Giving the Mouth Its Due
Network - Summer 2009
By Mark Chambers, D.M.D., with Bayan Raji
Patients may be unaware that treatment for cancer can affect the hard and soft tissues of the mouth. In some cases, patients even delay or stop their treatment because they experience painful complications in their oral cavity or oropharynx.
Complications vary by patient, depending on the individual’s oral and dental status, the type of malignancy and the therapeutic approach. To help manage these oral side effects, the dentist and oncologist can work together — before and during cancer treatment — to make recovery as comfortable as possible.
At least two weeks before treatment begins, cancer patients should schedule a thorough dental checkup. At this visit, the medical history can be updated, dental cleaning performed and existing oral problems, such as decayed or broken teeth, addressed.
Patients also should provide the dentist with contact information for the medical oncologist and treating physicians for use in future communications regarding any oral complications.
During cancer treatment, patients should gently brush teeth at least twice daily unless the dentist recommends otherwise. A fluoridated toothpaste should be used to optimize oral health. If patients discover they cannot tolerate the flavor of their regular toothpaste, they should try unflavored toothpaste or toothpaste with reduced levels of flavoring agents. Patients also should gently floss teeth once a day, avoiding any sore or bleeding areas of the gums.
Tips for ongoing dental careOnce all complications of chemotherapy have been resolved and blood counts have recovered, most patients may resume their normal dental care schedule.
However, radiation therapy to the head and neck can cause oral complications that continue or emerge long after treatment has ended. Such treatment results in a lifelong risk of bone death, dry mouth and cavities.
Patients may decrease the risk or severity of oral complications by reducing the acidity in the mouth with a baking soda rinse. Use one-fourth teaspoon of baking soda and one-eighth teaspoon of salt in one cup of warm water. This is particularly helpful if vomiting after cancer treatment occurs.
If dry mouth develops, an artificial saliva replacement may be recommended. Taking frequent sips of water, sucking on ice chips or sugar-free candy, or chewing sugar-free gum may provide relief.
Patients should eat a soft, balanced diet and avoid using tobacco and alcohol. Mucosal ulcerations, infection and oral pain need to be assessed by a clinician and treated accordingly with topical coating agents or other medicine as deemed appropriate.
Preventing and treating oral complications of cancer therapy involve identifying the patient at risk, starting prevention before cancer therapy begins and treating complications as soon as they appear.
Oral side effects
Chemotherapy and radiation treatment can cause multiple oral side effects and functional disabilities:
- Caries (rampant tooth decay)
- Xerostomia (dry mouth)
- Mucositis (inflammation and ulceration of the mucous membranes)
- Oral pain
- Infection (hard and soft oral tissues)
- Macroglossia (swollen tongue) or odynophagia (burning mouth/tongue)
- Trismus (stiffness in the jaws)
- Dysgeusia (altered taste acuity)
- Dysphagia (trouble swallowing)