As Cancer is fast turning into an epidemic in India, with about two million registered patients, the one thing that does not get due importance in such patients is oral care. Paying attention to basic oral health should be an important part of a cancer patient’s routine in order to prevent dental problems that could hinder treatment.
It is recommended to visit a dentist at least one month before starting chemo or radiation therapy. With this proactive approach, your dentist can take care of any existing dental problems you might have and advise you as your cancer treatment progresses, lessening your chance of serious complications.
Chemotherapy cannot tell the difference between normal cells and malignant cells and sometimes injures both. It increases chances of bleeding and infections. 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; Irritation from sharp teeth or fillings may worsen the condition. These symptoms are short lived and generally subside after chemotherapy ends.
Unlike chemotherapy, radiation therapy has long-term side effects in the mouth. The most common side effect is dry mouth (xerostomia). 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.
Before treatment with chemotherapy or head and neck radiation
It is very important to get rid of any dental problems atleast a week prior to starting chemotherapy or radiotherapy. The course of events may be as follows
- A thorough cleaning and scaling of teeth should be done to remove tartar (calculus).
- Teeth with cavities should be restored with fillings.
- All sharp areas should be smoothed to prevent unnecessary 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.
Oral hygiene instructions:
- Brush three times a day with a soft toothbrush
- Floss daily
- Apply fluoride gel to teeth with custom tray twice daily
- Eat a nutritionally balanced diet, low in sugar
Other important instructions
- Wear dentures only for meals.
- Avoid commercial mouthwashes because they contain alcohol that may burn .
- To prevent discomfort when eating, you may apply Viscous Xylocaine to your mouth, especially before meals. Viscous Xylocaine can be swished and spit out or it can be applied directly to a specific area with a cotton tipped applicator.
- Avoid spicy food and food that is difficult to chew. Citrus and tomato juice may irritate the patients mouth when having mouth sores.
- Dry mouth (xerostomia) can be helped by drinking plenty of fluids throughout the day.
- Drink at least eight glasses of water or juices daily.
- Avoid caffeinated beverages as the caffeine may increase mouth dryness.
- Artificial saliva can be tried and is available in most pharmacies. You may find that chewing sugarless gum or sucking on sugarless candy is helpful.
- Coating your lips with a lip balm such as Vaseline or Chapstick will help prevent them from cracking. A cool mist humidifier will add moisture to your room.
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