Of the 1.2 million Americans diagnosed with cancer each year, approximately 400,000 will develop oral complications from their treatments. (Source: ACS)
While eliminating oral complications is not possible, the goal is to educate and prevent severe levels of stomatitis, and mucositis which will prevent the completion of treatment or lead to infections that can spread via the bloodstream through a cancer patient’s already compromised immune system.
Oral Side Effects of Cancer Treatment:
Stomatitis/ Mucositis: or an inflammation of the oral mucosa, evidenced by red and swollen mouth and or throat and may include ulcers. While they are generally the same thing, mucositis is caused by chemo/radiation therapy and stomatitis is caused by other sources. Some differentiate and consider mucositis to include the entire mucosa of the digestive tract. Other call mouth ulcers stomatitis.
Dental Caries and Gingivitis: Cancer patients are considered to be at high risk for dental decay and infection, bleeding and or red gums during and after treatment.
The National Cancer Institute recommends that cancer patients complete dental work two to four weeks before treatment and they should advise their dentists of their treatments plans. Future dental treatment should be evaluated based on your recovery and the status of your blood counts to prevent infection.
Good dental practices before and after cancer treatment-
- Change your toothbrush often and keep it in a dry place.
- Brush your teeth with a soft bristle toothbrush at least every four hours.
- Use a mild toothpaste and rinse. Note that some may contribute to nausea.
- Floss gently using care not to touch the gum line when your blood counts are low
- Avoid foods that contribute to dental decay such as sugary bevaerages and chewy candy
Oral Care Preventive Practices-
- Rinse your mouth thoroughly after brushing using a baking soda and salt rinse.
- Inspect your mouth and tongue every four hours for red spots that indicate an ulcer or white patches that may indicate a candidiasis (thrush) infection.
- Keep your mouth moist by sipping on non sugar beverages.
Most oral problems will resolve within two to four weeks of the completion of treatment, however to avoid the discomfort and prevent complications consider the following steps:
- Avoid hot, spicy foods that may irritate mucosa
- Avoid alcohol including mouthwashes with alcohol
- Refrain from smoking which will dry and irritate the mucous membranes
Most hospitals have an oral “cocktail” that is prescribed in a swish and swallow or swish and spit manner which may include an analgesic for pain, and an antacid to coat the mucosa and/or an anesthetic to numb. This is given prior to meals so the patient can tolerate food.
Your physician may also order a painkiller and or an antibiotic.
A note on candidiasis or oral thrush:
You may notice curd like white patches in your mouth or on your tongue. Scraping them reveals red and inflamed tissue. A compromised immune system due to chemotherapy may have created a perfect environment for this infection. The goal is to eliminate and prevent a systemic infection.
Your physician may order an antifungal medication and a medicated oral rinse. He will no doubt want you to continue your diligent oral care.
National Cancer Institute: Management of Oral Complications During and After Chemotherapy and/or Radiation Therapy
American Dental Association: Oral Care for Cancer Patients
Clinical Trials . Gov: Current Clinical Trials Involving Mucositis and Stomatitis