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Maintaining Oral Health During Cancer Therapy

(the following has been published by The American Academy of Periodontology in a brochure under the same name)

Almost half of all American adults have some form of periodontal disease. The majority of them do not even know they have it. Periodontal diseases are bacterial infections of the gums, bone and other supporting structures of the teeth.

Periodontitis, a form of periodontal disease, is one of the primary causes of tooth loss and is usually painless and silent until its advanced stages. Symptoms can include:

bulletPersistent bad breath
bulletGums that bleed when you brush your teeth
bulletRed, swollen and tender gums
bulletGums that have pulled away from the teeth Loose or separating teeth
bulletPus between the gum and tooth
bulletA change in the way your teeth fit together when you bite

Periodontal diseases can be diagnosed and treated by your dentist and/or periodontist. A periodontist is a specialist with advanced training in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth.

Some forms of periodontal diseases have also been linked to other significant health problems, including heart and respiratory diseases, diabetes, osteoporosis and premature and underweight births of babies.

Just as periodontal health can affect your overall health, certain health conditions and their treatments can affect your periodontal health. One of these is cancer therapy.

If you or someone you know has been diagnosed with cancer, it is essential to make the periodontist or dentist a member of the cancer team. Cancer therapy can cause oral complications that compromise periodontal health, so a visit to your dental professional is important to help you keep your gums healthy.

Prior to beginning your cancer treatment, an oral evaluation by a periodontist or knowledgeable dental professional is important. Identifying and correcting potential oral problems may ease discomfort so it does not intensify or interfere with your cancer treatment. Oral surgery is not recommended during cancer therapy, because tissues take more time to heal. This is why oral pretreatment is essential. Pretreatment care also provides the following benefits: Reduces the risk and severity of oral complicationsduring cancer therapy Reduces the chances of oral pain and ultimately may protect oral health Allows for timely diagnosis and treatment of existing infections Improves the chances of receiving optimal doses of cancer treatment Improves overall health

Daily Oral Hygiene Routine- In addition to pretreatment care, your periodontist or dental professional likely will recommend an at-home oral hygiene routine. Daily oral hygiene will provide comfort reduce the risk of infection by periodontal bacteria, and minimize the effects of complications caused by your cancer treatment. In addition to the oral hygiene routine tailored by your dental professional, following are some tips to help you keep your mouth as comfortable and healthy as possible:

bulletGently brush your teeth, gums and tongue with a soft- bristled toothbrush and fluoride toothpaste after every meal and before bed.
bulletIf brushing hurts, soften the bristles in warm water.
bulletFloss teeth gently every day temporarily avoiding areas if gums are sore or bleeding.
bulletTopical fluoride applications may be prescribed by your dental professional. Fluoride applications will fortify the enamel to help it resist decay caused by decreased saliva production during radiation therapy.
bulletFor a sore mouth, rinse a few times a day with one cup of warm water mixed with '/4 teaspoon baking soda and '/s teaspoon salt. Follow with a plain water rinse.
bulletAvoid candy and soda unless it is sugar-free. Also avoid using toothpicks, tobacco products and alcohol.

Even though pretreatment and daily oral hygiene can go a long way toward keeping your mouth comfortable and disease-free during cancer treatment, sometimes it's hard to keep the negative effects at bay. If you are experiencing one of these problems, there are a few easy steps you can take to minimize discomfort and the harm it causes.

Caring for Dry Mouth- Chemotherapy and radiation can decrease your salivary secretion causing excessive dryness in the mouth. And, a dry mouth could increase your susceptibility to oral infections.Keep your mouth moist and stimulate saliva flow by:

bulletSipping cool water often
bulletAllowing ice chips to melt in your mouth
bulletChewing sugarless gum or candy
bulletLubricating your lips with lip balm
bulletAsking your dental professional for a prescription saliva substitute or medication that may stimulate saliva
bulletUsing a humidifier in your bedroom to alleviate or reduce nighttime oral dryness

In addition, avoid mouthwashes containing alcohol and acidic, carbonated or caffeinated beverages because these chemicals will dry out your mouth.

Eating with care, adequate nutrition and fluid intake are important for oral and general health. Occasionally, patients develop nutritional deficiencies because their mouths are sore from cancer treatment. If your mouth is sore, choose easy-to-chew foods that are bland in flavor and lukewarm in temperature. Youmay also want to soften your food with sauces, milk, yogurt or gravy or in a blender to facilitate swallowing. If your diet is compromised, then consider nutritional or vitamin supplements.

Protecting Enamel- If a dry mouth or vomiting is a side effect of your cancer treatment, your periodontist or dental professional can prescribe fluoride trays. Use of fluoride trays will prevent the tooth enamel from wearing away as a result of the gastric acids from vomiting or the increased bacteria as a consequence from a dry mouth. Rinsing your mouth after vomiting with 1/4 teaspoon of baking soda in 1 cup of warm water will also cleanse your teeth and gums of the gastric acids. If you are experiencing vomiting, you may want to ask your oncologist or primary care physician to prescribe anti nausea medication during your cancer therapy to treat the nausea and vomiting.

Follow-Up and Long-Term Care- Relationships with your periodontist and dental professionals are as important after your cancer therapy as they are before and during your treatments. These continued relationships will help you maintain a comfortable, confident smile for years.


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Reference: The American Academy of Periodontology- Maintaining Oral Health During Cancer Therapy.  Brochure 2002