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What You Eat (or don’t eat) Affects Your Oral Health.

Know the role of nutrition in supporting optimal oral health.

“Let your medicine be your food and your food be your medicine.” - Hippocratic principle.

Good nutrition is a cornerstone of support for your body during and after cancer therapy. During surgery, radiation, and chemotherapy - the most common procedures used in cancer treatment - your body's ability to tolerate certain foods and its ability to assimilate nutrients can be altered. The nutrient needs of a cancer patient vary from person to person. The treatment process can put unusual and stressful demands on your body in addition to the unavoidable damage to healthy cells and normal bodily functions. The stress of these combined tasks requires a proportionally higher amount of the right nutrients, the lack of which can negatively impact your overall health and response to treatment.

The mouth, gums, and teeth can be particularly vulnerable to the various types of chemotherapy used to treat malignancies, as well as to radiation or surgery treatments for head and neck cancers. During treatment you may develop loss of appetite, nausea, vomiting, diarrhea, constipation, dry mouth, blistered mouth, or other oral or digestive issues. It may be necessary to alter your food choices for a period of time during and after cancer treatment has completed to allow these tissues to heal and for your body to adapt to some of the side effects that may not resolve quickly enough.

Carbohydrates, fats and proteins are the building blocks that supply the energy the body needs for tissue maintenance and repair, along with vitamins such as A, B, C, D, E and K which are also essential for healing and quicker recovery time. Vitamin A, for example, significantly reduces the healing time for repairing inflamed tissue. Vitamin A is also particularly important for optimal saliva production. Vitamin D plays a crucial role in bone and tooth mineralization. Vitamin C helps keep the connective tissues in your gums healthy and strong, which hold your teeth in place. In addition, minerals also play a significant role in maintaining good oral health. Calcium isn’t just good for your bones; it’s good for your teeth, too. Phosphorus combines with calcium in forming crystalline calcium phosphate which is the main component of tooth enamel. It also supports calcium's role in bone production and remodeling. Magnesium and calcium work together and complement each other in their efforts to build hard tooth enamel and maintain bone density.

A healthy diet is crucial during cancer treatment to help you with good oral health while maintaining optimal energy levels, reducing fatigue and helping with good bowel health. The type of cancer and the treatment modalities you are receiving may affect what foods you can eat, so be sure to talk to your cancer care team and/or your oncology dietitian before you start making any significant change in your nutrient intake. Optimizing your nutrition to maintain good oral health can help you lessen the severity of the side effects of treatment, recover faster and maintain a healthy body weight.

Here are some nutrition tips to optimize your oral health:

  • Include foods high in calcium. Calcium helps lay the foundation for tooth structure and can help enhance enamel remineralization. Good sources include milk, cheese, yogurt, and broccoli.

  • Eat crunchy fruits and veggies. Raw fruits and veggies like apples, carrots, celery, etc. can help to keep teeth clean by removing material that causes plaque on the tooth’s surface. Not just that, fresh fruits and veggies also provide beneficial plant compounds that can reduce your risk of many cancers.

  • Chew xylitol gum after meals. Most sugar free gum and mints contain a sugar alcohol called xylitol. Xylitol has been shown to prevent the bacteria in your mouth from producing the acids that cause cavities. In addition, the act of chewing gum increases saliva flow helping keep the mouth clean. Look for gums that carry the ADA seal.

  • Limit or avoid sodas (including the diet kind). Regular soda contains a lot of added sugar without any nutritional benefits. Eating or drinking sugary foods and drinks can produce acids that attack your tooth enamel. In addition, most carbonated drinks, including diet soda, are acidic and can cause damage to your teeth. If you do choose to have the occasional soda, make sure to use a straw to avoid contact with your teeth and drink it with a meal to neutralize the acid.

  • Limit sugary foods and drinks. In addition to soda, drinks like fruit juice, regular energy drinks and sports drinks also contain excess sugar. Sugar interacts with the plaque bacteria in the mouth to produce acids. The acid then dissolves the enamel slowly which can lead to cavities and tooth decay. It’s best to limit or avoid these drinks whenever possible. Sweet foods like candy, cakes, cookies, and pies also have a lot of sugar which will have the same effect.

  • Limit or avoid alcohol. Drinking alcohol can not only lead to dry mouth and dehydration but excessive use can increase your risk for oral cancer as well. If you do choose to imbibe, make sure to limit yourself to 2 drinks or less per day for men and 1 drink or less per day for women.

  • Sip on green tea. Research has shown green tea helps decrease inflammation as well as makes the mouth more alkaline which can prevent the growth of bacteria that causes cavities and bad breath. Try to replace your soda with green tea.

  • Eat foods high in vitamin C for gum health. Vitamin C is not only good for your teeth but it’s essential for gum health. Vitamin C keeps the connective tissue in your gums healthy and inadequate vitamin C can lead to bleeding gums and gum disease. Foods high in vitamin C include berries, citrus fruits, peppers, sweet potatoes, broccoli, and kale.

  • Include foods with probiotics. Probiotics are made up of live (good) bacteria and/or yeasts that are found naturally in our bodies and can help keep us healthy. Research shows that probiotics may support oral health by reducing gum inflammation as well as by decreasing plaque and increasing the good bacteria in the mouth. Yogurt, kefir, sauerkraut, kombucha and kimchi and other fermented foods are great sources of probiotics.

  • Go easy on acidic foods and drinks. Acidic foods and drinks can gradually dissolve tooth enamel leading to dental erosion. Foods like pickles, vinegar and citrus fruits, and drinks like soda, red wine and orange juice are acidic and large amounts may cause damage. While citrus foods can be good for gum health, be careful not to overdo it. Try to avoid citrus juices.

  • Get your nutrients from foods first. Choose foods that provide plenty of calcium, phosphorus, magnesium, vitamin K and vitamin D- all of which are key nutrients to support a healthy mouth. Some good choices include leafy green vegetables, dairy products like milk, yogurt and cheese, nuts, seeds, beans, meats, fish, and eggs. A bonus for getting your nutrients from plant foods is that they also have beneficial compounds called phytochemicals which can reduce your risk of many cancers (including oral cancer).

The nutrients in food forms all work together for a synergistic effect, meaning they will be absorbed and utilized in our bodies better than nutrients in a pill or powder form. It is important to remember that unless you are deficient in a certain vitamin or mineral, excess supplements may be harmful. Always be sure to talk with your oncology dietitian or cancer care team before starting any vitamin, mineral or herbal supplement.

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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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