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 is known to 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.
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.
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. Below are some helpful tips on how to keep up oral care during treatment
- Make an appointment with the dentist before you begin 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:
- Dental examination and x-rays
- Dental cleaning
- Impressions for fluoride trays. Fluoride trays are custom-fitted soft plastic trays that are used to apply fluoride. Fluoride is used to help prevent the formation of cavities.
- 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
2. Stick to your oral care routine. You may not feel great some mornings, but don’t let that keep you from properly cleaning your mouth! Make sure you brush for a full 2 minutes.
3. If your mouth is sore, some of the following tips may help:
- Use a soft toothbrush or a sponge applicator such as a toothette to brush your teeth.
- Don’t floss if it causes bleeding when your platelet count is low.
- Wear dentures only for meals.
- Rinse your mouth with warm salt water or baking soda and water (a teaspoon of either dissolved in eight ounces of warm water).
- Avoid commercial mouthwashes because they contain alcohol that may burn your mouth.
- If your doctor prescribes both an antibacterial rinse (Peridex) and an antifungal rinse or lozenge (nystatin), do not take them together because they will not work as well. Separate them by at least one hour.
- 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. Other topical anesthetics are available at your pharmacy. Ask your doctor or nurse about specific products.
- Pain medicine may also be used. Tylenol or stronger pain medication may help reduce oral pain. If taken half an hour before meals it may be more comfortable to eat. It is important to avoid using aspirin or non-steroidal medication (Advil, Motrin) products while on chemotherapy since they may cause bleeding problems.
- Do not smoke cigarettes, cigars, pipes, or chew tobacco and avoid drinking alcohol. These are all very irritating and drying to a sore mouth.
- Avoid spicy food and food that is difficult to chew. Citrus and tomato juice may irritate your mouth when you have 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.
4. Speak with your doctor if :
- If your mouth pain increases and you are unable to control it with your pain medicine.
- If you are unable to eat or drink because of severe mouth sores.
- If you have a fever.
- If you have bleeding that is difficult to control.
- If you have any difficulty swallowing.
5. After treatment keep up with your regular dental check ups. The salivary glands may still not be creating enough saliva leaving the mouth vulnerable to sores and infections. If any dental extraction becomes necessary it is important that your dentist talk with your oncology team who are familiar with your treatment.