Many adult cancer patients are surprised to learn that cancer treatments, such as chemotherapy and radiation therapy, can affect the mouth, teeth and gums.

Why: These therapies slow the growth of healthy cells in the mouth—impeding its ability to heal—as well as weaken the immune system and reduce the number of white blood cells that help defend against disease, making patients more prone to developing mouth infections.

Some patients may already have an abnormally low level of white blood cells due to their specific type of cancer (such as leukemia), making oral care particularly important.

Cancer treatment may also cause changes in the lining of the mouth and in the salivary glands, which can lead to xerostomia (dry mouth)…mucositis (inflammation of the mucous membrane in the mouth)…tooth decay…changes in taste…and generally painful mouth and gums.

According to the National Institute of Dental and Craniofacial Research, oral complications occur in almost all patients who receive radiation for head and neck cancer…in up to 75% of blood and marrow transplant recipients…and in nearly 40% of patients who receive chemotherapy for any type of cancer.

Most of these oral complications subside soon after treatment ends. However, high-dose radiation for head and neck cancer can cause lasting or permanent damage in the tissue of the mouth and the jawbone.

Example: A patient with a history of high-dose radiation to the head and neck who must undergo dental surgery or dental extraction has a risk of developing osteoradionecrosis, a rare and potentially severe complication that results in the death of bone tissue.

The good news: Oral care before and throughout cancer treatment can reduce or even prevent some of these complications.

TO MINIMIZE RISK FOR ORAL COMPLICATIONS

You can minimize your risk of developing oral complications from cancer treatment by receiving appropriate dental care and practicing good oral hygiene before, during and after treatment. What all cancer patients should do…

  • Discuss your risk for oral complications with your cancer doctor. He/she may suggest that you get a complete dental evaluation from your dentist or from a dental oncologist (a dentist who is trained in dental and oral care for patients with cancer).

    To find a dentist who is trained in treating cancer patients, ask your cancer doctor or check with other reputable resources, including the National Cancer Institute (800-422-6237, www.Cancer.gov).

    Your cancer doctor may want to discuss with the dentist your treatment plan and any potential oral complications that may arise.

  • Get a complete dental evaluation prior to your cancer treatment. Your dentist will do a thorough examination of your mouth, teeth and jawbone to identify potential problems that may arise during treatment. During your visit, discuss your risk for oral complications.

    Important: If your dentist has identified teeth that might become problematic during or after cancer treatment, make sure that these issues are addressed at least one month prior to the start of chemotherapy to provide enough time for your mouth to properly heal before treatment begins.

    If tooth extraction is required, wait at least two weeks or until adequate healing is accomplished before beginning cancer treatment.

  • Practice good home care. Oral hygiene during and after treatment can reduce your chances of getting mouth sores, infections and tooth decay. Brush your teeth after every meal and at bedtime using a soft toothbrush and fluoride toothpaste. 

    If you are receiving high-dose radiation to the head and neck, prescription-grade toothpaste is recommended, such as Colgate PreviDent 5000 Plus, which has more fluoride than regular toothpaste. Floss once a day to remove plaque. 

    Your dentist may recommend a fluoride mouth rinse in addition to daily brushing or a fluoride gel to reduce the chances of getting tooth decay.

  • Keep your saliva up. Saliva has antibacterial properties. Best: Keep your mouth hydrated with water.
  • Follow your oral-care plan throughout your treatment and recovery. In addition to getting regular dental checkups and practicing good oral hygiene, patients with a history of treatment for head and neck cancer should be evaluated by a dental oncologist at least twice a year even after treatment ends.
  • Take a moment every day to check your mouth for any changes or problems. Notify your dentist immediately if you notice swelling, lumps, soreness, ulcerations, bleeding or a sticky, white film in your mouth, which may indicate infection.
  • Eat a healthful diet to prevent tooth decay. While tooth decay is not a result of chemotherapy or high-dose radiation, dry mouth can increase risk for tooth decay. Avoid eating foods high in sugar. You may want to eat softer foods if your mouth is sore.

Alcoholic beverages should be avoided during treatment. If you smoke, it is especially important to stop during cancer treatment and to try smoking-cessation strategies as soon as possible.

Bonus: A well-balanced diet can keep you strong enough to endure cancer treatment and help your entire body to heal.

  • Use the “Popsicle technique.” To prevent mouth sores from developing, some oncologists recommend sucking on a sugar-free Popsicle or eating ice cubes or ice chips while chemotherapy is being administered. Ice not only acts as an anesthetic but hydrates as well.