The “C” Word and Your “T” Word

Kimberley Wahamaa:  Panoramic X-Ray at the Northeast Cancer Centre Dental Clinic.  I’ll be a patient here for the next 4-5 years.  They recommended the following tooth paste, morning X-Pur Tooth Revitalizing Paste and in the evening Fluoridex Daily Defense.  $10 each.  It has helped with my saliva and my teeth sensitivity.

The “C” Word and Your “T” Word by Mariah Leduc-Sloboda

How to maintain your dental health throughout your cancer treatment.Many people often forget about the importance of dental health once diagnosed with cancer. Like your own health, it is very important keep a sound dentition and to maintain that throughout your cancer process as well as your life. Whatever occurs in your mouth may further affect your overall health.

What to Look Out For

Cancer being a destructive disease can bring along many oral complications; especially once chemotherapy or radiation therapy has begun. Oral complications of cancer treatment arise in various forms and degrees of severity, depending on the individual and the cancer treatment.  The following are oral side effect common to both chemotherapy and radiation therapy and complications specific to each treatment.

Oral Complications Common to Both Chemotherapy and Radiation

·         Oral mucositis:  
-Inflammation and ulceration of the mucous membranes (soft tissue in mouth)

·         Infection:

·         Xerostomia/salivary gland dysfunction
-Dryness of the mouth due to thickened, reduced or absent salivary flow

·         Functional disabilities:
-Impaired ability to eat, taste, swallow and speak

·         Taste alterations

·         Nutritional compromise

·         Abnormal dental development:
-Occurs in children before the age of 9 receiving chemotherapy

Other Complications of Chemotherapy

·         Neurotoxicity:
-Persistent, deep aching and burning pain that mimics a toothache
-Also a side effect of certain classes of drugs such as vinca alkaloids

·         Bleeding

Other Complications of Radiation Therapy

·         Radiation caries(cavities):
-Lifelong risk of rampant (excessive) dental decay
-May begin within 3 months of completing radiation treatment

·         Trismus/tissue fibrosis:
-Loss of elasticity of your jaw muscles that restricts ability to open mouth

·         Osteonecrosis:
-Blood vessel compromise and death of bone exposed to high-dose radiation therapy

 

Are You at Risk

The risk of oral complications varies with cancer treatments as well as patients. Virtually anyone receiving treatment will have some sort of oral complication. The risk of getting complications ranges from low, moderate and high.

Low Risk: 

-If you are receiving chemotherapy that mildly decreases the immune system (myelosuppressive chemo)

Moderate Risk:  

-If you are receiving single-agent or outpatient therapy

High Risk:     

-If you’re undergoing head & neck radiation
-If you are receiving stomatotic chemotherapy resulting in prolonged suppressed immune system    

Be aware of the risks and make sure to talk to your dentist about the type of cancer treatment you will be receiving.                                                     

  Oral Care: Prevention and Treatment

Visiting your dentist before your treatment starts is important to the success of maintaining a healthy mouth. Pretreatment appointments help reduce the risk and severity of oral complications and it also allows the dental team to identify and treat any existing infection or problems.


              Visiting your dentist will also help you gain some knowledge on how to prevent or treat oral complications and how to keep a good oral regime.

Oral mucositis

Gentle tooth and gingival brushing with extra-soft toothbrush. Be sure to discontinue use of strong toothpastes and replace with baking soda/water paste. Also discontinue any alcohol-based rinses, full-strength peroxide and irritating foods

Infection

Frequent and consistent oral hydration with water, ice and/or saliva substitutes helps reduced any plaque buildup. Increase plaque control with brushing teeth or visiting dentist office to prevent infection or further increase it

Xerostomia/Salivary gland dysfunction

Eliminate the use of products with alcohol or irritating agents. Any caffeine and tobacco product use must be discontinued. Use a humidifier at night while sleeping to keep from your mouth drying out. Also you can consult your oncologist for salivary gland stimulants if the other options don’t work.

Bleeding

It is important to have good plaque control and removal by brushing your teeth or visiting your dentist so the plaque does not exacerbate the bleeding

Radiation Cavities

Make sure to keep mouth hydrated well and to keep a good oral hygiene regime. Consult your dentist about daily applications of fluoride for at home. Also avoid sugared or acidic food or beverages.

Trismus/Tissue fibrosis

Daily exercises can help relieve the stiffness in your muscles. To exercise your mouth, open and close your mouth 20 times. This should be repeated atleast 3 times a day.

Osteonecrosis

Be sure to check with your dentist that all teeth that have a poor lifelong prognosis are removed 14 to 21 days before the start of your radiation therapy

 

Over the Counter Remedies

                Here is a list of a few products that can help you through your cancer treatments. Many of them are available at your local drug store and are all cost friendly.

1.       Toothbrushes
-When purchasing a toothbrush, make sure to find one that is extra-soft or super-soft bristles
-Children toothbrushes may be useful for people with limited opening
-You can purchase a toothbrush at any local drug store or grocery store (Pharmasave, Rexall, Shopper’s, Independent Grocer)
Price ranges from  $2.29-4.10

2.       Floss
-Depending on your teeth and preference you can purchase waxed or unwaxed floss
-You can purchase floss at any local drug store or grocery store (Pharmasave, Rexall, Shopper’s, Independent Grocer)
Price ranges from $1.39-3.40

3.       Toothpaste
-Make sure when purchasing toothpaste it does not contain any strong flavoring agent or anything that may be irritating to your mouth. Cinnamon is usually the most irritating.
-If you can’t find any toothpaste without any flavoring in it, baking soda and water paste is a great alternative.
-You can find toothpaste and baking soda at your local drug store or grocery store (Pharmasave, Rexall, Shopper’s, Independent Grocer)
-Sensodyne ,Arm & Hammer and Biotene make a great toothpaste that contain low irritants, but again make sure to purchase a flavor free toothpaste
Price for those toothpastes ranges from $2.27-5.75

4.       Foam or sponge-stick and Gauze
-Foam or sponge-sticks and gauze are only used when regular toothbrushing can’t be done due to pain from ulcerated tissues
-These sticks can be impregnated with a cleaning agent
-With the gauze you can dip it in a saline solution or baking soda solution
-You can find these sticks and gauze at your local drug store(Pharmasave, Rexall, Shopper’s) or at your dentist’s office
-Price ranges

5.       Baking soda & saline rinse
-This is an easy rinse to make at home that has a big positive impact on your mouth
-You combine ½ tsp of baking soda, ¼ tsp of salt and 16 oz of water
-Make sure to use the rinse every 2-4 hours if you have dry mouth or mucositis and to rinse with water once after each use

6.       Topical anesthetics
-Topical anesthetics are used to control pain associated with mucosal ulcerations
-This includes alcohol-free Benadryl (gel) mixed in equal parts with a coating agent such as Maalox(liquid)
-OTC topical anesthetics may not provide full relief from pain so consult your oncologist
-Maalox ranges from $5.10-10.00
-Benadryl ranges from $3.97-8.69

7.       Saliva replacements
Saliva replacements are used to help replenish the moisture lost in your mouth and relieve xerostomia (dry mouth)
-This includes rinses and gels such as Biotene
-A diet with high-moisture foods, oily food and sugar and acid-free foods is recommended
-Gum or candy containing xylitol are great at stimulating saliva glands (Trident)
-You can also talk to your dentist or oncologist about prescription drugs such as pilocarpine
-You can find Biotene at your local drug store (Pharmasave, Rexall, Shopper’s) or at your dentist’s office
-Biotene ranges from $10.95-13.99

8.       Chlorhexidine gluconate .012%
Chlorhexidine is used as a bactericidal mouth rinse because it reduces plaque biofilm and oral microbes
-Make sure to rinse for 30 seconds with 1 capful
-As great as chlorhexidine sounds, it can cause staining on your teeth so it may not be the first choice on your list
-Talk to your dentist before you use chlorhexidine
-This product can be found at your local drug store (Pharmasave, Rexall, Shopper’s) or your dentist’s office
-Chlorhexidine cost between $4.01-18.00

Mariah Leduc-Sloboda,  Dean’s List – final year Dental Hygienist  Student, (Graduate of Dental Assistant Program) , Cambrian College, Sudbury

I am diligent with my follow ups…

Hi Kimberley, I’m Stacy’s friend and I’m from South Florida.  Stacy’ shared your site with me.  Here is my story.  I had stage 1 breast cancer, diagosed March 2012, I was 58.  I had a painful lump that is how mine was discovered.   I had a lumpectomy by the end of March and April 24th was my first of 4 chemo treatments. I had estrogen position, HR2 neg, clear lymph nodes and clean margins. The reason why I needed chemo was because my oncotype # was 30, so the benefits of Chemo out weighed the side effects. Then I had 33 radiation treatments and now I’m on an Estrogen blocker … The last one of the four. I had side effects from the other three but so far side effects are minimal with this one. I had a great team of docs that all worked together. Today they say to call myself a survivor (cancer free) but never cured. I had only 2 lymph nodes removed.  The doctors didn’t like me to use my right arm for blood pressure or blood draws but if they can’t get blood from left side which has happened to me they have been able to use right arm with no lymphadema. After the surgery the doctor recommends that you wear a sports bra for a few days, no one told me, so I had a friend go out and buy one!  I have osteoporosis so they tried Tamoxifen first because that’s easiest on the bones but it flared up my IBS something awful. Then they put me on Arimidex and after 3-4 weeks I started having severe palpitations and thought I was losing my mind. My thoughts and what I was saying was all jumbled. My doctor said the side effects I have had from both of those were unusual but that’s me I always react different than most from medicine’s. Then the third one aromasin elevated my liver enzymes and gave me uncontrollable diarrhea. I’m now on Femara and I’m trying really hard to stay on it. My oncologist really wants me to. The thing that separates me from most is that I was a survivor of the worst kind even before cancer … So to me whatever cancer through at me was a cake walk. I must say though that I did fine even with being sick for three months thru chemo, losing my hair, walking around with scarfs or wigs (which I found quite uncomfortable ) or actually bald. I had no problem going out bald. The hard part was waiting for my hair to grow back to a decent length …. Lol of all the things to get upset about that’s what upset me. Also if u need chemo I do suggest cutting your hair short once it starts to fall out and shaving it. I think my hair grew in thicker and better because of it.Best of luck and please keep me posted on your progress, catching this at stage 1 is GREAT!!!!. All my doctors were females so that helped too.  There were I believe 26 full breast radiation treatments. Then seven localized to the area of my lumps. Oh yes I had 2 very find less then 2cm lumps right next to each other. Another reason why I was a candidate for chemo. They thought the lumps were connected but they weren’t. I’m due next week for my next mammo and this time I get an ultrasound with it. I am diligent with my follow ups.

Trust Your Bust.