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Your Mouth During Oral Cancer Treatment

Each year, many people are treated for oral cancer. Chemotherapy treatments for cancer and radiation treatment for head and neck cancer often cause oral complications. About half of chemotherapy patients experience oral complications, particularly those being treated for leukemia and those who receive bone marrow transplants.

These oral cancer complications significantly decrease quality of life and can lead to serious systemic problems, complications, septicemia, eating difficulty, nutritional deficiencies, and dehydration. The following are descriptions of oral problems that can occur with cancer treatment:

Infections of the oral cavity can be caused by the usual organisms found in the mouth or by opportunistic organisms not usually found in the mouth. These infections can lead to serious systemic infections. The risk is higher for individuals who have reduced numbers of circulating white blood cells (leukopenia).

Candidiasis is the overgrowth of candida albicans, a fungal organism that normally is found in the mouth.

Musositis is painful and causes problems with eating and speaking. Soft tissues are red, ulcerated, and inflamed. The oral cavity is susceptible to mucositis because of its high cell turnover.

Hemorrhage or bleeding of the oral cavity can occur when clotting factors are affected and during bone marrow suppression.

Xerostomia or dry mouth is associated with decreased, sticky, or thickened saliva. Dry soft tissues are more susceptible to pain, infection, and irritation. Dry mouth is associated with a high number of dental caries.

Altered taste or loss of taste is common and is related to the reduced saliva volume, as well as its altered consistency.

Developmental abnormalities such as altered craniofacial growth and dental/tooth deformities occur with cancer treatment during developmental periods.

Trismus, fibrosis, and scarring of the chewing muscles and temporomandibular joint (TMJ, the joint that moves the lower jaw) that were in the radiation field may make opening the mouth difficult and limited.

Osteoradionecrosis (soft tissue and bone necrosis) can be spontaneous or secondary to trauma, extractions, or dental prostheses. The radiated tissues have reduced blood vessels, decreased cells, and decreased oxygen that predisposes the tissues for years after the radiation therapy to this compromised state that makes oral surgical procedures risky. Therefore, prior to and post oral surgery, patients who have had head and neck radiation may require hyperbaric oxygen treatments and antibiotic therapy to prevent osteoradionecrosis.

Radiation dental caries is a term used for rapid tooth demineralization and severe cavities that occur with head and neck radiation, particularly when the parotid, submandibular, submental, or submaxillary salivary glands are in the radiation field.

Pain accompanies oral infection, mucositis, xerostomia, trismus, dental caries, osteoradionecrosis, candidiasis and dental caries.

To reduce risk for oral cancer complications, a dentist should perform a pretreatment oral examination, as well as necessary dental treatment before initiating chemotherapy or head and neck radiation. It is important that the dentist consult with the physician or oncologist before dental treatment because people who are about to undergo treatments for cancer may be immunosuppressed or thrombocytopenic (blood clotting disorder).

The goals of the dental examination and dental treatment are to eliminate existing or potential oral infection and potential for trauma. Infection, potential infection, and trauma can be associated with soft tissue lesions, decayed or broken teeth, dental implants with poor prognosis, periodontal disease, and poorly fitting full or partial dentures. The oral examination consists of hard and soft tissue examinations, periodontal assessment, and necessary radiographs. Since long-term effects of head and neck cancer radiation treatments will be harmful to the bone in the radiated area (field), patients who undergo head and neck radiation treatment should have teeth and implants with potential for future problems considered for extraction before the cancer treatment begins.

The patient's ability and interest in maintaining oral health, as well as the ability to comply with an oral cancer prevention routine, should be factors that are considered as the dentist develops and discusses dental treatment recommendations with the patient.

By Denise J. Fedele, DMD, MS

Learn About Tooth Abrasion and Overbrushing

Recently, the issue of over brushing and its direct link to tooth abrasion has been a topic in many journal and news articles. A story in The Wall Street Journal (dated February 4, 2000) stated that in many cases, "the culprit in toothbrush abrasion is the toothbrush itself." This issue is particularly important because people can damage healthy teeth and gums by brushing too hard, oftentimes with a medium- or hard-bristled toothbrush. In fact, dentists and representatives of the American Dental Association have recommended for years that people use a soft-bristled toothbrush for their dental care.

Our teeth and gums are susceptible to wear and tear like all other parts of our bodies. In cases of improper brushing, such as brushing too vigorously, gum tissue can be worn away. Receding gums then lead to other significant dental problems such as sensitive teeth, periodontal disease, cavities, root canals, and potentially removal of teeth.

Solutions to brushing too hard and causing tooth abrasion include adjusting the angle of your toothbrush (it should be at a 45-degree angle), lessening the amount of pressure you use, monitoring the length of time, as well as making sure that you are using a soft-bristled toothbrush. In addition, always ask your dentist for specific recommendations related to your oral health care.

While the potential harm to teeth and gums through over brushing is significant, an even greater percentage of the population suffers damage to their teeth from occlusion (bad bite), genetic factors, and poor overall dental hygiene. It is critical to carefully maintain and monitor your oral health. The best approach to maintaining good oral health is to brush your teeth twice a day with a soft-bristled toothbrush to prevent tooth abrasion with fluoride toothpaste, floss or clean between the teeth using an interdental cleaner (special brushes, picks or sticks), and visit your dentist every six months. Follow your dentist's advice with regard to any changes to this regimen.

By Brian J. Gray, DDS, MAGD, FICO