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Patients who are receiving cancer therapy often have changes in the mouth. This information can help you understand possible side effects of cancer treatment, including tips for mouth care that may help prevent or minimize these changes.
Chemotherapy affects rapidly dividing cells. Cancer cells and some normal cells, such as those lining the mouth, the gastrointestinal tract, bone marrow cells, and hair cells, divide rapidly.
Chemotherapy cannot tell the difference between normal cells and malignant cells and sometimes injures both. Chemotherapy may lower your white blood cell count, platelet count, and red blood cell count. This is known as bone marrow suppression (another name is myelosuppression). This makes you more at risk for infection and/or bleeding.
If there is pre-existing dental infection such as cavities, abscesses, or gum (periodontal) disease, the infection may become worse. In addition, your gums may bleed easily if they are irritated or swollen.
Chemotherapy may also cause mouth sores (mucositis). These sores usually heal in one to two weeks; however, more serious ulcers may become infected with bacteria or yeast that are commonly found in the mouth. Irritation from sharp teeth or fillings may worsen the condition. Medications to prevent sores and help with discomfort are available and can be prescribed for you.
As a comfort, ask for ice chips or sugar free popsicles to suck on while you are receiving chemotherapy. Research has shown this may decrease mouth sores by 60 percent.
Radiation therapy is often used to treat individuals with cancer of the head and neck. It is delivered to the head and neck area to destroy cancer cells but unfortunately, some normal cells are injured as well. During radiation treatment, patients may also experience mouth sores. This usually lessens within a couple of weeks after therapy ends. Unlike chemotherapy, radiation therapy has long-term side effects in the mouth. The most common side effect is dry mouth (xerostomia). Xerostomia is a result of radiation injury to the salivary glands. It means the salivary glands produce less saliva and the saliva is thicker. The normal protective effect of saliva on the teeth is lost and there is an increase in oral bacteria that cause cavities. Also, plaque and tarter deposits occur faster, which places you more at risk for cavities and gum disease.
Another side effect of radiation treatment to the head and neck is severe bone infection. This is caused by a decrease in the blood supply to the bones of the head and tissue of the neck during radiation treatment. These changes result in slow healing from infection, trauma or especially when teeth are removed soon after radiation therapy. Restorative and preventive dental care is very important to avoid infection.
To prevent infection and tooth decay, it is very important to see your dentist early in your treatment and to continue good mouth cleaning daily. Outlined below are helpful suggestions for mouth care inpatients undergoing cancer treatment.
See your dentist so that (s)he may identify potential sources of dental infection or irritation. Teeth with severe infection or those that may cause problems during or after therapy should be removed (extracted). Extractions should be done at least one week before the start of chemotherapy or radiation therapy to provide enough time for proper healing. Teeth with cavities should be restored with fillings. A thorough cleaning and scaling of teeth should be done to remove tartar (calculus). All sharp areas should be smoothed to prevent unnecessary irritation. Procedures that may be included in the first dental visit are:
During treatment it is important to adhere strictly to your mouth care plan. If your mouth is sore, some of the following tips may help:
Fluoride treatments are important during and after radiation treatments to the head and neck area. They should be done twice daily by using soft trays that are custom made for you by your dentist.
When therapy ends, you need to continue with good dental care in order to keep your teeth and gums healthy. Your salivary glands will be making less saliva and you will still be at risk for developing cavities and gum disease.
You will need to have:
Mouth dryness may continue after therapy. Salivary flow will gradually increase, but may not completely return to normal. To add moisture to your mouth it is helpful to:
Dentures should be made or relined about six months after treatment to allow for changes in your mouth. There should be no pressure areas which could result in irritation to your mouth.