Pathology · patient case with 2 questions
Patient scheduled for head and neck chemotherapy
Patient: Adult with a head and neck malignancy
Chief complaint: Referred for dental assessment before oncological treatment.
Background: Due to commence chemotherapy for a head and neck tumour.
Current findings: Baseline pulp testing performed as part of the pre-treatment assessment.
Question 1
How will this patient's pulpal response to cold testing be affected?
Show answer and explanation
Correct answer: D. Reduced response
- A. An exaggerated response suggests irreversible pulpitis, not the effect of oncological treatment.
- B. A complete absence of response would indicate necrosis, which is not the expected general effect.
- C. The response is not unchanged — pulpal sensitivity is measurably altered.
- D. Treatment directed at the head and neck reduces pulpal blood flow and damages the neurovascular supply, producing a BLUNTED but not absent response to thermal testing. This matters diagnostically: a reduced response in these patients must not be misread as necrosis.
Question 2
Which is the most important dental measure BEFORE oncological treatment begins?
Show answer and explanation
Correct answer: D. Eliminate all active infection and extract non-restorable teeth, allowing time for healing
- A. New dentures fitted before mucositis develops will not fit the altered tissues afterwards.
- B. Deferring is precisely wrong — the pre-treatment window is the safest time to intervene.
- C. Elective aesthetic work is not a priority and consumes the limited pre-treatment window.
- D. CORRECT. The pre-treatment window is used to remove sources of infection. Extractions should ideally precede radiotherapy by at least two to three weeks to allow mucosal healing, because afterwards the risk of OSTEORADIONECROSIS makes extraction in irradiated bone hazardous. Fluoride trays, hygiene instruction and prosthesis assessment also belong to this phase.
Note: Carry the numbers: extractions at least 2–3 weeks before radiotherapy. Afterwards, extraction in irradiated bone risks osteoradionecrosis, and the risk is lifelong.