Other Oral Health Complications

In addition to oral mucositis, there are other oral health problems that can develop from cancer and/or its treatment. Dry mouth, or xerostomia, (which can also lead to oral mucositis) occurs when the salivary glands do not produce enough saliva. Symptoms of xerostomia may include thick or stringy saliva, taste changes, cracked lips, sore tongue, and/or changes in your ability to speak clearly.

Also, pain or difficulty swallowing, or dysphagia, is another complication. Symptoms of dysphagia may include the following: pain while swallowing, inability to swallow, choking or coughing while eating, a sensation of food getting stuck in the throat, and soreness, pain and/or swelling in the throat or mouth.

A serious oral health complication which can result from a high dose of radiation to the mandible (lower jaw) is called osteoradioneucrosis. Osteoradionecrosis occurs when the supporting bone around the teeth loses vitality as a result of radiation therapy to the head and neck region.

What Causes Oral Mucositis?

The following are possible causes of oral mucositis, or mouth sores:

• Some cancers (e.g., oral, throat, esophageal, laryngeal)
• Some cancer treatments (e.g., chemotherapy, radiation to the head and neck, stem cell transplant)
• Some medications
• Infection in the mouth
• Xerostomia (dry mouth)
• Poor oral hygiene
• Dehydration
• Poor diet (lack of protein and/or vitamins)
• Excessive use of alcohol and/or tobacco
• Autoimmune disease

If you are receiving chemotherapy, mucositis may occur three to 10 days following treatment and heal by itself within two to four weeks. Mucositis caused by radiation therapy sometimes lasts six to eight weeks or longer, depending on the treatment regime.

Why is Good Oral Health Important for People Fighting Cancer?

The side effects of cancer and its treatment, such as mouth sores, can significantly impact your quality of life. Mouth sores can be painful and make it difficult to chew, swallow and talk. These difficulties can lead to poor nutrition, weight loss and dehydration.

When oral mucositis becomes severe, it can also cause bleeding or infection. Cancer and its treatment can weaken the immune system and damage the cells lining the mouth, making you more susceptible to infections in the mouth. In addition, chemotherapy drugs may affect the ability of blood to clot and cause bleeding.

Furthermore, dry mouth can cause additional complications. Since saliva is needed for chewing, tasting, swallowing, and speech, dry mouth can cause difficulty when talking and eating. Saliva also helps to neutralize acid in the mouth and clean the teeth and gums, thereby helping to prevent infection, mouth sores, tooth decay, and gum disease.

Thus, good oral health, including the management of mouth sores, plays an important role during cancer treatment. Sometimes oral mucositis can become severe enough that it is necessary to modify or delay your treatment so your mouth can heal. By learning good oral hygiene, you can help decrease the severity of mouth sores and other problems.

How is Oral Mucositis Treated?

If mucositis occurs, oral care is based on several patient-specific factors, including cancer type, treatment regime, and symptoms. Aside from the help your health care team provides, there are some things you can do to manage mouth sores and maintain oral health.

NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS REPORT ANY ORAL HEALTH CONCERNS TO YOUR PHYSICIAN OR DENTIST IMMEDIATELY.

Tips for Managing Mouth Sores During Cancer Care

• Visit a dentist. It is important to visit your dentist before you begin treatment, particularly if you are going to receive radiation therapy to the head and neck region. Your dentist can check the health of your mouth and teeth and help you understand the oral side effects of cancer treatment. Your dentist can also help lessen the severity of oral complications like infection, and provide guidance on how to safely keep the mouth clean when blood counts are low. Your dentist can also provide rinses to fight infection in the mouth, medication to increase saliva production, and fluoride treatments to prevent tooth decay.
• Check your mouth daily. It’s important to check your mouth each day to look for any changes. Use a small flashlight and a padded popsicle stick to check the inside of your cheeks, the roof of your mouth, your lips, gums, and under your tongue. Look for red areas or white patches, which often become sores. Inform your health care team if your mouth looks or feels different, or if you notice changes in your taste.
• Stay hydrated. Try to drink plenty of fluids (e.g., 8-10 glasses of water) each day to moisten the mouth and avoid dehydration. If swallowing is difficult, sip water or suck on ice chips to keep your mouth and throat wet. You can also chew sugarless gum or suck on sugarless candies to help increase saliva flow. Drinking with a straw may help bypass sore areas in the mouth. Try to avoid drinking fluids that are very hot or cold, as well as acidic drinks (e.g., orange juice, grapefruit juice) which can irritate mouth sores.
• Eat right. Eating a well-balanced diet can help the body tolerate cancer treatments, fight infection and rebuild tissue. Try bland and lukewarm/cool foods that are easy to swallow. Moisten dry foods with gravy, broth, or milk, or puree food in a blender to make it softer and easier to eat. Ask your doctor if there is a solution you can rinse with to numb your mouth sores, or a pain medication you can take before meals. Avoid hard, dry, or crusty foods, or foods that are hot, spicy, or salty. Also, stay away from alcohol, caffeine and tobacco. Also avoid acidic or high-sugar fruits and juices, which can make you more susceptible to tooth decay. A registered dietitian can offer advice on maintaining a balanced diet.
• Maintain routine oral hygiene. Good dental hygiene during and after cancer treatment, including proper cleaning of the mouth and teeth, can help reduce complications, such as mouth sores, infections and cavities.
  
• Tooth brushing. Gently brush your teeth, gums and tongue with a soft bristled toothbrush in the morning, after meals, and before bedtime. Before brushing, rinse your toothbrush with warm water to help soften the bristles. Make sure you rinse your toothbrush well after each use and store it in a cool, dry place. Choose mild-tasting, non-abrasive toothpaste with fluoride. Avoid whitening toothpastes.
• Flossing. Floss gently once a day. However, if you do not usually floss, talk with your doctor before you start. He/she may also give you some guidelines about flossing. Tell your doctor if flossing causes bleeding or other problems.
• Lip care. To prevent dry or cracked lips, keep your lips moist with lip moisturizer or mild lip balm. Avoid petroleum jelly, as the oily base may promote infection.
• Rinsing. Rinsing may help remove bacteria from the mouth, prevent infections, and improve healing of mouth sores. Try rinsing with sterile water, or a bland, non-irritating solution, several times a day, particularly after meals and at bedtime. Avoid mouthwashes and other products that contain alcohol. A solution of salt (1/8 teaspoon), baking soda (1/4 teaspoon), and water (one cup) may help clean the mouth, provide moisture for the membranes, neutralize acid, and dissolve thick saliva. Make sure you get your doctor’s approval before trying any rinses.
• Dentures. If you have dentures, remove and clean them whenever possible, such as after meals and at bedtime. Do not wear loose-fitting dentures that may irritate the mouth and gums. If mouth sores are severe, or dentures fit poorly, do not wear them.

• Stay on top of pain. It’s important to address pain caused by mouth sores so you can eat well, sleep well, and maintain your quality of life. Ask your doctor about topical medications for pain. Some common pain methods for mucositis include creams that dull pain and medications to numb the mouth and/or reduce inflammation. It can also help to use a cool mist humidifier at night to keep your mouth and throat moist while sleeping.
• Seek supportive therapies. Various complementary medicine therapies may help you cope better with mouth sores and other oral complications. For instance, a speech and language pathologist can help teach you to swallow more easily. A naturopathic clinician may be able to recommend natural therapies to help with mouth sores, dry mouth and/or difficulty swallowing. In addition, mind-body medicine can help you relax with techniques like distraction, guided imagery, stress management, acupuncture, etc.

NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER REGARDING ANY ORAL COMPLICATIONS YOU MAY BE EXPERIENCING.

At Cancer Treatment Centers of America (CTCA), we help you fight cancer by treating the whole person, not just the disease. We understand cancer-related oral complications, like mouth sores, can impact your quality of life. By offering conventional treatments in combination with complementary medicine therapies, your multidisciplinary care team at CTCA helps you fight cancer on all fronts.

Here, medical, surgical and radiation oncologists, along with other cancer specialists, will deliver innovative treatment modalities and technologies for all types and stages of cancer. In addition, your CTCA care team will include other clinicians in the following disciplines:

• Nutrition therapy: Our nutrition team will work closely with you to develop an individualized nutrition plan to help prevent malnutrition and ensure you maintain a balanced diet. If mouth sores are preventing you from eating whole foods, our dietitians can provide a variety of protein powders, supplements, or liquid diets, to make sure you receive the necessary nutrients. We can also can provide nutrition parenterally (through a vein) or enterally (through a feeding tube).
• Naturopathic medicine: Our naturopathic medicine team can recommend specific vitamins and mineral supplements, botanicals, and homeopathic medicine to strengthen your immune system and ease oral symptoms.
• Oncology rehabilitation: Our oncology rehabilitation team includes speech and language pathologists who can help resolve any swallowing problems that may limit your ability to eat, and help you with speech production. Rehabilitation therapists can provide techniques to help restore an efficient safe swallow in patients treated for head and neck cancer. At CTCA at Southwestern Regional Medical Center, we offer auriculotherapy, an electrical stimulus applied to external ear points that correspond to locations on the body, which may help alleviate dry mouth, swallow dysfunction, and pain.
• Pain management: Our pain management team will use various pain management methods to control pain associated with oral complications.
• Mind-body medicine: Our mind-body medicine team will provide techniques like stress management, relaxation and guided imagery training, to promote your emotional well being.
• Spiritual support: Our pastoral care team will provide spiritual counseling to help nurture your spiritual well being so that you may find hope and strength throughout your journey.

Cancer can be overwhelming, particularly if you are managing side effects like mouth sores at the same time. At CTCA, we provide whole-person cancer care so you can fight cancer and enjoy a good quality of life.

I hope this information has helped you in some way. I will check in with you again next month. In the meantime, stay strong and hopeful.