As to be expected when receiving cancer treatment, the process and everything that comes with it can consume all your focus to the exclusion of other health issues.
But these other health issues still need attention, especially when the treatment of cancer has a lasting impact on other areas of your body.
It’s something that Dr Liesl-Mari Els of Lumino The Dentists Glenfield, has experienced first-hand in her line of work and feels passionately about.
“Everyone knows someone who has been affected by cancer,” she says. “And what I am noticing is that people don’t know just how severely their oral health is affected by cancer treatment,” she adds.
On a personal level, Liesl has seen first-hand how cancer can affect one’s oral health. Her own mother suffered from cancer and so she understands how difficult this time can be in a person’s life.
Liesl says the fact of the matter is that cancer treatment has a major impact on all parts of one’s health, including oral health.
“Many treatments have side effects that impact a patient’s mouth, teeth, and salivary glands,” she says.
“I was finding patients had not been told of these by doctors,” she says.
These side effects can make it difficult to eat, talk, chew, or swallow. Patients may experience more rapid tooth decay; a burning feeling in the mouth or throat; mouth sores; and infections in the mouth.
Liesl says if your mouth is not as healthy as possible prior to cancer treatment, you may be more susceptible to infection. If the infection is serious enough, it can delay your cancer treatment.
She adds that fortunately, with good care, you and your dentist can reduce the risk of these side effects and manage them if they do occur.
Below we outline some important information around cancer treatments and oral health.
Types of cancer treatments:
- Cancer is treated with radiation (high-energy x-rays that kill or harm cancer cells)
- Chemotherapy (medicine used to kill cancer cells)
- Surgery and bone marrow transplantation (replacement of the spongy tissue inside bones that is killed or harmed by chemotherapy or radiation)
Which treatment you have depends on the type of cancer you have.
Oral health side effects of cancer treatments:
Many side effects during cancer treatment will disappear once treatment stops; however, some are longer lasting. Side effects include:
- Dry mouth
- Thickened saliva
- Changes in taste
- Mouth sores
- Tooth decay
- Difficulty swallowing
- Difficulty chewing or opening the mouth
- Infection
- Bone disease
- Inflammation or pain in the lining of the mouth and tongue
Radiation therapy can especially change the amount and consistency of your saliva. This increases your risk of dental decay. To prevent dental decay, your dentist will likely recommend maintaining very good oral hygiene and special fluoride treatments during radiation therapy. This treatment, along with a diet low in sugar, can help protect your teeth. Your doctor or dentist may also recommend exercises to prevent stiffness in the jaw.
Chemotherapy has different types of oral side effects depending on the person and the types of medicine used to treat cancer. These side effects include sore mouth and gums (eating, swallowing and talking may become hard to do), burning or swelling of the tongue, dry mouth, infection and foods not tasting the same as they usually do.
Preventing adverse effects:
Patients who have good dental health before treatment have a lower risk of developing some side effects, therefore, it is important to see a dentist at least 4 weeks before starting cancer treatment.
Ask your dentist to share details about your oral health with your cancer doctor. This way, both doctors can work together to plan your care.
Typically, you should allow at least 2 weeks for healing between dental surgery and starting cancer treatment. You should also talk with your dentist or another member of your health care team about which mouth problems you should tell your dentist about right away. If you’ve started your cancer treatment and haven’t seen a dentist, see one as soon as possible.
Regular communication with your health care team is important for preventing dental and oral side effects. During treatment, the following tips may help improve your oral health and prevent side effects:
- Gently brush your teeth 2 times a day and floss regularly. Soak an extra-soft toothbrush in warm water to soften the bristles before brushing. Try using a child-size, soft toothbrush if your regular brush is too bulky or uncomfortable. Your doctor may also give you special instructions to reduce the risk of bleeding and infection. In regards to flossing, make sure you make part of your every-day routine. Flossing daily helps to remove food that’s stuck and helps remove plaque.
- Avoid alcohol and extreme textures and flavours in your diet. Eat foods that are soft and mild. Extremely hot, cold, spicy, acidic, or crunchy foods may irritate your mouth. Watch your sugar intake. The bacteria in your mouth use sugar to live, and this process makes the acid that causes tooth decay.
- Promote good bone health. Getting enough vitamin D and calcium each day helps your jaw and teeth stay strong and healthy. Dairy products are good sources of calcium and, if fortified, vitamin D. Fortified foods are foods to which extra nutrients have been added. Examples of these nutrients include vitamin A, B vitamins, vitamin D, folic acid, iodine, and iron. Other good food choices may include fortified fruit juice and fortified breakfast cereals. Talk with your health care team before taking any supplements.
If you experience any dental or oral side effects during treatment, let your health care team know right away. Relieving side effects is an important part of cancer care and treatment. This is called palliative care or supportive care. The specific treatment your doctor recommends will depend on your symptoms. There are several common treatments for dental and oral side effects:
- Mouth rinses that contain salt and baking soda may help treat mouth sores. However, if you are taking high blood pressure medication, you may need to avoid mouth rinses with salt. There are also a variety of prescription rinses that may soothe sore spots.
- Pain medications, including narcotics, may also be used to treat pain from mouth sores. Medications may be placed directly on the sores, taken by mouth, or given through an IV.
- Antibiotics, antiviral drugs, and/or antifungal drugs are used to treat infections.
- Drinking water and sugarless drinks may help manage dry mouth. Sucking on ice chips may also help. Avoid things that will dry out the mouth, such as soda, fruit juice, cigarettes, chewing tobacco, and alcohol.
- Medications that produce saliva may help some people prevent or minimize dry mouth. Topical oral gels or other medications may help dry mouth caused by radiation therapy to the head and neck.
Liesl-Mari Els graduated from the University of Stellenbosch in 2003 with a B.Ch.D./BDS (stel). She has a special interest in general dentistry and crown-and-bridge work. Liesl-Mari loves meeting different people when at work. Her aim is to make her patients happy and feel like family at all times.