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)
· 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
-Persistent, deep aching and burning pain that mimics a toothache
-Also a side effect of certain classes of drugs such as vinca alkaloids
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
-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.
-If you are receiving chemotherapy that mildly decreases the immune system (myelosuppressive chemo)
-If you are receiving single-agent or outpatient therapy
-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.
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
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.
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
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.
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.
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.
-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
-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
-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
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