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Cancer Treatments and Oral Health

Cancer Treatments and Oral Health

What is the relationship between cancer, cancer treatments and oral health?

Both cancer and cancer treatments can have an impact on your mouth regardless of which body part has the cancer. Your immune system is weakened which can make you more prone to getting infections if your mouth is not as healthy as possible. This can be helped by practicing good oral hygiene before, during and after your cancer treatments. If you are being treated with radiation in the head and neck region, you may experience some dry mouth. This means that your mouth does not have enough saliva, which can cause tooth decay and infection.

Cancer Treatments and Their Side Effects in Your Mouth

Will I get side effects in my mouth from my cancer treatments?

Although cancer treatments such as radiation therapy and chemotherapy are used to help treat cancer, they can sometimes cause some side effects in the mouth. Side effects of the mouth caused by cancer or cancer treatments will vary based on where your cancer is and what kind of treatment you are receiving.

What side effects should I expect in my mouth?

Radiation specific side effects can include:

  • Dry mouth
  • Thickened saliva
  • Changes in taste
  • Mouth sores
  • Severe tooth decay
  • Difficulty swallowing, chewing, or opening the mouth
  • Sore mouth or gums
  • Lots of cavities
  • Jaw stiffness
  • Infection
  • Bone disease
  • Inflammation or pain in the lining of the mouth and tongue.
  • Side effects are different for everyone. Side effects depend on which area of the body is being treated and the specific type of treatment that is being given.

Ask your doctor for more details on the specific side effects to expect with your treatment.

Chemotherapy specific side effects can include:

  • Dry mouth
  • Sore mouth and gums
  • Changes in taste
  • Burning or peeling of the tongue
  • Infection
  • Mouth ulcers
  • Temporary decrease in your body’s ability to produce infection-fighting cells
  • Side effects are different for everyone and can depend on what kind of treatment you are receiving.

Ask your doctor for more details on the specific side effects to expect with your treatment.

What will these side effects be like and how do I address them?

Mouth Sores:

  • Little ulcer like lesions that develop inside and around your mouth in places like your gums, tongue or lips.
  • Why does this happen? Chemotherapy and radiation are meant to destroy the dangerous cells in your body, however, they also affect the healthy cells too. 
  • Talk to your dentist as well as your cancer team. They may be able to provide you with products that can help to relieve your pain.
  • Since your immune system is compromised, you should remove debris as often as possible. Brush with fluoride toothpaste at least two times a day, after every meal and before going to bed. Soak a soft toothbrush in warm water to make the bristles softer and less likely to irritate your mouth. Always remember to brush your tongue!
  • Floss daily. This will clean out anything hiding between your teeth, but be gentle, and make sure to avoid sore or bleeding areas.  
  • Stay away from any foods that will irritate your mouth. This includes anything crunchy, spicy and acidic or anything with sharp edges. Also stay away from alcohol and tobacco as these will cause even more irritation. This includes alcohol-based mouth rinses. 
  • Rinse your mouth to help wash away debris about five to six times a day.
  • Rinsing after vomiting may help to wash the acid off your teeth, which can ruin your enamel.
  • Rinses can be done with water or a non-alcoholic mouthwash.

 

Dry mouth:

  • Why does this happen? This happens when your mouth does not have enough saliva because of your cancer treatments or other medications. Saliva aids in protecting against tooth decay and helps wash away food and bacteria. When saliva is not present, you may be more prone to infections. You may also experience burning feelings, sore throat, trouble swallowing or hoarseness. 
  • Talk to your dentist as well as your cancer team. They may be able to provide you with products that can provide artificial saliva or help to reduce the risk of tooth decay.
  • Since your immune system is compromised, you should remove debris as often as possible. Brush with fluoride toothpaste at least two times a day, after every meal and before going to bed. Soak a soft toothbrush in warm water to make the bristles softer and less likely to irritate your mouth. Always remember to brush your tongue!
  • Floss daily. This is especially important with dry mouth as it will clean out anything hiding between your teeth that saliva is not getting to. Be gentle, and make sure to avoid sore or bleeding areas. 
  • Drink lots of water and stay away from beverages containing alcohol as they may cause your mouth to dry out more. Sugar free candy or gum can sometimes be beneficial in keeping the mouth wet. Ask your dentist if this would be a good option for you. 

 

Sensitive Gums and Gum Disease:

  • Sometimes cancer treatments can cause the tissues in your mouth to swell. However, sometimes sore or swollen gums can indicate something more serious such as gum disease. Since your immune system may be weakened, your body may be more susceptible to bacteria and infection, and the bacteria in your mouth may spread to other parts of your body. Because of this, it is important to discuss changes in your gums with your dentist so that any gum disease can be properly treated. 
  • Speak to your dentist as well as your cancer team even before you start treatment. Keeping your mouth healthy can reduce the risk of unnecessary infections which may slow the progress of your treatment. 
  • Since your immune system is compromised, you should remove debris as often as possible. Brush with fluoride toothpaste at least 2 times a day, after every meal, and before going to bed. Soak a soft toothbrush in warm water to make the bristles softer and less likely to irritate your mouth. Always remember to brush your tongue!
  • Floss daily. This will clean out anything hiding between your teeth, but be gentle, and make sure to avoid sore or bleeding areas.  
  • Stay away from any foods that will irritate your mouth. This includes anything crunchy, spicy, or acidic or anything with sharp edges. Also stay away from alcohol and tobacco as these will cause even more irritation. This includes alcohol-based mouth rinses. 
  • Rinse your mouth to help wash away debris about five to six times a day.
  • Rinsing after vomiting may help to wash the acid off your teeth, which can ruin your enamel.
  • Rinses can be done with water or a non-alcoholic mouthwash.

 

Jaw and facial pain:

  • You may experience symptoms such as a tender jaw, headaches, pain in or near the ears, or pain when chewing. This could be due to something as simple or grinding your teeth, which can sometimes be caused by stress. However, it could also be linked to radiation treatments to the HEAD and NECK regions of the body, since radiation may cause some inflammation. 
  • Talk to your dentist about possible treatment options. If your pain is due to stiffness in your jaw, it is suggested to try opening and closing your mouth as wide as you can, without causing more pain. It is recommended that you do this 20 times for three times a day. 
  • Sometimes head and neck cancer treatments may leave you with a metallic taste in your mouth as well. Some things that may help are avoiding acidic foods as well as eating with plastic utensils. 

 

Other helpful tips:

  • See a dentist before starting treatment and make sure he and your cancer doctor have the appropriate information for contacting each other, so they can talk about your cancer treatment.
  • Saliva helps to prevent tooth decay, but radiation can change the amount and consistency of your saliva. Keep mouth moist by drinking lots of water and using sugar free gum or candy.
  • Avoid any foods or drinks that may hurt your mouth such as foods that are hot, spicy, sharp or crunchy. Also, avoid alcohol and tobacco.
  • If you are having radiation to the head or neck you may want to talk to your doctor about learning some jaw muscle exercises to prevent jaw stiffness and using fluoride toothpaste to help prevent tooth decay.
  • Maintain very good oral hygiene. A dentist or radiation oncologist may be able to suggest a special fluoride treatment for you to use during the course of your radiation treatments.
  • If you have dentures, clean, brush and rinse them after meals. Have your dentist check them to make sure they still fit you well. Keep dentures moist when not being worn. Place them in water or a denture soaking solution recommended by your dentist. Do not use hot water, which can cause the denture to lose its shape.

 

How do I help prevent side effects before treatments even start?

  • Having good dental health before treatment can lower your risk of side effects during treatment.
  • Visit a dentist at least four weeks before you start your cancer treatments. He can treat decayed, broken or infected teeth and ensure your dentures fit properly and aren’t irritating your mouth.
  • Flossing is very important. This will clean out anything hiding between your teeth that could lead to infection.
  • Ask dentist about possibly using a fluoride gel or rinse.
  • Stopping tobacco use can help your body heal faster .
  • Keep your bones healthy. Get enough vitamin D and calcium each day to help your jaw and teeth stay strong and healthy. Dairy products are good sources of calcium and if fortified, vitamin D. Talk with your health care team before taking any supplements.
  • Healthy foods will help boost your immune system which can aid in fighting off infections. Examples of healthy foods as described by MyPlate, a website from the Center for Nutrition Policy and Promotion, and agency of the U.S. Department of Agriculture include: fruits and vegetables, grains, low fat or fat free dairy. Also included are proteins such as lean beef, skinless poultry, fish, eggs, beans, peas, and legumes.
  • Stay away from citrus which is highly acidic.

 

How do I maintain oral health even after treatments are completed?

  • Make sure you visit your dentist regularly after treatment to make sure your mouth is properly cared for and cleaned. 
  • Brush teeth with fluoride toothpaste at least two times a day, especially after each meal and before bed. Soak a soft toothbrush in warm water to make the bristles softer and less likely to irritate your mouth. Always remember to brush your tongue!
  • Floss daily. This will clean out anything hiding between your teeth, but be gentle, and make sure to avoid sore or bleeding areas.  
  • Avoid tobacco and alcohol (including alcohol based mouth washes) which are harsh on your body and can have very negative effects on the health of your mouth. 
  • Maintain a healthy diet to help boost your immune system. According to MyPlate, a website from the Center for Nutrition Policy and Promotion, and agency of U.S. Department of Agriculture, a balanced and healthy diet should include: 
  • Fruits and vegetables - these should make up 50 percent of your meal.
  • Grains - mostly whole grains such as oatmeal, whole wheat bread, and brown rice.
  • Dairy - specifically low-fat or fat-free.
  • Protein - this includes lean beef, skinless poultry, fish, eggs, beans, peas, and legumes. Strive for at least eight ounces of seafood a week.