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Oral Care in Cancer Patients

Why is it important and how to go about it.

Coordination by a comprehensive cancer care team can significantly reduce the physical and emotional toll and contribute to successful treatment outcomes in cancer patients. Pre-treatment oral assessment and supportive oral care during and after cancer therapy can increase quality of life and decrease higher treatment and supportive care costs.

It is important to maintain good oral care during cancer treatment and survivorship. Being prepared and understanding what to expect as well as knowing the general state of your teeth, gums and the entire oral cavity prior to starting treatment can be helpful in dealing with expected and unexpected side effects from chemotherapy, radiation, surgery and immunotherapy which are standard of care depending on the type of cancer you have.

Dental and oral side effects can make it difficult to eat, taste, talk, chew, or swallow. There are several ways to lower the risk of these side effects and manage them if they do happen. Your general dentist and if needed, specialized dental health professionals can help with your oral care before, during, and after cancer treatment.

If you have started cancer treatment and have not seen a dentist, see one as soon as possible.

Dental health is impacted by cancer treatment and ideally, you should be seeing a dentist before you start cancer treatment. Having good dental health before treatment decreases your risk of several side effects as mentioned in the previous blog including common side effects such as mucositis, decreased saliva production, increased risk of tooth decay, mouth sores, changes in taste and ability to chew. Therefore, it is important to see a dentist at least 4 weeks before starting cancer treatment so that any possible infection or irritation can be treated. Your dentist can make sure any infected teeth or tooth decay is treated, your dentures optimally fit your mouth and evaluate your gum health. If you need dental surgery, it is recommended you have at least 2 weeks for healing between dental surgery and starting cancer treatment. You should also talk with your doctor or another member of your health care team about which mouth problems you should tell your dentist about right away.

However, if you see a dentist during your cancer treatment, it is important that he or she talks with your cancer care team to make sure that any dental treatment you receive going forward is safe for you. It always helps to have a checklist of questions to ask your dentist during your visit.

“Aggressive treatment of an oncological disease produces inevitable effects on normal cells. Due to its high rate of cell proliferation, the gastrointestinal tract mucosa, including the oral mucosa, is the main place where the toxic effects of cancer treatment are observed.” - Ahrens W, Pohlabeln H, Foraita R. Oral Oncol. 2014;50:616–625.

While your dentist along with your cancer care team will prescribe ways towards better oral care, here are some time-tested and proven solutions that can help with side effects:

  • Brush teeth, gums, and tongue gently with an extra-soft toothbrush after every meal and before bed. If brushing hurts, soften the bristles in warm water.

  • Floss teeth gently every day with un-waxed floss. If gums are sore or bleeding, avoid those areas but keep flossing other teeth. If you haven’t flossed regularly before treatment, don’t start flossing now.

  • Follow instructions for using fluoride gel as recommended by your dentist /cancer care team.

  • Avoid mouthwashes containing alcohol or peroxide unless recommended by your cancer care team.

  • Rinse the mouth with a baking soda and salt solution, followed by a plain water rinse 4 to 5 times a day. Do not use salt if you have mucositis.

  • Exercise the jaw muscles three times a day to prevent and treat jaw stiffness from radiation. Open and close the mouth as far as possible without causing pain; repeat 20 times.

  • Use a lip moisturizer 4 to 6 times a day to prevent dry lips.

  • Don’t apply lip moisturizers 4 hours before radiation therapy to the head and neck.

  • Avoid candy, gum, and soda unless they are sugar-free.

  • Avoid spicy or acidic foods, toothpicks, tobacco products, and alcohol.

  • Keep your follow-up appointments as recommended by your dentist and always ensure there is good communication between your dentist and your cancer care team.

The right foods and diet can also help with optimal oral health while you are on cancer treatment. The next few blogs will continue to cover oral side effects of cancer treatment, what to expect in terms of treatment of side effects, what to eat when side effects occur during and after treatment and recommendations for products that can help with oral care.

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Reason to Hope

There is new research from Brigham and Women’s Hospital that indicates a Western-style diet that is rich in red and processed meat, sugar and refined grains/carbohydrates is tied to higher risk of colorectal cancer through the intestinal microbiota.  Gastroenterology, 2022;DOI:10.1053/j.gastro.2022.06.054 

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