Evidence Update: Dental Health During & After Cancer Treatment
Once given the life-altering diagnosis of breast cancer, the furthest thing from the patient’s mind may be dental care. Planning for the oral health needs of the patient before chemotherapy or radiation therapy begins will improve outcomes and lower the risk of side-effects. Professional oral health care is a vital component to healthy oral habits long before a cancer diagnosis, but is essential before, during and after cancer treatment. Common side effects of chemotherapy and radiation may include mouth sores, dry mouth, pain, infection, difficulty chewing or swallowing, inflammation, and bone disease. Your dentist is an important part of your cancer care team and can help reduce and manage side-effects that may occur in the mouth during and after chemotherapy and radiation.
Chemotherapy affects rapidly dividing cells like cancer cells but may also impact normal cells that divide rapidly like those in the oral cavity and gastrointestinal tract. Chemotherapy may also lower your white and red blood cell count as well as your platelet count. This is known as “bone marrow suppression” (myelosuppression), which may lead to increased risk of infection and / or bleeding. In fact, some pre-existing conditions such as cavities, abscesses or gum (periodontal) disease may become worse during treatment. If these conditions exist, it is important to address them prior to beginning cancer treatment.
Mucositis – mouth sores – are often cited as the most common side-effect of chemotherapy. Other side-effects of chemotherapy may also include mouth pain, peeling of the tongue and even changes in taste. At times, mucositis may be severe enough to alter treatment regimens and even require prescription pain medication to alleviate the symptoms. One way to lessen the discomfort and even reduce the likelihood of mouth sores resulting from chemotherapy is to ask for ice chips or sugar free popsicles to suck on during treatment. Some mouth rinses that contain salt or baking soda may also help ease mouth sores. Unfortunately, there are not too many approved treatments for mucositis. Low-level lasers can relieve or cure the ulcers (sores), but much more definitive research is needed. Talking with a dietitian may help with changes in taste and identification of foods that cause less irritation to mouth sores and are easier to eat.
Radiation is also used to destroy cancer cells, but as with chemotherapy can result in damage to healthy cells. Radiation to the head and neck area can damage salivary glands resulting in xerostomia (dry mouth). With xerostomia, salivary glands produce less saliva and the saliva that is produced is thicker. The importance of saliva cannot be overstated. It controls bacteria in the mouth by constantly rinsing the mouth, and it delivers part of the immune system into the oral cavity. Dry mouth can lead to difficulty speaking or swallowing as well as increased bacteria in the mouth, which can lead to cavities and gum disease. To reduce the impact of dry mouth, patients can soften or thin food with liquids, chew sugarless gum, and suck on ice chips. Your dentist may also prescribe a saliva stimulant to help ease dry mouth.
Possibly the most significant complication of radiation therapy is osteonecrosis of the jaw – ONJ (weakening and loss of bone in the jaw). ONJ may result in pain, swelling, infection, loose teeth and even exposure of underlying bone tissue. The good news is that ONJ can be managed with oral antibiotics, proper dental hygiene and routine care by a dental professional. New studies are now being done with hyperbaric oxygen to understand how this treatment may aid in wound healing and the prevention of ONJ.
Oral health side-effects resulting from chemotherapy and radiation treatments are a risk for patients and can even result in changes to the treatment regimen. New research is underway to better understand the underlying causes of mucositis, xerostomia, and osteonecrosis and identify ways to reduce these side-effects and improve treatment outcomes. Patients can improve and manage their oral health by including their dentist as part of their cancer care team and maintaining good oral health habits.
Source: American Dental Association, American Society of Clinical Oncology & National Institute of Dental and Craniofacial Research.