Maintaining Oral Health During Cancer Treatment

Just as periodontal health can affect your overall health, certain health conditions and their treatments can affect your periodontal health.  Cancer therapy is one example. 

Cancer therapy can cause oral complications that compromise your periodontal health, so if you have been diagnosed with cancer it is essential that you make the periodontist a member of your treatment team.  Keeping your gums and teeth healthy during this difficult time may help to prevent complications during your cancer treatment. 

According to the National Institute of Dental and Craniofacial Research (NIDCR), of the 1.2 million Americans diagnosed with cancer each year, approximately 400,000 will develop oral complications from their treatment.  Unfortunately, many patients do not receive oral care until serious, painful complications develop. 

Oral Complications

Common side effects of chemotherapy, radiation to the head and neck, and bone marrow transplantation can negatively impact your overall health and quality of life. Radiation and chemotherapy kill cancer cells, but can also affect normal cells as well, including the cells in the mouth.  Complications can vary depending on the individual and type of treatment received.  These problems can become so significant that your treatment plan may be altered to reduced doses or discontinued entirely. 

Oral complications from radiation, bone marrow transplantation or chemotherapy may include:

• Inflamed gums, mouth ulcers and infection
• Dry mouth
• Difficulty speaking, chewing and swallowing
• Dental decay or erosion of the tooth enamel and root
• Loss of taste sensation
• Jaw stiffness
• Delayed healing

Pretreatment Evaluation

If at all possible, an oral evaluation by a periodontist or knowledgeable dental professional should be obtained prior to beginning your cancer treatment.  Identifying and correcting a potential oral problem may ease discomfort so it does not intensify or interfere with your cancer treatment.  Oral surgery is not recommended during cancer therapy because tissue takes longer to heal during this time.  This is why oral pretreatment is essential.

Pretreatment care also provides the following benefits:

• Reduces the risk and severity of oral complications during cancer therapy
• Reduces the likelihood of oral pain and ultimately may protect oral health
• Allows for timely diagnosis and treatment of existing infections
• Improves the chances of receiving optimal doses of cancer treatment
• Improves overall health

Daily Oral Hygiene Routine

In addition to pretreatment care, your periodontist or dental professional will likely recommend an at-home oral hygiene routine.  Daily oral hygiene will provide comfort, reduce the risk of infection by periodontal bacteria, and minimize the effects of complications caused by your cancer treatment.  In addition to the oral hygiene routine tailored by your periodontist or dental professional, below are some tips to help you keep your mouth as comfortable and healthy as possible:

• Gently brush your teeth, gums and tongue with a soft-bristled toothbrush and fluoride toothpaste after every meal and before bed.  If brushing hurts, soften the bristles in warm water. 
• Floss teeth gently every day, temporarily avoiding specific areas if gums are sore or bleeding.
• Topical fluoride applications may be prescribed by your periodontist or dentist. Fluoride applications will fortify the enamel to help it resist decay caused by decreased saliva production during radiation therapy.
• For a sore mouth, rinse a few times a day with one cup of warm water mixed with ¼ teaspoon baking soda and ⅛ teaspoon salt.  Follow with a plain water rinse.
• Avoid candy and soda unless it is sugar-free.  Also avoid using toothpicks, tobacco products and alcohol.

Special Considerations

Even though pretreatment and daily oral hygiene can go a long way toward keeping your mouth comfortable and disease-free during cancer treatment, sometimes it’s hard to keep the negative effects at bay.  If you are experiencing a problem, there are a few easy steps you can take to minimize discomfort and the harm it causes.

Caring for Dry Mouth

Chemotherapy and radiation can decrease your salivary secretion, causing excessive dryness in the mouth.  A dry mouth could increase your susceptibility to oral infections. Keep your mouth moist and stimulate saliva flow by:

• Sipping cool water often
• Allowing ice chips to melt in your mouth (no chewing)
• Chewing sugarless gum or candy
• Lubricating your lips with lip balm
• Asking your periodontist or dentist for a prescription saliva substitute or medication that may stimulate saliva
• Using a humidifier in your bedroom to alleviate or reduce nighttime oral dryness

In addition, avoid drinking acidic, carbonated or caffeinated beverages and do not use mouthwashes/mouth rinses containing alcohol, because these chemicals will dry out your mouth.

Eating with Care

Adequate nutrition and fluid intake are important for oral and general health. Occasionally, patients develop nutritional deficiencies because their mouths are sore from cancer treatment.  If your mouth is sore, choose easy-to-chew foods that are bland in flavor and lukewarm in temperature.  You may also want to soften your food with sauces, milk, yogurt or gravy, or in a blender to facilitate swallowing.  If your diet is compromised, then consider nutritional or vitamin supplements.

Protecting Enamel

If a dry mouth or vomiting is a side effect of your cancer treatment, your periodontist or dentist can prescribe fluoride trays.  Use of fluoride trays will prevent the tooth enamel from wearing away as a result of the gastric acids from vomiting or the increased bacteria as a consequence from a dry mouth.  Rinsing your mouth after vomiting with ¼ teaspoon of baking soda in 1 cup of warm water will also cleanse your teeth and gums of the gastric acids.  If you are experiencing nausea or vomiting, you may want to ask your oncologist or primary care physician to prescribe anti-nausea medication during your cancer therapy.

Follow-Up and Long-Term Care

Relationships with your periodontist and dental professionals are as important after your cancer therapy as they are before and during your treatments.  These continued relationships will help you maintain a comfortable, confident smile for years to come.

Adapted from “Maintaining Oral Health During Cancer Therapy” brochure