water.
Xylitol
mints to
stimulate
saliva.
Salivary
substitute.
Caffeine,
tobacco
and
alcohol
must be
avoided.
Room
humidifier
are used.

18. Palliative rehabilitation therapy
 GOAL: Involves supporting people to adapt to and
come to terms with irreversible changes in function.
 Terminally ill patients .

19. Current
State
and
Barriers
Lack of training in oncology
rehabilitation of rehabilitation
providers.
Effective procedures are not
being administered to patients
due to lack of universal
therapist knowledge.
A lack of interaction between
two medical professionals
regarding patient.

20. Overcoming barriers
 Fostering a better understanding of cancer
rehabilitation.
 Advancing collaborative interdisciplinary
care coordination.

21. Conclusion
The management of patients with oral cancer
does not conclude with elimination of the
disease but continues with rehabilitation of
function, restoration of aesthetics and
prevention of infection and maintenance of
proper oral hygiene.

22. Rehabilitation And Palliative Care
Matters-
The End of Life Deserves As Much
Beauty, Care And Respect As The
Beginning.

23. References
• Dental Hygiene Care of The Head and Neck Cancer Patient and Survivor.
Can J Dent Hyg 2014;48(1):20-26.
• Oral Rehabilitation Following Head and Neck Cancer Treatment- Review of
Literature. Falcao, et al., J Palliat Care Med 2015, 5:2.
• A Comprehensive Review Of Head And Neck Cancer Rehabilitation:
Physical Therapy Prespectives. Indian J Palliat Care. 2012 May-June; 18(2):
87-97.
• Cancer Rehabilitation And Palliative Care: Critical Components In Delivery
Of High-Quality Oncology Services. Support Care Cancer DOI
10.1007/s00520-015-2916-1.
• Palliative Care and Rehabilitation. Cancer Rehabilitation In The New
Millennium: Opportunities and Challenges- New York, June 4-5, 1999.
• Oral Rehabilitation After Treatment For Head And Neck Malignancy. Wiley
InterScience DOI: 10.1002/hed.20176.
• Rehabilitative Palliative Care, Enabling People To Live Fully Until They
Die- A Challenge For The 21st Century. Rebecca Tiberini and Heather
Richardson.(Hospice UK)
• Stem cell therapy: A novel treatment approach for oral mucosal lesions.
J Pharm Bioallied Sci. 2015 JanMar; 7(1): 2–8.