Oral health related to oncology

Being a cancer patient is already daunting with a long journey of treatment and recovery. Oral side effects don’t have to be an additional burden. Oral hygienist, Sarie Liebenberg, enlightens us.

Effects of chemotherapy

Chemotherapy affects rapidly dividing cells. These include cells of the lining of the mouth, gastrointestinal tract, bone marrow- and hair cells. Chemotherapy can’t differentiate between normal and malignant cells and sometimes injures both. It may lower your white blood cell-, platelet- and red blood cell count, known as marrow suppression. This increases the risk for infection and/or bleeding. 

Infection may become worse if there are pre-existing dental infections, such as cavities, abscesses or periodontal (gum) disease. 

Dry mouth (xerostomia) can develop when salivary glands are damaged by chemotherapy. Saliva volume decreases and consistency thickens. Therefore, the protective buffering capacity decreases, allowing oral bacteria to proliferate. This contributes to a higher risk of dental decay. 

Decreased blood supply to the bone can cause bone infection, especially with extractions. The result is slow-healing or no healing at all. 

Thus, preventative dental care is of utmost importance in the oncology patient.

Check-up before treatment

Before a patient begins chemo, it’s advisable to identify potential sources of dental infection. Especially when extractions are required and sufficient time for healing is needed. 

A professional dental cleaning and restorations of cavities or unsound existing fillings will reduce and/or eliminate causes for additional pain and discomfort. This will ensure an optimal environment for healing. 

Your dentist/hygienist will suggest a treatment plan regarding follow-up visits and a daily dental home care routine. Because of the reduced saliva flow and therefore higher risk of decay, this might include using fluoride in custom-fit fluoride trays, in addition to your brushing and interdental (between the teeth) care.

Dos and don’ts 

During chemotherapy, the patient needs to follow a balanced diet low in sugar. Brushing with a soft toothbrush is recommended. Dentures should ideally only be worn while chewing. Rinse with salt water after meals and avoid rinses containing alcohol. Antibacterial and antifungal rinses should be used at least one hour apart. 

Nicotine, alcohol and caffeine are contributing factors for dry mouth. Rehydrating spray/gel can be used to relieve the dryness. Drink plenty of water. Sugar-free chews/lozenges are a great help, as is lip balm for dry lips. 

If eating is very painful, a topical anaesthetic can be used or pain medication can be taken 30 minutes before a meal. Avoid non-steroidal medication, like aspirin, ibuprofen and naproxen.

Seek professional dental advice if pain in the mouth increases and you’re unable to eat/drink because of mouth sores, battle to control bleeding, or find swallowing difficult.

Oral care after treatment

After chemotherapy, it’s important that the patient continues practicing good daily oral hygiene care. This must include fluoride applications and professional cleanings every three to four months or as advised by your dentist/hygienist. This will depend on individual dental needs. 

Any invasive dental treatment, like extractions/dental surgery, should be discussed with your oncologist, especially when bisphosphonates drugs is/was taken, which increases the risk of osteonecrosis (death of bone cells). 

After radiation to the head and neck, there will be a lifelong risk for osteoradionecrosis (bone death due to radiation).

If dry mouth persists, use products to substitute saliva. Sip water regularly and have sugar-free chews/lozenges often. Avoid alcohol, caffeine, nicotine and foods dry in texture. There might be a decrease in taste sensation. Use more herbs and less spices and salt. 

A liquid food supplement might be a good idea.

Can I go to the dentist during COVID-19?

The answer is a definite yes. Dental professionals are trained to prevent the transfer of bacteria and viruses. 

Not only do they have adequate protective measures to prevent the transfer of bacteria and/or viruses from one person to another. But, we also have the knowledge and understanding not to cross contaminate our working environment. Ultimately, the environment that you are treated in.So, with relation to contracting the COVID-19 virus, it’s probably safer to go to the dentist than to the supermarket.