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Oral Care during cancer treatment is very important and can differ greatly from routine oral care. We outline the things that patients must look out for as well as the practices they must follow to prevent dental problems from cropping up.

Close to 50.000 Americans will be diagnosed with oral cancer this year. oral cancer will cause almost 10.000 deaths, killing roughly 1 person per hour, 24 hours per day [1]. The importance of oral care during cancer treatment cannot be overstated, especially if the targeted lesion is present in the head and neck region [2]. Patients are treated with either chemotherapy, radiation, surgery or a combination of all the three.

Ideally, the patient should have undergone a dental checkup prior to the beginning of cancer treatment so that any areas of infection could have been treated but that is not always the case. Here are some things that patients need to be aware of during cancer treatment to minimize the risk of oral problems.

Oral Care During Cancer Treatment

Some amount of side effects will be felt during cancer therapy and the steps being outlined here all help minimize their effects. Remember that these side effects can be highly individualized and vary from person to person.

The most common oral side effects of cancer treatment include dryness of the mouth (xerostomia), inflammation of the oral tissues (mucositis), opportunistic infections, fibrosis or a loss of elasticity of the oral tissues [3,4].

Dryness Of The Mouth

Most patients who receive radiation in the head and neck region will suffer from a decreased amount of salivation. In severe cases, there may be a complete cessation of salivary production.

Saliva is extremely important to maintain the normal, healthy condition of the teeth as well as the soft tissues and its loss leads to a number of complications.

Patients may find that they develop tooth decay at an alarming rate and in a number of teeth at once. Periodontal disease (gum disease), which is usually slow to develop, can also progress rapidly — leading to pain, discomfort and tooth loss.

A lack of saliva also makes chewing, talking and swallowing very difficult. Alteration in taste perception can make eating difficult as can the inability to tolerate even mild spices.

The doctors may prescribe systemic medication (drugs that work throughout the body) called sialagogues [5] that increase the amount of natural salivation. Unfortunately, this medication will only work if there is some function remaining in the salivary glands. For others, artificial salivary substitutes are recommended.

These artificial salivary substitutes make the patients feel better but are most often devoid of the protective functions that natural saliva has.

Sugar-free chewing gum or lozenges can help stimulate the salivary glands and produce more saliva, while sugar-free popsicles can be used to keep the mouth moist.

Patients must also continue to maintain a very high level of oral care during cancer treatment to prevent decay from occurring. Tooth cleaning (scaling) can continue and is recommended during cancer treatment.

The use of a fluoride gel (1.1%) must begin on the day of the radiation therapy to prevent tooth decay [6].

Inflammation Of The Oral Tissues

Mucositis (inflammation of the oral tissues) is almost inevitable during radiation of the head and neck region. It can be extremely painful and cause a great deal of discomfort to the patient. Some of the most common methods to try and minimize as well as counteract mucositis include the use of topical gels and rinses. Unfortunately, very few clinical trials have been carried out about their efficacy.

According to scientific literature, the only mouth rinses that you should be considering for mucositis include q chlorhexidine rinse before the beginning of radiation and sucralfate suspension to coat the oral tissues and provide some relief [7].

If a severe amount of pain is present, then the use of benzydamine hydrochloride (Tantum) mouthwash is recommended [8]. A study also found that a home-made mouthwash of a

  • Teaspoon of salt
  • A teaspoon of baking soda
  • In around 250 ml of water

was as effective as other commercially available mouthwashes in reducing mucositis [9].

Opportunistic Infections: Fungal And Viral Infections During Cancer Treatment

The reduced immunity during chemotherapy and radiation treatment can allow even otherwise harmless infections to wreak havoc inside the mouth. Patients commonly suffer from fungal and viral infections during cancer treatment.

Nystatin mouth rinses are often prescribed for the treatment of fungal infections and that should be sufficient in most cases, however, sometimes systemic antifungal medication like Amphotericin B and Fluconazole may also need to be prescribed [10].

The use of a chlorhexidine rinse is highly recommended for the prevention and treatment of minor fungal diseases since it has been proven to have antifungal properties in addition to preventing the formation of plaque.

There are also a number of antiviral medications like acyclovir and its derivatives that can be used for patients that suffer from herpes simplex infections during cancer treatment [11].

Fibrosis

The term fibrosis refers to the hardening of the collagen fibers that are present inside our oral tissues. This translates to a loss of flexibility, a decreased ability to open the mouth, feeling tired after talking or eating, and changes in speech patterns. It is difficult to prevent fibrosis, since cancer medications can cause a decreased ability to renew collagen fibers.

Luckily, treatment through the use of placental extracts, antioxidants, and the injection of enzymes that break down collagen is quite successful in relieving the problems associated with it. [12]

Advisable Oral Hygiene Practices During Cancer Treatment: How To Look After Your Mouth And Teeth

Patients should be meticulous about their oral hygiene and use the prescribed mouthwashes only. Certain commercially available mouthwashes have alcohol or other flavoring agents that can cause discomfort to patients.

Their own brushing regimen should also be very meticulous, taking care not to injure the gums or the surrounding oral tissues and making sure that every surface of every tooth is cleaned.

Special medicated toothpaste that is mild in taste and much higher in fluoride content than commercially available ones should be used by patients.

Ask your doctor to prescribe you one if they did not already do so during the counseling session. If you are using any dentures or other removable prostheses, they should be used with extreme caution during cancer treatment.

Do not use the dentures or the dental prosthesis if they are causing ulcers, pain or discomfort. If the denture is continuing to be used, then it should be cleaned every day with an antimicrobial rinse.

Conclusion

Patients are often told by their relatives or well-wishers to postpone dental treatment until their cancer treatment is out of the way but that well-meaning advice can backfire in a big way. The idea of continuing preventive dental treatment during cancer treatment is to reduce any further need of curative treatment since the choices are often restricted.

Elective dental surgery or even routine dental extractions may have to be avoided for six months after radiation is complete or be carried out in a hospital setting in case of an emergency.

The quality of life of a patient can worsen considerably if they are suffering from an unchecked outbreak of dental problems and thus, preventing any of these problems from occurring at all should be made a priority.  

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