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Dental Considerations for Patients Undergoing Cancer Therapy

The 4th of February is World Cancer Day. According to Cancer Australia, the estimated number of new cancer cases diagnosed in 2017 was 134,174. The aim of this article is to provide dental guidance for our patients to help them through this difficult phase in their lives.

Cancer treatment does not only affect the targeted cancer cells but normal cells throughout the body including the mouth. Some of the resulting oral side effects are significant and include:

1. Oral Mucositis which is  characterized by mouth pain, ulcers,  bleeding, difficulty swallowing and breathing. The presence of these symptoms can be debilitating, and may affect eating and therefore nutrition leading to a decline in health. In it’s worst form, mucositis may lead to delay of cancer therapy, which may affect treatment outcomes.

2. Xerostomia or dry mouth characterised by ropey saliva, sticky sensation, less saliva, chapped lips, bad breath, to mention but a few.

 3. Oral thrush or Fungal infections which result in red or white patches throughout the mouth- these are painful too and eating may be affected.

4. Neurosensory changes which result in altered taste.

5. Rampant tooth decay

6. Trismus or limited jaw opening as a result of muscle spasm.  This is more associated with head and neck radiation therapy. 

Recent advances in cancer therapy has significantly increased the survival rates in some cancer types, necessitating the need to maintain optimum oral health before, during and after cancer treatment.

Once a cancer diagnosis has been received, a consultation with the dentist for assessment of dental health and implementation of basic oral care prior to commencement of cancer treatment is recommended. Treating clinicians (oncologists and dentists) should remain vigilant to recognize oral complications in their early phases.
Prior to commencing cancer treatment, patients should have their teeth professionally cleaned, which may help to reduce the severity of mucositis. Small decay lesions may receive fluoride and temporary fillings until definitive treatment can be completed. Extraction of teeth with poor prognosis due to periodontitis (advanced gum disease), those causing pain or infection, and those at risk of causing infection should be done about 2-3weeks before commencement of cancer treatment.  

Basic oral care includes preventing infection, treating active infection, controlling pain, maintaining oral function, managing oral complications, and improving quality of life.

Basic oral care guidelines:

  • Brush twice daily, with an ultrasoft toothbrush and a fluoride toothpaste.
  • Rinse with a fluoride containing mouthwash. Avoid alcohol-containing mouthwashes. Alternatively make-up your own mouthwash: 1 teaspoon salt, 1 teaspoon bicarbonate of soda, 1litre of water. Discard the solution at the end of the day.
  • Floss gently, before tooth brushing and avoid using wooden toothpicks.
  • Rub a high fluoride containing gel eg neutrafluor 5000ppm gel paste onto the teeth, and don’t rinse it off
  • If xerostomia is present, sip tap water (contains fluoride) through the day and chew xylitol, sugar free gum. If xerostomia is severe, the dentist will recommend other products, including Biotene products readily available in most pharmacies.

Once cancer treatment is complete, more frequent professional cleaning visits are recommended.