Oral Care for Chemotherapy and/or Head and Neck radiation Patients.

Chemotherapy and Head and neck radiation have a huge impact on your mouth!!!!!!

When you are diagnosed with cancer you have a lot of things to think about and what impact that the treatments will have on your teeth and mouth probably isn’t one of them.  The truth is that patients going through chemotherapy may have anywhere from slight mouth irritation to severe pain with life threatening consequences, depending on the drugs you are given.   The good news is that we can help you manage the complications and your oral health will go back to normal within a few weeks after completing chemotherapy.   If you are someone going through head and neck radiation you too may have mild to severe pain that we can help you manage.  The difference for you to know is that the radiation may destroy your salivary glands and they normally do not return to normal after your treatments have stopped and therefore lifelong management of your mouth and teeth is necessary.

If you are going through either chemotherapy or head and neck radiation please remember to visit the dentist before treatments begin.  All decay or infected teeth will need to be restored.  Ill fitting dentures and partials need to be adjusted.  Sometimes you are instructed not to wear dentures during treatment so that you don’t get sore spots and sometime they will never fit again due to tissue changes and dry mouth.  If you are going through head and neck radiation treatments you should have fluoride trays made and instructions on wearing them before treatment starts to help prevent decay. Both treatments may cause oral mucocitis, which is very sore, inflamed tissue that may require pain medicine, mouth washes and possibly stopping treatments until it heals.  After chemotherapy almost everything in the mouth goes back to normal.  After radiation, you usually end up with dry mouth (xerostomia), which causes decay, difficulty swallowing, not being able to wear dentures, and discomfort.  Lifelong fluoride and regular dental visits are essential.  Extractions after bone has had radiation should only be done if there is no other way to save a tooth.   Your dentist and dental hygienist should be able to help you manage all problems you may encounter, from pain management to fungal infections, to nutrition.  Dentist should work closely with your oncologist.

Medication is the number one cause of xerostomia, most of the medicines that you take to treat high blood pressure, diabetes, even antidepressants cause dry mouth.     Other culprits are systemic diseases such as diabetes, autoimmune diseases like Sjogren’s syndrome, head and neck radiation, alcoholism, and smoking.   Whatever the cause we want to help you manage the symptoms.

 Many of our patients develop xerostomia and the problems that come with it .  Xerostomia can be a mild nuisance or a big problem.  Xerostomia makes it difficult to chew and swallow food, makes it difficult to speak and pronounce words correctly  , makes it difficult to keep dentures in place , and causes rampant decay.   Here are some tips to treat xerostomia.

Reduce decay risk:  without saliva you are more prone to cavities, make sure to brush 2-3 times a day.  Use a fluoride rinse, neutral sodium fluoride is the best option.   If decay gets out of control we may put you on special fluoride toothpaste or make fluoride trays for you to use at home.   Eliminate sugar and citric acid from your diet.  This includes sodas and fruit juices.    Chew sugar free gum and have sugar free hard candies.  This will stimulate salivary flow.  Gums with xylitol or sorbitol will actually fight cavities.

Manage dry mouth:   sip on water frequently throughout the day.  Use mouth rinses made for dry mouth, such as Biotine, Oasis, or Act .  Never use a mouth rinse that contains alcohol because alcohol dries you out even more.  Do not use a toothpaste that contain  Sodium lauryl sulfate (SLS), which is the foaming agent in toothpaste. Most children’s  toothpaste do not contain SLS.  See if your doctor can change your medicines if possible.

Dry mouth due to radiation:  your oncologist can prescribe medicines to help with your salivary flow.  Sometimes the salivary glands are completely destroyed so reducing decay is your priority.  Chewing sugar free gum may not help with salivary flow but can still help with fighting cavities.  Good oral hygiene is essential and modify your diet.

Dentures:  if you have dentures and you suffer from dry mouth you may be more prone to sores and fungal infections.  Never wear your dentures at night, soak them in water.  Use a mouth rinse for dry mouth and spray on your dentures throughout the day. 

Biotine has a great line of defense for dry mouth sufferers.  Biotine  mouth rinse, toothpaste, gum, and a gel which is like Vaseline that you can coat your mouth with before bedtime.

I hope this was helpful. We published a full version on our facebook that you can share with anyone you think this could help.