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Dental health and cancer treatment

Author: Laurie Wertich

Importance of oral health

Dental and oral health refers to the well-being of the entire mouth, which includes the teeth, gums, mucosa (lining of the mouth) and salivary glands. Cancer or not, many people tend to overlook dental health, but it is a critical component of overall health.

Dentist Glenda Payas, DMD, MAGD, of Tulsa, Oklahoma, says, “Dental health is key for a person’s general health. Without good oral health, many times the rest of the body can be at risk due to the vast amount of bacteria living in the mouth, which can create problems.”

Oral health has been linked to a variety of health conditions, such as diabetes and heart disease. As a result, the World Health Organization has integrated oral health into its efforts to prevent chronic disease.

Cancer Treatment and oral health

When most people think about the side effects of cancer treatment, they conjure images of nausea and hair loss—but there are a variety of other common side effects, including oral complications such as mouth sores (mucositis) and dry mouth (xerostomia). These seemingly small complications can have serious consequences because they can interfere with planned cancer treatment, reduce quality of life and even lead to life-threatening infections.

Several types of cancer treatments are associated with oral side effects, including chemotherapy, bone marrow transplantation and radiation to the head and neck. These treatments can slow or stop the growth of new cells, limiting the ability of oral tissue to repair itself. What’s more, some cancer treatments can upset the healthy balance of bacteria in the mouth, which can lead to mouth sores, infections and tooth decay. Finally, radiation to the head and neck can directly damage and break down oral tissue, salivary glands and bone.

Preparing for treatment

Sometimes oral complications are inevitable, but a little preparation goes a long way toward minimizing their effects. Dr. Payas recommends that people pay a visit to the dentist prior to beginning cancer treatment, if possible. “Make sure you are in good oral health prior to starting cancer treatment because it will be easier to maintain,” she explains.

Because the environment of the mouth changes during cancer treatment, an increased risk of cavity growth is possible in people who have neglected their teeth. Ideally, patients should undergo a comprehensive oral evaluation one month before beginning cancer treatment. This allows for adequate recovery time in the event that invasive dental procedures are necessary. The pretreatment evaluation should include a thorough examination of the hard and soft tissues of the mouth. “Many patients will come in prior to starting treatment and have teeth extracted, cavities filled and gum health checked,” Dr. Payas says. “This is important because once treatment starts, the immune system is depressed and the body is at higher risk of infection and other complications.”

Just as cancer treatment can affect oral health, oral health can affect cancer treatment. Dr. Payas explains that some oral health problems can interfere with a patient’s ability to begin treatment. “I’ve had patients who have had to delay starting cancer treatment because they had oral issues that had to get resolved before treatment,” she says. “For example, they needed to have teeth extracted and then allow ample time for the socket to heal before they could begin treatment.”

Maintaining dental health before, during and after treatment

Dr. Payas is quick to note that dental health is important all of the time but especially during cancer treatment. She recommends that patients do the following:

  • Brush teeth.
  • Floss.
  • Scrape the tongue.
  • Stay hydrated.
  • Eat a healthy diet low in sugar and carbohydrates.

“A lot of the issues that arise during treatment are the result of a dry mouth,” Dr. Payas explains. “A dry mouth is very susceptible to cavities, so it is important to stay hydrated and maintain a healthy diet.”

Cancer patients may want to focus on maintaining a more alkaline environment in the mouth, as opposed to an acidic environment. “Research indicates that an acidic environment makes us more susceptible to cavities,” Dr. Payas says. “This is a diet-related issue. Carbohydrates and sugar are not so conducive to good oral health. It is important to have good nutrition for a variety of reasons.”

Should you undergo dental procedures during cancer treatment?

What if dental health issues arise during cancer treatment? Should you undergo dental procedures or wait? According to Dr. Payas, that depends on the dental health issue, the type of cancer treatment and the advice of the treating oncologist.

“I always defer to the health care provider,” she says. “Many don’t recommend any type of oral invasive treatment done while a patient is undergoing cancer treatment. That is their call.”

Often cancer treatment can compromise the immune system, and an invasive oral procedure could be risky in terms of infection. If dental treatment is absolutely necessary during cancer treatment, to reduce the risk of infection it is important to coordinate it between chemotherapy cycles and at a time when white blood cell counts are high.

Long-term dental health for cancer survivors

Once cancer treatment is complete, it is important to continue staying on top of oral health, as cancer treatment can have long-term effects. High-dose radiation can result in a lifelong risk of dry mouth, cavities and even osteonecrosis of the jaw, which is a severe bone disease that occurs when the jawbone is exposed and begins to starve from lack of blood. Because of this risk, this subset of patients should avoid invasive surgical procedures, including extractions that involve irradiated bone.

“There is definitely a long-term impact,” Dr. Payas says. “Typically, we see a change in the mouth, especially if someone has undergone radiation to the head and neck. This can cause dry mouth and more susceptibility to cavities.”

Ultimately, cancer survivors may need to pay closer attention to their oral health and schedule more-frequent visits to the dentist. It is worth it because good oral care before, during and after treatment can prevent or reduce the incidence and the severity of oral complications, which can enhance survival and quality of life.

“Go to the dentist and have everything that you can have corrected for oral health done prior to starting treatment,” Dr. Payas advises. “And then maintain that good oral health and general health for the rest of your life.”

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