Oral Health During Cancer Treatments

There’s a six-letter word that no patient wants to hear their doctor say during an appointment: cancer. However, up to 50 percent of people in Canada will receive a cancer diagnosis in their lifetimes. In 2017, more than 206,000 Canadians were diagnosed with some type of cancer.

One reason why so many people in Canada might receive a cancer diagnosis at some point in their lives is that people are living longer. Population growth in the country also plays a role in the increase of diagnoses.

It’s important to understand that for many patients, cancer isn’t a death sentence. From 1988 to 2017, the number of people who died as a result of cancer decreased. About 60 percent of people will survive for at least five years after diagnosis, and just 25 percent of people die from cancer.

Cancer treatment can have side effects that affect other areas of the body, including the mouth. After receiving a cancer diagnosis, there are things you can do to improve your quality of life and reduce side effects in the mouth and elsewhere.

What Is Cancer?

Before looking at the effects cancer can have on the mouth and the ways you can maintain oral health, it’s helpful to understand what cancer is, why it develops and who it affects.

Although the word cancer is often used as a catch-all, there are more than 100 separate cancers, and depending on the classification system, more than 200 different types of cancer. Cancer develops when the cells in the body stop dividing and copying themselves in the usual way. It’s normal for cells to die after a certain point. In the case of cancer, however, cells that should die continue to live, and cells that should stop dividing continue to divide.

The constantly dividing cells often form tumours or growths. Not all types of tumours are cancerous, but the ones that are can spread to other areas of the body. The earlier a cancer is detected and diagnosed, the better the prognosis, as a doctor will most likely be able to remove all of the cancer cells, eliminating the risk that cancer will spread to other areas of the body.

Cancer Treatments

Multiple treatments for cancer exist. The type of treatment a doctor recommends to a patient usually depends on the type of cancer the patient has and the stage of the disease (how advanced it is). A patient’s age and personal preferences also help to determine the type of treatment that is most appropriate.

Some of the most common treatments for cancer are:

  • Surgery. A doctor might perform surgery as a preventative measure, removing tissue that has a chance of developing into a malignant tumour. Surgery can also be performed to remove cancerous cells.
  • Chemotherapy. Chemotherapy involves the use of drugs that will kill cancer cells. Often, a patient undergoing chemotherapy will receive a cocktail of drugs to improve the chances of success.
  • Radiation therapy. Radiation therapy involves the use of high levels of radiation energy to damage cancer cells, ultimately destroying them. The most common type of radiation therapy is external. During external radiation therapy treatment, a beam of energy is targeted at a tumour or cancer cells. A different kind of radiation is internal, which involves placing an implant inside the body, near the location of a tumour.

Cancer treatments might be performed on their own or together. For example, it is not uncommon for a cancer patient to undergo both radiation and chemotherapy.

Side effects can occur during treatment for cancer. Although the goal of chemotherapy and radiation therapy is to target the cancer cells, the procedures can also sometimes affect otherwise healthy cells in the body. In some cases, cells in the mouth can be affected, leading to side effects such as inflammation of the mucous membranes and mouth sores.

For that reason, patients who are receiving treatment for cancer are usually advised to work closely with their dentists to help protect their teeth, gums and other areas of the mouth during cancer treatment.

Why Maintaining Oral Health During Cancer Treatment Is Important

After receiving a cancer diagnosis, brushing your teeth and flossing might be the last thing you are going to think about. It might not seem like the ideal time to schedule a dental appointment, either.

But oral side effects as a result of cancer treatment are more common than you might think. About 40 percent of patients who undergo chemotherapy develop oral complications. Maintaining or improving oral health before and during cancer treatment can help to reduce the risk of complications significantly.

Before you begin a cancer therapy, improving the health of your mouth is likely to minimize the chance of developing dental problems. There are over 500 different types of bacteria that live in your mouth. When you are healthy, and your immune system is functioning normally, your body can keep those bacteria in check. Regular brushing, flossing and dental visits also help to keep the mouth bacteria in check in a healthy patient.

But cancer treatment tends to suppress the immune system, making it more difficult for your body to fight off bacteria and infections. When the immune system is unable to control the bacteria levels in the mouth, there’s the chance that the bacteria will spread to other areas of the body, potentially causing or contributing to other health conditions, such as heart disease.

To help detect and treat any dental issues before cancer treatment begins, it’s usually recommended that cancer patients see a dentist at least two weeks before treatment begins. During the visit, a dentist or hygienist will deep clean the mouth, minimizing the amount of bacteria present. If there are problems with the teeth, such as cavities, or issues with the gums, such as gingivitis, the dentist can treat those as well.

A dentist can also work with you to put together a plan for mouth care during cancer treatment. Maintaining the health of your teeth and gums during cancer therapy can help with the following:

  • Reducing pain in the mouth
  • Reducing infection
  • Protecting the bones of the jaw from necrosis
  • Ensuring you get the nutrition you need
  • Improving oral hygiene and lowering the risk of complications associated with poor oral health (such as cavities)

If a problem develops in the mouth during cancer treatment, it might be necessary to stop treatment until the issue is fixed. Working with a dentist throughout your treatment can help to ensure any problems are detected early and treated as soon as possible so that you can continue to receive the cancer treatment you need.

How Chemotherapy, Radiation and Transplants Affect the Mouth

Different cancer treatments can affect the health of your mouth in different ways. Understanding how a particular treatment might affect your mouth allows you to prepare a plan for effective mouth care throughout your therapy.

Chemotherapy’s Effects on the Mouth

The drugs used during chemotherapy are designed to damage and ultimately kill cancer cells. Unfortunately, those same drugs can also hurt healthy cells, including the cells in your mouth. How chemotherapy affects the mouth often depends on the type of chemo drugs you receive and the overall health of your mouth and oral cavity. Some people might have more severe oral side effects due to chemotherapy than others.

Radiation Therapy’s Effects on the Mouth

Like chemotherapy, radiation therapy damages cancer cells and can also harm healthy cells. Radiation therapy often has the most significant effect on cells that divide rapidly. That includes cancer cells as well as the cells on the inside of the mouth.

The location of the radiation therapy plays a big role in determining whether it affects the mouth and how severe the side effects might be. Usually, radiation to the head and neck is more likely to cause changes in the mouth than radiation to another area of the body. The amount of radiation a person receives, the type of radiation, how often the radiation is delivered and certain factors about the patient, such as age and overall health, can also play a part in determining how the therapy will affect the mouth.

A Bone Marrow Transplant’s Effects on the Mouth

Some types of cancer, such as leukemia, are treated with a bone marrow transplant, also known as a stem cell transplant. A stem cell transplant is performed after radiation therapy or chemotherapy to replace cells that have been destroyed by the treatment. The transplanted stem cells can come from the patient or from another person who has similar cell-surface markers.

During a transplant, a patient’s immune system is usually very suppressed, which increases the risk of infections in the mouth and elsewhere. After a transplant, a complication known as graft versus host disease can also contribute to side effects in the mouth. Graft versus host disease occurs when the newly transplanted stem cells attack the patient’s body. In the mouth, graft versus host disease can cause symptoms such as tenderness or pain and dry mouth.

Oral Side Effects of Cancer Treatments

Although the side effects caused by cancer treatment do vary from patient to patient, some of the more common ones include:

  • Dry mouth. Chemotherapy and radiation therapy can affect the production of saliva in the mouth, leading to a condition known as xerostomia, or dry mouth. Dry mouth can also be a side effect of graft versus host disease.
  • Tongue changes. Chemotherapy can cause changes to the tongue, such as a burning sensation or swelling.
  • Infection. Since many cancer treatments suppress the immune system, it is more difficult for the body to fight off infections. Some people develop bacterial infections in their mouths. Fungal infections, such as an oral yeast infection, can also occur.
  • Change in taste/Loss of taste. During chemo, you might notice that the taste of certain foods is different. If you are receiving radiation therapy, you might experience a loss of taste. In some cases, changes in taste or a loss of taste are temporary. Less commonly, a change in or loss of taste is permanent.
  • Cavities. Radiation therapy can increase a person’s risk of developing tooth decay.
  • Changes in the jawbone. Less commonly, radiation therapy to the head or neck can lead to something called osteoradionecrosis, or death of the jawbone. The side effect is incredibly rare but can develop as a result of a reduction in the supply of oxygen to the bone during radiation therapy.
  • Mouth sores. It’s not uncommon for people to develop painful sores, known as oral mucositis, as a result of cancer treatment. The sores can make it difficult for you to speak, eat or swallow. Although they might clear up after treatment ends, in some instances, the sores persist.
  • Bleeding. Some cancer treatments interfere with blood clotting, which can increase the risk of bleeding from the gums.

How to Maintain Good Oral Health During and After Cancer Treatment

Your dentist can help you maintain good oral health before, during and after your cancer treatment. Here are a few things you can do at home and with the support of your dentist to improve oral hygiene and keep your mouth healthy:

  • Brush your teeth regularly and floss daily. Maintaining good oral hygiene is a must to help reduce the risk of tooth decay during cancer treatment. Brush your teeth twice a day, using a toothpaste with fluoride. To avoid irritating your gums and the soft tissue in your mouth, use a brush with soft bristles.
  • Stay hydrated. Drinking enough water can help to ease the symptoms and discomfort of dry mouth.
  • Check your mouth for sores. Sores can develop on your gums, the soft tissues in the mouth and the throat. Checking inside your mouth regularly will help you detect any sores as they form.
  • Suck on ice chips before treatment sessions. To help ease any soreness in your mouth and throat that occurs right after treatment, it can help to suck on ice chips for about 30 minutes before each treatment session starts.
  • Avoid products that contain alcohol. Many types of mouthwash contain alcohol, which can further dry out your mouth. Your dentist can recommend rinses that don’t have alcohol or give you tips for making your own rinse with baking soda.
  • Eat soft foods. If you have discomfort in your mouth and throat, hard foods or foods with sharp edges — like potato chips — can make things worse. Try to stick with soft foods, such as yogurt, mashed potatoes and soup that’s not too hot.
  • Don’t smoke. Smoking or using other tobacco products have an adverse effect on your oral health, whether you have cancer or not. Smoking irritates the gums and makes it more challenging to keep the mouth clean. If you do smoke, your dentist and doctors can work with you to put together a plan for quitting.

Protect Your Mouth During Cancer Treatment: Contact Gateway Dentistry Group Today

Whether you are about to begin cancer treatment and want to check up on the health of your teeth and gums or are in the midst of treatment and are experiencing side effects, we can help. Fill out an appointment request form or contact us today to set up a dental visit and learn more about what you can do to protect your oral health during cancer treatments.

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