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october 2012

Call The Dentist Before Chemotherapy

Dr Rashmi R Acharya 
Not many are aware that treatment and care of cancer patients also requires special attention to their oral health, and that is irrespective of what cancer it is. Oral complications are especially pronounced in cancer patients who are subjected to chemotherapy.

A cancer patient would be best advised to visit a dentist especially in the time gap between his/her decision to go in for chemotherapy and the actual start of the therapy. In doing so, the patient can take precautionary measures which can limit the impact of chemotherapy on his/ her oral health.

Most side effects of chemotherapy are linked to the state of the patient’s oral health before the start of treatment. Not all oral problems can be avoided but fewer side effects mean the patient is more likely to stay on chemotherapy schedule. Some problems that affect the oral cavity due to chemotherapy could lead to delay or even halt the course of treatment.

Side Effects
The side effects of chemotherapy on the oral cavity depend on the chemotherapy drugs and how the patient’s body reacts to them. They may manifest only during the course of treatment or for a short time after the treatment ends.
  • Extremely dry mouth or xerostomia (It is a disturbing condition where Dr Rashmi R Acharya the saliva is thickened, reduced or absent.)
  • Rampant tooth decay
  • Burning, peeling and inflamed tongue
  • Stiffness of the jaws
  • Impaired ability to eat, speak or swallow
  • Change in taste and inability to eat spicy foods
  • Oral infections - bacterial, fungal and viral
Oral Care Before Chemotherapy
Schedule a thorough dental checkup for the patient at least two weeks before the start of chemotherapy. See that the patient gets the following done:
  • A proper oral and periodontal examination.
  • Take X-rays and panorex X-rays
  • Take care of mouth problems, restore decayed tooth, other compromised tooth and also treat any existing oral infection
  • Learn how to take care of the oral cavity to prevent side effects
  • Perform oral prophylaxis if indicated
  • Cease smoking
Oral Care During And After Chemotherapy
During the course of chemotherapy too, a cancer patient can do a lot to help oneself against the fallout on oral health. Preventing sores must assume importance.

Check the mouth every day for sores or other changes

Keep the mouth moist

  • Drink a lot of water
  • Suck ice cubes
  • Use sugarless gum or sugar-free hard candy
  • Use a saliva substitute to help moisten the mouth
Clean the mouth, tongue, and gums
  • Brush the teeth, gums, and tongue with an extra-soft toothbrush after every meal and at bedtime. (If brushing hurts, soften the bristles in warm water.)
  • Use a fluoridated toothpaste and floss gently once a day
  • Don’t use mouthwashes with alcohol in them (Antifungal mouth washes are preferred.)
  • Floss gently every day. If gums bleed and hurt, avoid the areas that are bleeding or sore, but keep flossing the others.
  • Rinse the mouth several times a day with a solution made of 1/4 tsp baking soda and 1/8 tsp salt in one cup of warm water and follow with a plain water rinse
  • A magic mouthwash is in a mixture of Benadryl, Maalox, Nystatin and Lidocaine
  • Ill-fitting dentures can cause problems. Eliminate such sources or cause of oral trauma and irritation
Most side effects of chemotherapy are linked to the state of the patient’s oral health before the start of treatment. Know how to manage it and help the patient in your care.

If the mouth is sore, watch what the patient eats and drinks
  • Choose foods that are good and easy to chew and swallow
  • Let food be taken in small bites, chew slowly, and sip liquids with the meals
  • Eat a balanced diet
  • Soft, moist foods such as cooked cereals, mashed potatoes, and scrambled eggs, are good for sore mouth
  • If there is trouble in swallowing, soften the food with gravy, sauces, broth, yoghurt or other liquids
  • Sipping liquids with meals will make eating easier

Stay away from sharp, crunchy foods, like taco chips, that can scrape or cut the mouth and foods that are hot, spicy, or high in acid, like citrus fruits and juices, which can irritate the mouth and sugary foods, like candy or soda, which can cause cavities

Avoid toothpicks, because they too can cause cuts in the mouth

Avoid all tobacco products and alcoholic drinks

The dentist and the oncologist attending on the patient must work together before and during the cancer treatment, to make recovery as comfortable as possible for their patient. Once all complications of chemotherapy have been resolved, the patient may be able to resume the normal dental care schedule.
Dr Rashmi R Acharya is Consultant, Aesthetic & Endodontics & General Dentistry, Apollo Hospitals, Bhubaneshwar.