Oral Hygiene For The Cancer Patient: Looking After Your Mouth Through Chemotherapy

Chemotherapy and radiation are necessary treatment protocols to aggressively treat and prevent the recurrence of an oncogenic lesion. These procedures have helped prolong lives and even completely treat millions of people all over the world. The main drawbacks of these procedures are a large number of side effects that a patient has to go through as a result of these medications. While work is being done to develop better targeted medicine and those with minimal side effects, the nature of cancer itself means that some amount of collateral damage is necessary and even inevitable. Cancer cells are identified by their rapid rate of division, and so certain normal cells that also divide at a rapid rate like the ones found in the oral cavity, also get caught in the cross fire.

Pretherapy Treatment

It is now standard protocol for a patient about to undergo head and neck radiation to undergo a thorough dental checkup beforehand. This is because even a small lesion, mouth sore or pre-existing inflammation will get exacerbated during the course of the treatment. The approach to treatment for a patient about to undergo cancer therapy is very different from that of a normal patient. The focus is on minimizing any and all possible causes of infection, however minimal they might be.

No new root canals will be started and extractions will be preferred instead. An X-ray of the entire jaw will be taken to determine which teeth may cause trouble in the future. These teeth include previously treated teeth with an asymptomatic apical pathology or third molars which are unerupted/half erupted and periodontal compromised teeth as well. These teeth may not have anything wrong with them at the present time however they will still be marked for extraction as per existing recommendations and protocols.

Since the ability of the body to heal even minor sores or cuts reduces drastically after chemotherapy and radiation, a thorough inspection will be done to identify any sharp edges or improperly placed teeth that can cause such sores. These will be rounded off or if that is not possible, extracted. Similarly, existing prosthetic and orthodontic appliances that may be being used without any trouble will be inspected and in most cases the use of these devices is stopped until the oral tissues return to normal.

See Also: Chemotherapy And Cancer: Questions And Answers

The reason why such aggressive methods are advised before cancer therapy is that blood circulation is severely affected, along with the breakdown of sensitive barrier membrane cells. This makes our oral cavity sensitive to minor forces and insults, the kinds that would go unnoticed earlier. This is associated with a severe reduction in the wound healing abilities of the body as well. 

Oral Care For The Cancer Patient: During And After treatment

Dental Care During Cancer Treatment

The aim of providing dental care during the phase of cancer treatment is aimed at making the patient as comfortable as possible. If all the pre-therapy protocols have been followed correctly then there would not be any active sources of infection in the mouth needing treatment.

The patients are advised to brush very gently using a super soft tooth brush or a sponge applicator so as not to cause any damage to the gums. Since platelet counts can fall to alarmingly low levels, even small cuts and nicks can bleed without clotting for a long time. Patients are asked to avoid using floss as it damages the inter-dental gingiva. The toothpaste itself is different for cancer patients. They have a very high level of fluoride content to prevent dental caries.

One of the anatomic structures most commonly affected during head and neck radiation are the salivary glands. These glands are responsible for producing saliva which has many protective functions for the teeth and the oral mucosa. A decrease in saliva production and even a complete cessation can be seen following radiotherapy thus making cancer patients extremely prone to develop dental caries.

Any and all prosthetic appliances must only be worn to facilitate function. Dentures should be worn only to help eat and not for esthetic purposes. It is likely that your doctor will prescribe you multiple medicated mouthwashes to help fight bacterial and fungal infections. These are opportunistic infections that thrive as soon as the immune system of the body becomes compromised. One thing to remember is that these mouthwashes often have active ingredients that are counteract each other and so should be used at a slight gap from each other.

Avoid anything spicy as it will burn and cause a severe stinging sensation. The use of a local anesthetic before food is advisable. Topical gel preparations of  xylocaine are commonly prescribed for this purpose although there are many others available as well.

Dental Care Once Cancer Treatment Is Complete

There will be some amount of permanent damage that will have taken place to the cells of the salivary gland as well as those of the oral mucosa. It is absolutely imperative that you keep a very high level of oral hygiene and visit your dentist every three months for a reevaluation. Disease occurrence and disease progression will be accelerated in such cases and thus it is necessary to catch the problem as soon as possible. The use of fluoridated toothpastes, medicated mouthwashes as well as treatment for dry mouth will continue even after cancer treatment is complete.

See Also: Why Your Cancer Specialist (in the USA) May Be Forced Out of Business

Conclusion

Oral care for the cancer patient is rigorous and demanding, however it is necessary to help improve the quality of life for the patient. Newer techniques, better targeting and use of increasingly effective shields is making the associated morbidity to the normal structures lesser, however there is still a long way to go in that regard.