Importance of Dental Care During Cancer Treatment

Treatment for blood and marrow cancers can cause a number of changes to the tissues in your body, including those in your mouth. Whether you are receiving chemotherapy, radiation therapy, or a stem cell transplant, oral complications can cause big problems if not treated properly.

In fact, these types of side effects can actually limit the doses of medications or the timing of your treatments. Therefore, taking care of your mouth and teeth is an important part of your cancer care.

Cancer treatments affect both malignant cells as well as healthy ones. As with any side effect, certain therapies are harder on your mouth tissues than others and some people are more susceptible to these types of complications. Treatment for leukemia and lymphoma may cause:

• Oral mucositis, or painful sores in your mouth or throat
• Taste changes
• Xerostomia or dry mouth
• Bleeding gums and tissues, especially if you have low platelets
• Tooth decay
• Nerve pain
• Changes to jaw muscles, which may restrict how well you can open your mouth (“trismus”)
• Osteonecrosis or “bone death” from changes to the blood vessels that supply the bones of your jaw
• Impaired tooth development in children with cancer

These changes can lead to other complications, such as serious infection and decreased nutrition.

Some of the dental problems that are caused by cancer treatment are unavoidable. However, with proper care and surveillance by a dentist, additional complications and treatment delays can be minimized. A dentist can help by:

• Identifying potential problem areas, such as loose or ill-fitting dental appliances, undiagnosed cavities, or unhealthy gums
• Caring for infections in your mouth before they spread to your blood stream
• Suggesting strategies for maintaining your oral hygiene during treatment
• Preventing complications that could lead to poor nutrition
• Helping you avoid the decreases or delays in treatment that oral complications can cause
• Managing or preventing mouth pain
• Keeping your smile looking beautiful, even if you aren’t using it as much as usual

Many centers have a dentist on staff that acts as part of the cancer care team. If this is not the case in your facility, it is important that you find a dentist who is knowledgeable about your cancer and its treatment. Your dentist should be in contact with your oncologist or hematologist to coordinate care.

If you have known dental problems, or require any dental procedures, discuss the best timing and approach with your cancer specialist.

You also play a role in avoiding mouth problems during cancer treatment. Here are a few things you can do to prevent complications:

• Follow a good mouth care protocol
• Drink lots of water or stimulate saliva production with sugar-free candy or gum to minimize dry mouth
• Inspect the inside of your mouth daily for any changes, sores, or signs of infection
• Clean or rinse your mouth out after vomiting. Club soda or baking soda and water make great mouthwashes
• Prevent stiffness in your jaw muscles by exercising them! Stretch your mouth open as far as you can, then close it. Repeat several times each day
• Quit smoking and avoid alcohol during treatment
• Ask your doctor about fluoride treatments
• Request pain control for sore mouth and throat so you can keep up good nutrition

Remember that cancer patients may be at higher risk of dental problems for the rest of their lives. Keeping up with dental care on a long-term basis is an important part of survivor care.

You should call your specialist or nurse if you:

• Develop a fever
• Notice white patches or open sores in your mouth
• Have a painful mouth or throat, whether you can see a problem or not
• Notice your gums are bleeding
• Are experiencing a very dry mouth

Blood and marrow cancer patients can be at a high risk of developing complications to their mouth and teeth, both as a result of their condition and the treatment of it.

A dentist can be a very important part of your care during cancer therapy. If your dentist is not affiliated with your cancer center, be sure to let them know about your medical history and also let your oncologist or hematologist know about your dental concerns.