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Taking the Bite out of Oral Complications

by Theresa Hofstede, DDS

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People receiving cancer treatments are at risk of developing oral complications. The most common include oral ulcers, infection, dry mouth, and changes in taste. The type and severity of these problems differ with the form and intensity of treatment. Appropriate oral care before, during, and after cancer treatment can help minimize complications.

Oral ulcers (mucositis) are common complications of chemotherapy, and logical steps can be taken to minimize these challenges. Before chemotherapy, it is wise to treat sources of oral infection. Teeth may need to be pulled if an abscess (pus or infection) is present, or if the tooth is loose or broken. Teeth should be professionally cleaned to remove plaque and tarter and reduce bacteria. Conditions that could injure the inside of the mouth (sharp teeth, orthodontic bands, poor-fitting dentures) should be removed to help reduce ulcers. Try to avoid spicy and coarse food items.

During chemotherapy, it is important to maintain oral hygiene by brushing with a soft toothbrush and carefully flossing between the teeth after meals. Frequent rinsing will help clean, lubricate, and soothe the tissues and reduce microbial buildup. Common rinsing solutions include saline (½ tsp. salt in 8 oz. water) or a neutral rinse (¼ tsp. salt and ¼ tsp. baking soda in 1qt. water).

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Dr. Theresa Hofstede

Mucositis that develops should be evaluated by your cancer doctor. Various topical rinses can be prescribed to reduce discomfort and infection. Appropriate treatment for oral ulcers can prevent infection with bacteria, viruses, or fungus.

Individuals who wear dentures or removable partial plates should minimize their use during treatment to reduce frictional irritation and ulcers of the gums. If you wear dentures, you should thoroughly clean them twice daily and remove them while sleeping.

Routine dental care (fillings, cleanings, crowns) should be completed with caution during cancer therapy. Ideally, this should be done before or after active treatment. During cancer treatment, the oral tissues are susceptible to abrasion and infection. Even simple dental treatment can scrape the oral tissues and create ulcers and infections. Emergency dental treatment during cancer therapy must be carefully coordinated between the dentist and the cancer doctor.

Taste changes are a common side effect of chemotherapy and radiation therapy to the head and neck. These changes can be caused by oral ulcers, reduced saliva flow, or changes in the oral microbial balance. This problem may be unavoidable; however, consuming softer foods with various flavors and increasing liquids may improve taste. Some people may even start to enjoy foods that they previously avoided. In many cases, taste sensation slowly returns to normal after cancer therapy is completed.

Radiation Therapy
Multiple oral side effects are possible after radiation therapy to the head and neck region: dry mouth, cavities, infection, and exposed bone. Dry mouth is a very common side effect of radiation therapy to the head and neck because it affects the salivary glands that are within the treatment field. Dry mouth often lasts beyond the treatment. A dry mouth may create difficulty with taste, chewing, swallowing, infection, ulcers, more dental cavities, and difficulty wearing dentures. However, a number of dry mouth rinses and artificial saliva can be used on a regular basis to moisten the mouth. Many people sip on water or sugar-free drinks or chew sugar-free gum to help moisten the mouth.

Teeth are more susceptible to developing cavities in a dry mouth. Regular steps must be taken to prevent the deterioration of the teeth. It is important that any drinks, gum, or candy used to moisten the mouth do not contain real sugar, or the teeth will develop cavities quickly. Sugar-free products should be used instead of real sugar. Daily brushing, flossing, and fluoride treatments are necessary to prevent cavities. After the cancer treatments are completed, it is also important to have regular checkups with a dentist, routine dental cleanings, and to have cavities filled promptly.

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Dr. Theresa Hofstede is an assistant professor of Oncologic Dentistry and Maxillofacial Prosthodontics at The University of Texas MD Anderson Cancer Center in Houston, Texas.

This article was published in Coping® with Cancer magazine, May/June 2010.