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Cancer and Your Mouth

Many of the articles that I write for this newspaper are a result of patient interactions that I have had. The topic today is derived no differently than those before. Cancer is a daily part of some people’s lives and only a distant concern for others. However cancer’s effects on society are widespread and ever increasing. This makes the following discussion relevant to most readers.

In the last month I have become aware of how little is known about dental health and how it relates to the various cancer treatments. Today dentists screen patient’s mouths for oral cancer. In our office we perform biopsies on suspicious lesions to obtain a definitive diagnosis. When a lesion comes back positive for cancer we inform, educate, and refer our patients to the oncologist. Patients that come through the dentist receive a dental prospective on their oral health and how it will be affected by the subsequent treatments.

Most patients receive their diagnosis through other avenues ( OB/GYN, Gastrologist, Pulmonologist, and Dermatologist) and do not receive dental education. Most medical practitioners do not really consider the oral cavity when treating cancer, but should. All forms of cancer are managed best by a team of health care professionals. The primary members of the team will be pathologist, radiologist, surgeons, radiation oncologist and medical oncologist. Secondary team member might include a general dentist, dental hygienist, along with nurses and other specialists.

Any time a patient has to receive chemotherapy or radiation therapy, they need to know the side effects. The side effects of chemotherapy and head and neck radiation can make it hard to eat, talk, or swallow which can delay or stop treatment. The potential oral side effects for cancer treatments include: dry mouth, cavities, risk of infection, loss of taste, sore mouth and gums, jaw stiffness, and loss of tissue and bone.

There are some very simple tips that people need to know when they are told that they have cancer and will need chemotherapy or radiation of the head and neck. See a dentist at least 2 weeks before beginning treatment. This simple act alone can help prevent serious complications. Many side effect of cancer treatment are a result of a person’s mouth not being healthy before treatment starts. If oral complications such as infection occur they may cause you to have to delay or stop treatment. Therefore it is important to see your dentist before you start therapy in order to bring oral health up to an optimal level.

Make sure that your dentist has your cancer doctor’s phone number. This enables your dentist to talk to your cancer doctor about your chemotherapy or radiation and help manage your oral health. When you see the dentist, he or she, will take a detailed medical history, including the diagnosis of cancer and the purposed treatment. The type and location of your cancer affects the risk to oral tissues. They will check your teeth, take necessary x-rays, identify oral health problems, develop a plan to restore mouth to optimal health, and educate you on how to take care of your mouth to prevent side effects of cancer treatment.

If you have infected teeth or gums you may need root canals, extractions, or periodontal therapy in order to rid your mouth of apparent infections. Teeth that have cavity or existing faulty restorations may need to be restored knowing that your potential caries risk after cancer treatment will be higher.

In some cases of head and neck cancer where large doses of radiation are used for treatment, we prophylacticly remove all teeth including good teeth with in the field of radiation. This is done because the radiation damages the blood supply to the bone around the teeth making it impossible to heal the extraction site if a tooth had to be removed. Often times this results in losing all or part of your jaw as well.

Missing teeth may also have to be restored to aid in eating food and keeping your weight up since having a complete set of teeth helps in chewing food to ensure complete digestion. Chemotherapy affects your appetite, taste glands, and your entire digestive track causing patients to lose weight. Furthermore, cancer therapy causes patients to feel horribly sick, and lose all their hair. By replacing missing front teeth, restoring their smile, keeps spirits up and fosters a positive attitude which are both critical to treatment success.

There are times when all the necessary or desired treatment cannot be delivered before cancer treatment has to start. In these cases I consult with the oncologist and obtain permission and timing to perform SIMPLE treatments such as fillings, dentures and possible cleanings. Cancer therapy will affect white blood cell counts to the point where it maybe unsafe to work on a patient. Things are carefully scheduled with the oncologist so safe treatment can be rendered.

Lastly your dentist should develop a home care and recall system to keep your mouth healthy while you undergo treatment. Brush your teeth at least two times a day for two minutes with an extra soft toothbrush using fluoride toothpaste. If the bristles still feel hard soften them in hot water. Do not forget to brush your tongue. Brush your teeth an additional two times a day for two minutes using a neutral fluoride gel. Do not use mouthwash with alcohol in it. The alcohol can burn already fragile gum tissue. Instead use a solution of ¼ teaspoon baking soda and 1/8 teaspoon of salt in one cup of warm water, and follow with a plain water rinse. If you have not made flossing part of your daily routine, this is the time. You may have only two weeks to get your gums in shape.

Tips for preventing a sore mouth and gums include: drinking a lot of water, sucking on ice chips, using sugarless gum or candy, using saliva substitutes, and KEEPING YOUR MOUTH CLEAN. Denture wearers should have their dentures checked for possible problems. An ill-fitting denture can cause sore spots that may pose risk to infection and delay treatment. Remember to brush your denture (mild soap not toothpaste) and keep it clean as well.

You will also need to watch what you eat. Choose foods that are nutritious and easy to chew and swallow. Take small bites of food, chew slowly and thoroughly. Sip liquids while you eat to help moisten your food. Cooked cereals, mashed potatoes, scrambled eggs and yogurts are all good food choices. Do not be afraid to talk to a dietitian about ideas of what to eat. You may be on cancer treatment for a long time, new ideas are always appreciated. Remember to stay away from sharp crunchy foods such as tortilla chips that may cut or scrape your gums. Foods that are spicy or acidic like citrus fruits can cause painful ulcers and, of course, stay away from sugary foods that can cause cavities. Avoid all tobacco products and alcohol (the combination of which increases your chances of oral cancer twenty five times).

These are obviously gross simplifications of what oral effect cancer treatments have on patients. Each case is very specific to the cancer, its location, and the individual patient. It is always best to ask your doctors. Remember that cancer therapy is a long hard road; going into it with a positive attitude and a healthy smile makes it go a little better. I would like to give special thanks to all my patients current and deceased that have shared their plight with cancer.

If you would like to know more about the effect of cancer treatment on the mouth or if you would like to meet Dr. Seume and his staff at Hitchcock Dental please call 409-986-6018.

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