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Cancer Treatment and the Mouth

16 September 2011

Having recently had three people, a colleague, a friend and a patient each go through the woes of chemotherapy / radiotherapy, it is important to realise that not only can dental health can affect cancer treatment but cancer treatment affects oral health as well. 

An unhealthy mouth can increase the risks of side effects from cancer treatments and may interfere with the therapeutic regime.

With chemotherapy, many parts of the body are affected, most frequently resulting in hair loss, gastrointestinal problems and others. With radiotherapy, almost all head and neck radiation patients will have oral complications.

Ideally, we would like to schedule a pre-cancer treatment examination about a month before treatment begins with the following objectives:

• Establish a schedule for dental treatment.
• Complete invasive procedures at least 14 days before head/neck radiation therapy starts; 7 to 10 days before myelosuppressive chemotherapy.
• Postpone elective oral surgical procedures until cancer treatment is completed.
• Identify and treat sites of low-grade and acute oral infections such as caries, periodontal disease, endodontic infections and lesions of the muscosa.
• Identify and eliminate sources of oral trauma and irritation such as ill-fitting dentures, orthodontic bands, and other appliances.
• Identify and treat potential oral problems within the proposed radiation field before radiation treatment begins.
• Instruct patients about oral hygiene.
• Educate patients on preventing demineralisation and dental caries.

By improving the oral health of the mouth, the aim is to:

• Reduce the risk and severity of oral complications
• Improve the likelihood that the patient will successfully complete planned cancer treatment
• Prevent oral infections that could lead to systemic infections
• Prevent or minimise complications that can compromise nutrition
• Prevent, eliminate or control oral pain
• Prevent or reduce the incidence of bone necrosis in patients receiving radiation therapy to the head and neck
• Preserve or improve oral health
• Improve the quality of life
• Decrease the cost of care

General Oral Complications of Cancer Treatment include:

• Oral mucositis/stomatitis – inflammation and ulceration of the mucous membranes
• Xerostomia/salivary gland dysfunction – dryness of the mouth because of thickened, reduced, or absent salivary flow
• Infection
• Xerostomia-associated cavities
• Taste alterations
• Nutritional compromise
• Functional disabilities
• Abnormal dental development in children 

 Specific complications from – 


• Neurotoxicity
• Bleeding

Radiation therapy:

• Radiation caries
• Trismus/tissue fibrosis – loss of elasticity of chewing muscles that restricts normal ability to open the mouth.
• Osteonecrosis -blood vessel compromise and necrosis of bone resulting in decreased ability to heal if traumatised and in extreme susceptibility to infection. 

Together these can mean that it is painful to brush and floss and food may not be able to be removed from around teeth resulting in a greater chance on decay. Products like Biotene Oral Balance, Dry-mouth gel and Tooth Mousse/Plus, fluoride rinses amongst other natural therapies can help to wet the mouth and improve clearance of food and help to protect the teeth.

 To maintain a health mouth:

• brush teeth twice daily with a fluoride toothpaste; 
• clean between your teeth every day with dental floss;
• stop the use of tobacco products;
• rinse after vomiting with a quarter teaspoon of baking soda in a cup of warm water;
• moisten a dry mouth by drinking water; sucking on ice; chewing sugar-free gum or sucking on sugar-free candies; avoiding mouthwashes that contain alcohol; use a product mentioned above

Always keep in mind that we are just a phone call away and can help advise on treatment or products that will help keep your mouth healthy. Good luck with your treatment. Keep your chin up and stay positive!