Cancer and Oral Care

Cancer and oral care

Cancer is renowned for the devastating effect it can have on the human body but what most people don’t know is that cancer and the subsequent treatments can also have a serious impact on a person’s oral health.

Immune system

White blood cells produced in bone marrow are responsible for strengthening the immune system and in turn, fighting infection. During chemotherapy the production of white blood cells slows and, in some cases, stops which can weaken the immune system and cause fatigue.

Cancer can also lead to a platelet deficiency. This is a cause for concern as platelets are responsible for clotting blood and essential for the prevention of infection as the stoppage of blood at an injury site creates a barrier, preventing the opportunity for infection to spread throughout the body. If unusual bleeding and bruising is encountered throughout cancer treatment, contacting your health care professionals is recommended.

It is important to know that the drugs used to treat cancer can also harm healthy cells including the cells in the mouth. Oral complications can arise due to reduced immunity however the severity may differ from case to case. The severity is dependent on the type of cancer, how the body reacts and an individual’s oral health prior to commencing treatment.

Common oral complications from cancer treatments

  • Dry mouth, thickening or stringy saliva.
  • Painful mouth and gums.
  • Sores, ulcers, infections.
  • Changes in taste, metallic taste and loss of appetite.
  • Inflammation of the mouth, burning, peeling swelling of the tongue.
  • Difficulties eating, swallowing, talking.
  • Tooth decay and gum disease.
  • Problems in the mouth and jaw caused by loss of tissue or bone from surgery.

How your dental team can help with oral care

Before cancer treatment starts it is of value to see both a dentist and a hygienist. They will examine the soft and hard tissues in your mouth, take x-rays to look for decay and clean the teeth. Along with this, time will be spent discussing how to manage oral health. Your dentist and/or hygienist will also provide advice on which products to use and tips for preventing or minimising side effects from cancer treatments. This is important as it will help prevent serious mouth problems from developing. Not all side effects from chemotherapy or radiation treatments can be avoided but dental professionals can help reduce the discomfort and severity. Prevention and control of side effects where possible is important throughout cancer care.

Preventing problems

  • Brush and floss teeth and gums well with an extra soft toothbrush or soft oscillation electric toothbrush.
  • Keep the mouth well hydrated by drinking plenty of water.
  • Suck ice chips or sip water.
  • Chew a sugar-free gum to increase natural saliva into the mouth.
  • Avoid using toothpastes and mouth rinses (eg: Listerine) that contain alcohols and detergents as they have a drying and often burning effect.
  • Use dry mouth products that will help moisten the mouth. Ask your Dentist or Oncologist for recommendations.
  • Keep dentures well brushed. Soak in denture solution when not in the mouth. See your dentist if dentures are not comfortable or fitting.
  • See a dentist regularly to check your mouth and clean your teeth.
  • Stop all use of tobacco products and alcohol as they slow the recovery and increase chances of secondary cancers.
Saliva is important

Saliva is vital to oral health as it carries hundreds of good bacteria that fight infection.  Saliva is also responsible for the start of food digestion before it gets to the stomach. When there is a lack of saliva, the soft tissues like the tongue and cheeks dry out and can stick together. This often happens during the night while asleep. When tissues are pulled apart small cells are torn away leaving a small opening in the tissues where bad bacteria in the mouth can enter and cause a small sore or ulcer.

Decay and gum disease can also be an issue when there is a lack of saliva as saliva dilutes plaque acids in the mouth. During cancer treatments excellent oral hygiene techniques to clean your teeth and gums are vital routines that need to continue to avoid dental disease.

Dry mouth treatment

Rinse and gargle first thing in the morning with a solution of ¼ teaspoon of salt to a cup of warm water or 1 teaspoon of baking soda to a cup of warm water. Warm salt solutions act as natural antiseptics. The isotonic solution helps rehydrate soft tissues and can gently work to remove bacteria from small infected areas. These rinses can be used as often as needed or every 2 hours to decrease soreness.

Use of dry mouth products designed to moisten the mouth and strengthen your teeth against decay is recommended. There is a large range of dry mouth products available, including but not limited to toothpastes, rinses, gels, chewing gums and sprays. Avoid any products that contain sodium lauryl sulphates, detergents and alcohols as they are drying and cause irritation to the oral tissues.

After eating, ensure teeth and gums are brushed and flossed. When brushing, a soft brush and dry mouth toothpaste with fluoride is recommended. Common brands include Bioteen and Oral 7. They help lock in moisture and reduce the dryness.

XyliMelts are another option for persistent dry mouth. These small oral discs stick on to the teeth or gums. They last for hours and can be used during the day or night moisturising and coating the mouth for comfort.  They also have a mild mint taste that will help freshen breath.  A natural sweetener is added called xylitol which also helps stimulate saliva and starve plaque bacteria from causing decay.

Protecting your lips by using moisturising lip care products, such as lip balms with lanolin will also help prevent drying and cracking.

Drink or sip plenty of water during the day. Chew a sugar free gum or dry mouth gum product to generate natural saliva flow.

Sore mouth treatment
  • Choose foods that are nutritious and moist and easy to chew and swallow. Scrambled eggs, mash potatoes, pureed vegetables, cooked cereals.
  • When swallowing is difficult, take small bites and chew slowly, sip liquids with meals, soften foods in sauces or gravies, sip broths, have yogurts.
  • Use mouth rinses and gargles after eating as a way of removing food particles and moisturising and reducing mouth acids.
  • If you are unable to brush use gauze dipped in warm salt water to gently wipe away plaque and food before applying topical medicines.
  • Pain relief may work if topical medications do not. Avoid aspirin-based painkillers as they increase the risk of bleeding.
  • If pain or irritation persists in the mouth see a Dentist or Oncologist.
Food and drink to avoid
  • Hot, spicy, acidic foods, citrus fruits and juices irritate the mouth.
  • Sugary foods, lollies, soft drinks as they can cause decay.
  • Dry, sharp and crunchy foods, chips, corn chips, crusty breads, crackers, can scrape or cut the mouth.
  • Tough meat, can be difficult to chew and sore to swallow.
  • Alcohol.
Following treatment

Taste, appetite and saliva will generally return slowly after completion of most chemotherapies however cancer and associated complications can affect each individual differently. It is important to keep in regular contact with health care professionals to address persisting complications and seek support where necessary throughout treatment.

Cancer Council Australia   Phone: 13 11 20

Compiled by: Vivienne Bidaud, The Health Hub Dental Hygienist

References.

https://www.cancer.gov/about-cancer/treatment/cam

https://www.nidcr.nih.gov/sites/default/files/2017-09/chemotherapy-and-your-mouth.pdf

https://blog.dana-farber.org/insight/2015/06/young-adult-shares-tips-for-coping-with-cancer/