Prevention and Management of Oral Complications for Cancer Patients 

Last week I talked about several oral complications that can occur with cancer treatments.  Today, I would like to share some tips on how to minimize these concerns if you or a loved one is ever faced with the need for cancer therapy. 

What can be done to keep a mouth healthy during chemotherapy?

Patients can do a lot to keep their mouth health during chemotherapy.  As I mentioned last week, the first step is to see a dentist before the cancer treatment starts!  One treatment begins, it is important to look in the mouth every day for sores or changes that may occur.  To help prevent and treat a sore or dry mouth, keep the mouth moist.  To do this, the patient should drink a lot of water, such on ice chips, use sugarless gum or sugar-free hard candy and utilize a saliva substitute (Yes, they really do have “fake saliva” and it works very well).  Mouthwashes that contain alcohol should be avoided since this will increase the dryness of the mouth even more.

Since the mouth is decay prone during and often after cancer treatment, thorough home care that includes brushing and flossing is critical.  If brushing hurts, soften the bristles in warm water first.  If your gums bleed, avoid flossing the areas that are bleeding, but keep flossing the other teeth. Your dentist can fabricate custom fitted trays for daily fluoride application to minimize the risk of decay.

If your mouth is sore, watch what is eaten.  Good nutrition is vital for overall health and foods should be chosen that are easy to chew and swallow.  If there is trouble swallowing, soften the food with sauces, broth, yogurt or other liquids.  Sipping liquids with a meal will make eating easier.  Stay away from sharp, crunchy foods that could scrape or cut your mouth.  Also avoid foods that are hot, spicy or high in acid like citrus fruits and juices that can irritate your mouth.

If pain in the mouth persists, topical anesthetic rinses or pain medications may be used.  Needless to say, sugary foods, alcoholic drinks and all tobacco products should be avoided.  To prevent decay, the use of home fluoride is highly advisable.  Your dentist can fabricate fluoride trays that will “bathe” the teeth in fluoride on a daily basis to help minimize the ravages of the disease.  A patient should rinse their mouth with a water and baking soda solution to neutralize acidity if vomiting is a problem.  

What about radiation of the head and neck?

In addition to the above, patients receiving radiation therapy to the head and neck are at high risk for developing other oral complications.  Following treatment, there is a decrease in blood supply to the field that is irradiated.  If after treatment there is a need to remove a tooth in this area, the bone may not heal properly and could “die”.  Because of this, the oncologist may recommend removal of questionable teeth in the proposed radiation field before treatment begins.  Pain or difficulty in moving the jaws also may occur.  Patients should exercise their mouth three times a day by opening and closing the mouth as far as possible, without pain, twenty times.  This will assist the muscles in maintaining strength and flexibility.  Often, there is a loss of taste sensation.  A nutritionist can be consulted for ideas that can help with this concern.

Is there a concern with Bone Marrow transplants?

Most bone marrow transplant patients develop acute oral complications.  As with chemotherapy and radiation, a pretreatment evaluation by a dentist is highly recommended.  Infections of the tongue and soft tissues of the mouth are common.  Herpes simplex and Candida albicans (thrush) are oral infections that typically occur.  Elective oral procedures should be delayed for at least a year.

I hope and pray that you or no one you love ever has to face the threat of cancer, but if like many you do, I hope these tips can help.