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Radiation of the head and neck regions is associated with a large number of side effects, chief among which is rampant tooth decay. We outline why this happens and what you need to do in order to protect your teeth from decay after radiation.

Cancer treatment involves the use of chemotherapy and/or radiotherapy in most and unfortunately, both of these come with a host of related side effects. When the primary lesion is in the head and neck region, the most severe symptoms can be seen in the head and neck region. These symptoms include dryness of the mouth, increased incidence of tooth decay, rampant gum disease, redness of the oral tissues, a burning sensation in mouth after cancer treatment and an inability to tolerate hot and spicy food [1].

All of these things are modifiable and can be prevented to a large degree through proper oral care during cancer treatment.

Tooth Decay During Cancer Treatment

Under normal circumstances, tooth decay occurs due to the presence of disease-causing bacteria, poor oral hygiene and sugars (direct or broken down from other food sources) in the oral cavity that allow these bacteria to thrive [2]. In cancer patients, the lack of normal salivary flow means that the body is unable to resist these bacteria and so the spread of tooth decay is much quicker and more extensive [3].

It is not uncommon for people who have had little to no problems with tooth decay to suddenly be faced with a situation where most of their teeth are decaying just a few months after the completion of cancer therapy.

So, How To Fight Tooth Decay After Radiation Treatment For Cancer?

This process starts with education. Not just of the patients but also the oncologists and support staff that will be dealing with the patients on a regular basis. If the patients are not aware of the need to take certain steps to prevent tooth decay then they can do nothing to stopping the destruction from happening.

Oral care before radiation treatment begins is absolutely essential for every single patient about to go radiation in the head and neck region [4]. During this process, the dentist will aggressively treat or remove any infected teeth so that preventing such teeth from worsening or others from becoming affected by tooth decay become easy for the patients [5].

If you are wondering whether you can wear dentures during cancer therapy: any dentures, crowns with sharp edges, functional or orthodontic appliances will be removed from the mouth because the oral tissues will find them very difficult to bear once the almost inevitable mucositis sets in [6].

Once the treatment has started, patients need to follow a meticulous oral hygiene regiment to prevent their teeth from getting decayed. This includes brushing twice daily with a medicated toothpaste that has an increased amount of fluoride in it.

A number of companies are providing toothpaste specifically for those patients that are undergoing radiation or suffering from other salivary disorders with a much higher level of fluoride than standard off the shelf toothpaste contain [7].

Patients should also use a sodium fluoride gel on their teeth after they have brushed. This application is made easier through custom trays that your dentist can fabricate for you.

The idea of using a high amount of sustained fluoride is to try and provide as much protection to the teeth as possible since numerous studies have proven the anti-caries effect that fluoride has. It does this through hardening the enamel and making it more resistant to acid attacks from decay-causing microorganisms [8].

The use of a chlorhexidine mouthwash must also be a part of the daily oral hygiene regimen ideally although some patients might find it too difficult to tolerate on their radiated soft tissues. Chlorhexidine is the gold standard when it comes to prevention of plaque formation and is the only chemical agent that binds to the tooth surface providing long lasting protection [9].

The last part of the puzzle is regular care provided by your dentist. Some patients are under the impression that dental visits for scaling and other treatment should be postponed during cancer treatment, however, they may actually be needed more often.

Oral care during cancer treatment is essential in the removal of any plaque, calculus which can lead to tooth decay as well as tackling any problems that arise as soon as possible. Grossly decayed teeth that require extractions, multiple root canals or other invasive procedures may be difficult for the patients to tolerate and may actually need hospitalization to be performed [10].

Conclusion

Patients must understand that the basic nature of tooth decay and why it occurs does not change in patients undergoing cancer treatment. The same things that help prevent it from occurring in healthy patients will also work in radiation patients.

It is just that the oral hygiene measures have to be much more meticulous and the dental care much more attentive otherwise the associated risks can affect the quality of the patient's life and lead to long-standing, serious and even life-threatening problems.

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