We love our dentists for all sorts of reasons. Our dentist helps our smile look its best, prevents cavities from going unchecked and contributes to our overall well-being. What few of us realize is how truly important our dentist is to our health. The body and mouth are inseparably linked -- if something is going wrong in our mouth, it can spread. A startling example of this is the prevalence of oral cancer.
In America, 30,000 people will be diagnosed with oral cancer or pharyngeal cancer this year. This results in 8,000 deaths, roughly breaking down to one death every hour of every day.
What makes this figure so terrifying is that early detection of oral cancer symptoms can result in an 80 to 90 percent recovery rate. Diagnosing symptoms of oral cancer too late is what keeps mortality rates so high.
Oral Complications of Cancer Treatment: What the Dental Team Can Do
Oral complications of cancer treatment arise in various forms and degrees of severity, depending on the individual and the cancer treatment. Chemotherapy often impairs the function of bone marrow, suppressing the formation of white blood cells, red blood cells, and platelets (myelosuppression). Some cancer treatments are described as stomatotoxic because they have toxic effects on the oral tissues. Following are lists of side effects common to both chemotherapy and radiation therapy, and complications specific to each type of treatment. You will need to consider the possibility of these complications each time you evaluate a patient with cancer.
- Oral complications common to both chemotherapy and radiation
- Oral mucositis: inflammation and ulceration of the mucous membranes; can increase the risk for pain, oral and systemic infection, and nutritional compromise.
- Infection: viral, bacterial, and fungal; results from myelosuppression, xerostomia, and/or damage to the mucosa from chemotherapy or radiotherapy.
- Xerostomia/salivary gland dysfunction: dryness of the mouth due to thickened, reduced, or absent salivary flow; increases the risk of infection and compromises speaking, chewing, and swallowing. Medications other than chemotherapy can also cause salivary gland dysfunction. Persistent dry mouth increases the risk for dental caries.
- Functional disabilities: impaired ability to eat, taste, swallow, and speak because of mucositis, dry mouth, trismus, and infection.
- Taste alterations: changes in taste perception of foods, ranging from unpleasant to tasteless.
- Nutritional compromise: poor nutrition from eating difficulties caused by mucositis, dry mouth, dysphagia, and loss of taste.
- Abnormal dental development: altered tooth development, craniofacial growth, or skeletal development in children secondary to radiotherapy and/or high doses of chemotherapy before age 9.
Other complications of chemotherapy
- Neurotoxicity: persistent, deep aching and burning pain that mimics a toothache, but for which no dental or mucosal source can be found. This complication is a side effect of certain classes of drugs, such as the vinca alkaloids.
- Bleeding: oral bleeding from the decreased platelets and clotting factors associated with the effects of therapy on bone marrow.
- Other complications of radiation therapy
- Radiation caries: lifelong risk of rampant dental decay that may begin within 3 months of completing radiation treatment if changes in either the quality or quantity of saliva persist.
- Trismus/tissue fibrosis: loss of elasticity of masticatory muscles that restricts normal ability to open the mouth.
- Osteonecrosis: blood vessel compromise and necrosis of bone exposed to high-dose radiation therapy; results in decreased ability to heal if traumatized.
The Role of Pre-Treatment Oral Care
A thorough oral evaluation by a knowledgeable dentist before cancer treatment begins is important to the success of the regimen. Pretreatment oral care achieves the following:
- Reduces the risk and severity of oral complications.
- Allows for prompt identification and treatment of existing infections or other problems.
- Improves the likelihood that the patient will successfully complete planned cancer treatment.
- Prevents, eliminates, or reduces oral pain.
- Minimizes oral infections that could lead to potentially serious systemic infections.
- Prevents or minimizes complications that compromise nutrition.
- Prevents or reduces later incidence of bone necrosis.
- Preserves or improves oral health.
- Provides an opportunity for patient education about oral hygiene during cancer therapy.
- Improves the quality of life.
- Decreases the cost of care.
With a pretreatment oral evaluation, the dental team can identify and treat problems such as infection, fractured teeth or restorations, or periodontal disease that could contribute to oral complications when cancer therapy begins. The evaluation also establishes baseline data for comparing the patient’s status in subsequent examinations.
Before the exam, you will need to obtain the patient’s cancer diagnosis and treatment plan, medical history, and dental history. Open communication with the patient’s oncologist is essential to ensure that each provider has the information necessary to deliver the best possible care
How to Use Custom Fluoride Carriers (Trays)
- At bedtime, remove partial or full dentures from the mouth. Brush teeth thoroughly with soft toothbrush and regular toothpaste. Floss teeth by sliding the floss up and down each side of each tooth. Note: It is very important to remove all food and plaque from between teeth before using fluoride. Food and plaque can prevent the fluoride from reaching the surface of the tooth.
- Place a thin ribbon of the fluoride gel into each upper and lower fluoride tray so that each tooth space has some fluoride. Either 0.4% stannous fluoride (Gel Kam) or 1.1% sodium fluoride (Prevident) may be used. The fluoride can be spread into a thin film that coats the inside of the trays, by using a cotton-tipped applicator, finger or toothbrush.
- Seat the trays on the upper and lower teeth and let them remain in place for 5 minutes. Only a small amount of fluoride should come out of the base of the trays when they are placed, otherwise, there may be too much fluoride in the trays.
- After 5 minutes, remove the trays and thoroughly expectorate (spit out) the residual fluoride. Very Important – do not rinse mouth, drink or eat for at least 30 minutes after fluoride use.
- For head and neck radiation patients, begin using fluoride in the custom trays no longer than one week after radiotherapy is completed. Repeat daily for the rest of your life!! Remember that tooth decay can occur in a matter of weeks if the fluoride is not used properly.
Care for Fluoride Carriers (Trays)
- Rinse and dry the trays thoroughly after each use. Clean them by brushing them with a toothbrush and toothpaste.
- Occasionally, the trays can be disinfected in a solution of sodium hypochlorite (Clorox) and water. Use one tablespoon of Clorox in about one-half cup of water. Soak them for about 15 minutes.
- If the trays become covered with hard water deposits, soak them in white vinegar overnight and brush them the next morning.
- Do not boil the trays or leave them in a hot car as they may warp or melt.