By Susan Calderbank, DMD
Every three minutes, someone in the United States is diagnosed with cancer. Oral complications resulting from anti-cancer therapies such as chemotherapy and radiation can significantly affect morbidity, the patients' tolerance, and their overall quality of life. Is your office prepared to handle the unique dental needs of these patients?
In 1989, The National Institutes of Health had a Consensus Development Conference titled The Oral Complications of Cancer Therapies: Diagnosis, Treatment and Prevention.1 The number one recommendation of the conference was that every cancer patient should receive a pretreatment dental oral evaluation, and any potential sources of infection be eliminated before initiating cancer treatment.
Sadly, 25 years later, this recommendation is largely not followed.
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As a dental professional, you have been schooled in the concept of prevention from the first day of your professional training. When dental professionals are an integral part of the cancer management team, the treatment-induced oral side effects of cancer therapies can be greatly diminished or even prevented altogether.
To effectively treat medically compromised patients, you must first understand what these oral complications include, and then how to manage and treat them.
In healthy individuals, the most rapidly dividing cells are the lining cells of the oral cavity and the upper esophagus. However, for patients receiving chemotherapy or radiation, these normally rapidly dividing cells of the mouth do not replicate, and as they are sloughed off via regular eating, brushing, etc., the tissue becomes thinner. As the tissue thins, it may also ulcerate. These ulcerations (mucositis) are the first and most common side effect, occurring as soon as eight to 10 days following the beginning of treatment. They can affect a patients' ability to chew, swallow, and even speak.
Oral infections are also very common in cancer patients when the ability to fight infection is lost as the white blood cell count drops. Fungal infections are by far the most common, characterized by redness of the tissue, a burning sensation, and a white coating on the tongue.
Another common complication from patients undergoing radiation to the head and neck area in particular is xerostomia (salivary gland dysfunction), resulting from reduced or absent saliva flow. It can leave patients with a sore throat, difficulty eating and speaking, hoarseness, cuts around their mouth or lips, and a burning sensation in their mouth or throat. Cancer patients experiencing xerostomia are at a higher risk for infection, and may require a saliva substitute or stimulant.
Oral hygiene program
The good news is that if you develop a proper oral hygiene program with your patients, it’s possible to lower the number of microorganisms in the mouth (bacteria, fungi and viruses) and reduce the painful inflammation associated with treatment-related side effects.
It is standard practice that all patients who will be undergoing cancer therapy receive a comprehensive dental evaluation before beginning treatment. This evaluation should include a thorough history, including medication use; a full cleaning and examination to detect any potential sources of infection; the restoration of any tooth that might become infected; the extraction of any tooth which might lead to an infection; and the removal of any sharp edges on dentures, partials, and teeth.
Another important aspect of the process is patient education. During this visit, make sure the patient is aware that they should be doing the following:
- Clean your mouth every four hours and before you go to bed. If you have a lot of mouth sores, you may wish to do this more frequently.
- Brush with a very soft pediatric toothbrush, and replace it often.
- Use a gentle, fluoride toothpaste.
- Rinse as often as possible with a soothing mouth rinse like The Natural Dentist Healthy Gums™ Mouth Rinse, that doesn’t contain alcohol, harsh chemicals, preservatives, or dyes. The Natural Dentist Healthy Gums Mouth Rinse is the only product on the market with a therapeutic amount of aloe vera, proven to soothe painful mouth irritations.2
- Avoid alcohol and tobacco products.
- Avoid crunchy and spicy foods, as well as citrusy drinks like orange juice.
- Don’t eat or drink food or beverages that are hot and can potentially burn your mouth.
- Examine your mouth every morning and night for changes.
Let the patient know that they should schedule frequent appointments during their cancer treatment (often times weekly) to prevent infections and enable you to troubleshoot areas before major symptoms develop.
Caring for patients undergoing cancer therapies requires confidence, knowledge, and compassion. By playing an active role in their therapy, you can help decrease the cost of their care and increase their quality of life.
Dr. Susan Calderbank, DMD, is an associate professor of oral medicine at the University of Pittsburgh School of Dental Medicine who operates her private practice in Greenville, Pa. She served on the Pennsylvania State Dental Board for 13 years and was the first female chairman in its history, and she holds fellowships in the Pierre Fauchard Society, the International College of Dentists, and the American College of Dentists. In April of 2003, Dr. Calderbank received a Special Public Service Award from the Pennsylvania Dental Association in recognition of her commitment to raising awareness of the oral complication of cancer therapies. She is also on the Professional Advisory Board of Breastcancer.org and is an active lecturer in the area of oral health as it relates to cancer therapies.