Cancer Treatment and Oral Health

More than on million Americans are diagnosed with cancer each year. Patients who undergo cancer treatment are sometimes unaware that a dental checkup and good dental care may help to improve the entire treatment outcome. That's because cancer treatment can affect the teeth, gums, salivary glands and other tissues in the mouth. The results can be painful and debilitating and may persist long after cancer treatment ends.

In some cases, patients delay or stop their cancer treatment because of painful oral side effects. To help prevent, minimize and manage these oral side effects, the dentist and oncologist can work together- before and during cancer treatment- to make recovery as comfortable as possible.

Oral Complications

Knowing the problems that can occur during and after cancer treatment can help you better understand how to control them. Chemotherapy and radiation treatments can cause:

• inflammation and ulceration of the mucous membranes
• painful mouth and gums
• an increase in the risk for oral and systemic infections
• xerostomia (dry mouth), a condition in which saliva is thickened, reduced or absent
• rampant tooth decay
• burning, peeling or swelling tongue
• stiffness in the jaw
• impaired ability to eat, speak or swallow
• change in ability to taste
• poor diet because of problems eating

Cancer drugs kill cancer cells but they also affect normal cells, including those in the moist lining of the mouth and in the saliva (spit) glands. Without adequate saliva to wash away food particles, bacteria and their byproducts attack tooth enamel. This condition, called xerostomia, or dry mouth, may persist long after treatment.

Radiation therapy may also cause a condition called radiation caries, a lifelong risk of rampant tooth decay that can begin shortly after treatment subsides. Radiation caries can occur when salivary glands become less active, causing the mouth to dry out.

Chemotherapy may cause other painful conditions such as neurotoxicity, a condition in which the patient experiences a persistent, deep aching and burning pain that mimics a toothache even when no dental source of the pain can be found. Depending on the dosage and duration, chemotherapy may also cause oral bleeding.

In some cases following head and neck radiation therapy, the blood supply to the jaws is so compromised that normal healing is not possible. This can result in a serious condition called osteoradionecrosis, which can lead to loss of the jaw bone. If the patient needs a tooth extraction, the dentist may suggest that this be done prior to cancer therapy to allow time for the oral tissues to heal.

Protect Your Smile

Your Dentist is an important member of the team treating your cancer. When possible, see your dentist for a thorough checkup at least two weeks before treatment begins. A checkup allows for prompt identification and treatment of existing infections, problem teeth and other conditions. Update your dental records and tell your dentist that you will undergo cancer treatment. Include the telephone number for the physician who is handling your cancer therapy. This is the first step in helping reduce the risk and severity of oral complications.

During the cancer treatment, continue to gently brush your teeth twice a day unless your dentist recommends otherwise. Use fluoride toothpaste and look for products that display the American Dental Association's Seal of Acceptance.

Patients who receive cancer treatment to the head and neck sometimes discover that they cannot tolerate the flavor of their regular toothpaste. If this happens, try another flavor that will not irritate mouth tissues.

Gently floss teeth once a day. If your gums are sore or bleeding, avoid those areas but continue to floss other teeth until the condition improves.

Your dentist may recommend a mouthrinse in addition to daily brushing. You may also be advised to use fluoride gel at home to help reduce the likelihood of tooth decay.

Avoid mouthwashes that contain alcohol. If you wear partial or full dentures, clean them regularly.

Rinse your mouth several times a day with a solution of baking soda and salt, followed by a plain water rinse. Use a teaspoon of baking soda and 1/8 teaspoon of salt in I cup of warm water. This is particularly helpful if you experience vomiting following cancer treatment.

If you develop dry mouth, your dentist may recommend a saliva replacement, an artificial saliva that is available over-the-counter at pharmacies. You may find some relief by taking frequent sips of water, sucking on ice chips or sugar-free candy, or chewing sugar-free gum.

Eat a balanced diet. The sense of taste may become impaired, making some foods bitter or tasteless. If your taste is affected, avoid adding too much sugar or salt to foods. If your mouth is sore, try eating soft, moist foods such as cooked cereals, mashed potatoes, scrambled eggs, etc. Take small bites, chew slowly and sip liquids with meals.

Avoid tobacco and alcohol and schedule regular dental checkups. Because any mouth infection may have serious implications for patients undergoing cancer therapy, contact your dentist or physician immediately should you notice any changes in your mouth. Your dentist and physician both want your treatment to be as safe and effective as possible.