Cancer Treatment and your Oral Health

Almost one third of all Americans diagnosed with cancer each year will develop oral health issues. Patients who undergo life saving treatments for various cancers are usually unaware they may develop painful and debilitating conditions following their cancer treatment. A thorough dental examination is a critical step in maintaining their overall health throughout cancer treatment. This includes examination prior to, during, and after cancer treatments.

Untreated oral disease can also complicate cancer treatment. The dentists role in patient management can be beneficial to the patient beyond their oral cavity. Cancer can be treated or slowed down with proper treatments like, chemotherapy and radiation therapy. The type of treatment can be very effective but also can have very debilitating or even painful side effects that can can affect other parts of your body. These can include your mouth, teeth, gums, oral tissues and salivary glands. Being aware of these possible cancer treatment side effects can help patients reduce and manage them with help from physicians and dentists alike.

How can your oral health be affected by cancer?

Chemotherapy and radiation therapy treatment for cancer can have oral side effects. This varies depending on the type of cancer and the aggressiveness of the treatment.

Those side effects can display themselves in different ways:

• -Dry Mouth (Xerostomia). Salivary production and flow are affected because the salivary glands can be affected during treatments for cancer.
• -Tooth Decay. This can happen very rapidly due to the dry mouth condition.
• -Burning Mouth Syndrome. There might be a painful or burning feeling in the mouth, tongue and gums.

This also occurs from the reduction in salivary flow.

• -Erosion of teeth due to high acid in the mouth following reflux and vomiting -Stiffness in jaws..
• -Problems with eating, speaking, and swallowing.
• -Alteration of taste sensation. Your ability to taste properly will decrease..
• -Gum inflammation and swelling, Periodontal disease can develop.
• -The immune system is weakened. In order to manage all the side effects from cancer, your dentist can make you recommendations to keep your mouth comfortable and healthy.

Dental Examination Before Treatment of Cancer A pretreatment dental examination can identify potential issues and help educate the patient about the importance of maintaining good oral care. This examination can be completed by a your local or by a hospital based dentist. The evaluation includes a thorough examination of hard and soft tissues It will also include x-rays to detect trauma and possible sources of infection.

Before cancer treatment begins, the dentist can also do the following:

• -Removal of orthodontic bands if highly stomatotoxic chemotherapy is planned or if the bands will be in the field of radiation.
• -Evaluate comfort and fit of dentures and oral appliances.
• -Any teeth that need to be removed or have large fillings, crowns, should be performed at least two weeks prior to the beginning of radiation therapy to allow for proper healing, and at least 7-10 days before myelosuppressive cancer chemotherapy starts.
• -For adults receiving head/neck radiation, removing teeth that may pose a problem in the future. The jaw bone , after being exposed to radiation does not heal properly following trauma, a simple removal of a tooth can result in bone death (osteonecrosis) which can destroy large areas of jaw bone. If you receive head and neck radiation you will need to take extreme precaution to avoid needing extractions for the rest of your lifetime.
• -For children, consider extracting highly mobile primary teeth and teeth that are expected to fall out during the cancer treatment window.
• -Instruct patients on the maintenance of proper oral hygiene, nutrition, the use of fluoride gel, rinses, dry mouth products, and the need to avoid tobacco and alcohol use. During the examination, the patient will also learn about home care to protect oral tissues and minimize oral complications. The dentist or hygienist will instruct the patient on special brushing and flossing techniques, mouth rinses, and other approaches to keep the mouth as moist and clean as possible to reduce the risk of infection and pain.

Oral Care during Treatment Even with examinations before cancer treatment, regular oral exams and care are necessary during cancer treatment. Good communication and planning between physician and dentist can reduce the risks of oral complications and maximize the efficacy of dental and supportive care.

Specific oral health symptoms to remember when treating patients undergoing chemotherapy or radiation include the following:

Symptoms can include:

• -A sticky, dry feeling in the mouth.
• -Trouble chewing, swallowing, tasting or speaking due to dryness in oral cavity.
• -A burning feeling in the mouth.
• -A dry feeling in the throat and tongue.
• -Dry,Cracked lips.
• -Mouth sores.
• -A fungal infection in the mouth or at the corners of the lips, like oral candidiasis.

Chemotherapy Issues

• -Fever of unknown origin may be linked to an oral infection.
• -Have the patient schedule appointments carefully. Patients should be seen when blood counts will be at safe levels.
• -Conduct blood work 24 hours before dental treatment to determine whether the patient’s platelet count, clotting factors, and absolute neutrophil count are at adequate levels to prevent hemorrhage and infection.
• -If the patient has a central venous catheter, careful consideration should be given to implementing the American Heart Association (AHA) prophylactic antibiotic regimen before any dental work.

Radiation Therapy Issues

• -Treat infections. Ulcerations and dry, friable tissues are easily infected.
• -Nutrition.Instruct the patient on the importance of healthy eating to maintain nutritional status, emphasizing the need to avoid foods that irritate sore tissues or cause dental decay.
• -Show patients exercises to reduce tightening of mouth muscles,( trismus). Fibrosis of the tissue may occur if the chewing muscles are in the direct field of radiation. Ask your dentist to teach you how to exercise and stretch these muscles properly to avoid or alleviate the symptoms.

Follow up Dental care

Patients may continue their regular dental care schedule once all complications from chemotherapy have subsided and blood counts have recovered. Once radiation therapy has been completed and acute oral complications have subsided, the patient should be evaluated by a dentist every four to eight weeks for the first six months. After that the dentist can decide the schedule the patient needs based on findings.

Post Cancer Treatment

Head and neck radiation therapy can cause oral complications that continue or emerge long after treatment has been completed. Although cancer patients may no longer be under an oncologist’s care at that time, what they learn about oral health during their treatment will affect how they deal with subsequent complications.

Patients receiving radiation therapy need to know about its risks:

• -High dose radiation treatment carries a lifelong risk of osteonecrosis, xerostomia and dental cavities
• -Because of the risk of osteonecrosis, people who have received radiation should avoid invasive surgical procedures (including extractions) that involve irradiated bone
• -Radiation to the head and neck may permanently reduce the quantity and quality of normal saliva. Daily fluoride application, good nutrition and maintaining proper oral hygiene are very important.
• -Radiation can change oral tissues. Dentures may need to be remade or relined after treatment is completed and the tissues have become stable. Some patients are never able to wear dentures following cancer treatment again because of friable tissues and xerostomia
• -A dentist should closely observe children who have received radiation to craniofacial and dental structures. They want to ensure that abnormal craniofacial growth and skeletal development does not occur.

Cancer can be a very debilitating disease in many areas. But if planned accordingly before cancer treatment, we can limit those issues together and face them head on to create the scenario for the best possible outcome from cancer.