• ADA: mouthhealthy.org

Cancer and Dental Health

More than one-third of all cancer patients develop complications that affect the mouth, according to the National Institute of Dental and Craniofacial Research. These mild to severe side effects can include mouth sores, infection, dry mouth, sensitive gums and jaw pain.

How Cancer Affects Your Mouth

Cancer and its treatments, like chemotherapy, can weaken your immune system. If your mouth is not as healthy as possible prior to your cancer treatment, you may be more susceptible to infection. If the infection is serious enough, it can delay your cancer treatment. In addition, radiation therapy, especially in the area of the head and neck, can damage salivary glands which can cause thick, sticky saliva and extreme dry mouth. A dry mouth can increase your chances of tooth decay and infection.


Before Treatment


If your mouth is not as healthy as possible prior to your cancer treatment, you may be more susceptible to infection. If the infection is serious enough, it can delay treatment.

Here are some dental health tips to consider before undergoing cancer treatment:


Visit Your Dentist

Your dentist can evaluate your dental health and discuss which treatment options you should consider prior to starting cancer treatment. By treating areas of concern you may reduce possible dental side effects associated with chemotherapy and radiation. Some treatment options may include fluoride treatments to prevent cavities, filling existing cavities, treating gum disease, removing infected teeth or restoring crowns or bridge work to ensure you will be able to chew your food.


Brush Regularly

Brush twice a day with fluoride toothpaste. You can soak your extra-soft toothbrush in warm water to make it softer, and don’t forget to brush your tongue!


Floss

Floss once a day. This helps remove plaque between teeth. If your gums are sore or bleeding, be gentle and avoid those areas, but floss in between the rest of your teeth.


Don’t Use Tobacco

Tobacco products are harsh on your body – especially your mouth health. Stopping the use of tobacco may help your body heal faster.


Eat Nutritious Foods

Eating healthy foods rich with vitamins and nutrients can help boost your immune system. Your individual nutrition and calorie needs depend on your age, gender, level of physical activity and other health factors. According to MyPlate, a website from the Center for Nutrition Policy and Promotion, an agency of the U.S. Department of Agriculture, a healthy diet should include: Fruits and vegetables, grains, low-fat or fat-free dairy, and protein such as lean beef, skinless poultry and fish. Vary your protein choices to also include eggs, beans, peas and legumes. Eat at least eight ounces of seafood a week.


Rinse Your Mouth Often

This will help keep food and debris off of your teeth and gums. Avoid rinses that have alcohol in them. Rinsing often, along with regular brushing and flossing, may help to reduce the chance of dental decay and infection. Rinsing is also helpful after vomiting to keep the acids from damaging the enamel on your teeth. You may also want to reduce eating citrus fruit or other high acid foods.

Rinsing solution ideas from the National Institutes of Health:

  • 1 teaspoon of salt in 4 cups of water

  • 1 teaspoon of baking soda in 1 cup (8 ounces of water)

  • One half teaspoon salt and 2 tablespoons baking soda in 4 cups of water


During Treatment


During the course of your cancer treatment you may experience mild to severe side effects. Be sure to consult with your cancer care team prior to dental checkups, especially if you have a port under your skin for receiving medication or feeding. This is important because patients with a port may also take anti-blood clotting medications, which can increase bleeding during dental and medical procedures and the risk of infection.


Below are some of the most common side effects and treatment options. Then, find out how to care for your mouth after treatment has been completed.


Mouth Sores


Mouth sores are ulcers that form in the soft tissue in and around your mouth including your tongue, gums, or lips. They can be caused by chemotherapy or radiation and can be mild. If your mouth sores are severe, your doctor may recommend delaying your cancer treatment until the infection is healed. According to the Mayo Clinic, chemotherapy reduces your blood’s ability to clot and could cause mild to severe bleeding from mouth sores. Bleeding and painful sores could affect your ability to eat which causes more stress to the body. Be sure to speak with your oncologist and dentist throughout your treatment.

Why are mouth sores common for cancer patients?

Chemotherapy and radiation work to destroy rapidly growing cells throughout your body. Unfortunately some healthy cells are affected in the process – including the cells in your mouth. Also because your immune system is low, your mouth is vulnerable to infection.

What can I do for relief?

Get a dental checkup and talk to your doctor about treatment options. They may be able to recommend topical treatments that can include coating agents which form a film to protect the sores or painkillers which can numb the sores in your mouth. Be careful when eating or brushing your teeth while taking numbing medication since you may not be able to feel if you are causing more damage. There are also over-the-counter products, such as fluoride toothpastes, that contain aloe vera and allantoin, which claim to be naturally soothing and gentle. Talk to your dentist about using these products.

Brush Your Teeth

Brush twice a day with fluoride toothpaste. You can soak your extra-soft toothbrush in warm water to make it softer. Don’t forget to brush your tongue!

Floss Daily

Flossing helps remove plaque between teeth. If your gums are sore or bleeding, be gentle and avoid those areas, but floss in between the rest of your teeth.

Watch What You Eat

Stay away from crunchy or spicy foods and alcohol. Your mouth can be very fragile during treatment. Steer clear of foods that can irritate your gums or mouth sores. This includes alcohol-based mouth rinses and alcoholic drinks which can burn mouth sores.

Rinse Your Mouth Often This will help keep food and debris off of your teeth and gums. Rinsing often, along with regular brushing and flossing, may help to reduce the chance of dental decay and infection. Rinsing is also helpful after vomiting to keep the acids from damaging the enamel on your teeth. You may also want to reduce eating citrus fruit or other high acid foods. Avoid the use of alcohol-based mouth rinses since they can be irritating to mouth sores and dry mouth.

Here are some rinsing solution ideas from NIH: o 1 teaspoon of salt in 4 cups of water o 1 teaspoon of baking soda in 1 cup (8 ounces of water) o One-half teaspoon salt and 2 tablespoons baking soda in 4 cups of water


Dry Mouth


Dry mouth happens when you don’t have enough saliva (spit). It is can be a side effect of certain medications, such as antihistamines, decongestants, pain killers, diuretics and many others. Dry mouth can cause a constant sore throat, burning sensation, trouble speaking, difficulty swallowing, hoarseness or dry nasal passages.

Why Is Dry Mouth Common for Cancer Patients?

Saliva is vital to our mouth health. It not only helps us break down and wash away food and bacteria from our teeth and gums, but it also provides disease-fighting substances throughout your mouth to help prevent cavities and other infections. For patients undergoing cancer treatment, the use of certain medications, chemotherapy and radiation can greatly reduce the amount of saliva produced by directly affecting the salivary glands. Less saliva may increase your risk of tooth decay.

What Can I Do For Relief?

See Your Dentist Get a dental checkup and talk to your doctor about treatment options. They may recommend the use of artificial saliva and/or a fluoride rinse or gel which may reduce tooth decay caused by dry mouth.

Brush Your Teeth Brush your teeth twice a day with fluoride toothpaste. You can soak your extra-soft toothbrush in warm water to make it softer. Don’t forget to brush your tongue, and avoid mouth rinses with alcohol in them since they may further dry your mouth.

Floss Daily Flossing helps remove plaque between teeth. This is essential since your body is not producing an adequate amount of saliva to rinse inside your mouth. If your gums are sore or bleeding, be gentle and avoid those areas but floss in between the rest of your teeth. Drink Plenty of Water Limit drinking alcoholic beverages since they may cause further dryness. Ask your dentist if other options such as sugar-free candies or gum may be helpful for you.


Sensitive Gums and Gum Disease


Sensitive gums may be a sign of minor tissue swelling from chemotherapy and radiation or a more serious indication of gum disease. Symptoms may include tenderness, bleeding, inflammation or even loose teeth.

Why Are Sensitive Gums and Gum Disease a Concern for Cancer Patients? Some cancer treatments, such as chemotherapy and bone marrow transplant, weaken your immune system. This can make your body vulnerable to bacteria and infection. The bacteria in the mouth can spread to the rest of the body. That’s why it is important to try to see your dentist soon after your diagnosis so that you may potentially treat any existing gum disease before undergoing cancer treatment.

What Can I Do for Relief?

See Your Dentist Get a dental checkup and talk to your doctor about treatment options. They may recommend a topical anti-inflammatory or a steroid rinse. An antibacterial or antifungal rinse is also commonly prescribed. By keeping your mouth healthy prior to beginning your treatment you could potentially reduce the risk of further infection which could delay your overall treatment.

Brush Your Teeth Brush your teeth twice a day with fluoride toothpaste. There are also over-the-counter products, such as fluoride toothpastes, that contain aloe vera and allantoin, which claim to be naturally soothing and gentle. Talk to your dentist about using these products. If your extra-soft tooth brush bristles are too hard, soak them in warm water to make them softer. Don’t forget to brush your tongue.

Floss Daily Flossing helps remove plaque between teeth. If your gums are sore or bleeding, be gentle and avoid those areas, but floss in between the rest of your teeth.

Rinse Your Mouth Often This will help keep food and debris off of your teeth and gums. Rinsing often, along with regular brushing and flossing, may help to reduce the chance of dental decay and infection. Rinsing is also helpful after vomiting to keep the acids from damaging the enamel on your teeth. You may also want to reduce eating citrus fruit or other high acid foods. Here are some rinsing solution ideas from NIH: o 1 teaspoon of salt in 4 cups of water o 1 teaspoon of baking soda in 1 cup (8 ounces of water) o One-half teaspoon salt and 2 tablespoons baking soda in 4 cups of water


Jaw Pain


Jaw and facial pain is a common side effect, especially if you have radiation therapy near your head or neck. Jaw and facial pain may include pain in or around the ear, tenderness of the jaw, pain when biting or headaches.

Why Is Jaw and Facial Pain Common for Head and Neck Cancer Patients? Radiation therapy can cause inflammation and scarring around the jaw muscles. Another source of jaw pain may be a result of tooth grinding, which is often associated with stress.

What Can I Do for Relief?

Get a dental checkup and talk to your doctor about treatment options. If your jaw pain is attributed to tooth grinding and stress, talk to your dentist about treatment options, which may include muscle relaxants, exercises and anti-inflammatory medications. To relieve stiff chewing muscles in your jaw, the NIDCR recommends opening and closing your mouth as far as you can without pain 20 times. Do this 3 times a day. Consult with your dentist for more recommendations.

Patients undergoing head and neck cancer treatments may experience a heavy metallic taste. Eating with plastic utensils helps, as does avoiding certain foods (usually those with higher acid).


Infection


An infection in your mouth can present itself in different ways. According to the NIDCR, you should contact your cancer care team if you see a sore, or a sticky, white film in your mouth or if you experience swelling or bleeding.

Why Is Infection Common In Cancer Patients?

Chemotherapy lowers your immunity, causing the germs that naturally live in your mouth to increase your risk for infections or make any infections you have worse. These mouth infections can be difficult to heal and if they are serious enough they may even delay your cancer treatment. It’s important to try to prevent them from happening in the first place.


What Can I Do for Relief?

Contact your cancer treatment doctors immediately. It will also be helpful to include your dentist. Brush Your Teeth Brush your teeth twice a day with fluoride toothpaste. There are also over-the-counter products, such as fluoride toothpastes, that contain aloe vera and allantoin, which claim to be naturally soothing and gentle. Talk to your dentist about using these products. If your extra-soft toothbrush bristles are too hard, soak them in warm water to make them softer. Don’t forget to brush your tongue.

Floss Daily Flossing helps remove plaque between teeth. If your gums are sore or bleeding, be gentle and avoid those areas, but floss in between the rest of your teeth.

Rinse Your Mouth Often This will help keep food and debris off of your teeth and gums. Rinsing often, along with regular brushing and flossing, may help to reduce the chance of dental decay and infection. Rinsing is also helpful after vomiting to keep the acids from damaging the enamel on your teeth. You may also want to reduce eating citrus fruit or other high acid foods. Here are some rinsing solution ideas from NIH: o 1 teaspoon of salt in 4 cups of water o 1 teaspoon of baking soda in 1 cup (8 ounces of water) o One-half teaspoon salt and 2 tablespoons baking soda in 4 cups of water


After Treatment


After cancer treatment, you may find yourself experiencing some dental issues or simply needing a regular checkup. As you're working toward your best health, don't forget to take care of your mouth. After all, it is the gateway to the rest of your body. Here are some things to consider after completing treatment.


Visit Your Dentist

Routine check-ups and cleanings are essential, so visit your dentist on a regular basis. Due to the effects of cancer treatment, you may have moderate to severe tooth decay as a result of dry mouth since saliva (spit) is essential in rinsing the mouth of food particles and plaque. Treatment may include filling cavities, root canals, or crown and bridge work.


Brush Regularly

Brush your teeth twice a day with fluoride toothpaste. Don’t forget to brush your tongue.


Floss Daily

Cleaning between your teeth once a day with floss or another product made to clean between your teeth will help remove plaque from your teeth and gums.


Rinse Your Mouth Often

This will help keep food and debris off of your teeth and gums. Avoid rinses that have alcohol in them. Rinsing often, along with regular brushing and flossing, may help to reduce the chance of dental decay and infection.


Avoid Tobacco

Don’t use tobacco products. Tobacco is harsh on your body – especially your mouth health. Need help quitting? Stop smoking in five steps.


Eat Nutritious Foods

Eating healthy foods rich with vitamins and nutrients can help boost your immune system. Your individual nutrition and calorie needs depend on your age, gender, level of physical activity and other health factors, but according to MyPlate, a website from the Center for Nutrition Policy and Promotion, an agency of U.S. Department of Agriculture, a balanced and healthy diet should include:

  • Fruits and vegetables. Combined, these should cover half your plate at meals.

  • Grains. At least half of the grains you eat should be whole grains, such as oatmeal, whole wheat bread and brown rice.

  • Dairy. Choose low-fat or fat-free dairy foods most often.

  • Protein. Make lean protein choices, such as lean beef, skinless poultry and fish. Vary your protein choices to also include eggs, beans, peas and legumes. Eat at least eight ounces of seafood a week.


This article, along with additional links, can be found at: https://www.mouthhealthy.org/en/az-topics/c/cancer-dental-health



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