During your studies and your dental career, you will no doubt care for patients experiencing cancer. We discuss how as a key member of their healthcare team you can support your patients as they undergo cancer treatment, and how you can help them work towards positive oral health outcomes.
Cancer therapy and oral health
Many patients with cancer are treated with chemotherapy, radiotherapy (the use of ionizing radiation), or a combination of both. While necessary, both of these treatments can cause very challenging side effects in patients. The most common oral side effects include:
- Xerostomia (dry mouth) caused by impaired salivary flow due to medications and/or salivary gland dysfunction.
- Mucositis, which involves inflammation and ulceration of the oral mucosa.
Adequate salivary flow is necessary to maintain optimum pH in the oral cavity, prevent the demineralization and support remineralization of the teeth after acid attacks, and to regulate the oral microbiome. Xerostomia puts the patient at greater risk of dental caries and periodontal disease, as well as oral infections.
Mucositis creates painful open lesions that can become infected, putting the immunocompromised patient at risk of catastrophic systemic infection. It also negatively impacts nutrition due to the difficulty and discomfort of eating when mucositis is present. In some cases, mucositis can require cancer therapy to be stopped or delayed, potentially affecting the patient’s outcome.
The role of the dental professional
At this already challenging time in your patient’s life, oral side effects like xerostomia and mucositis can significantly impact their wellbeing and quality of life, not to mention their health and prognosis. For that reason, as a dental professional it is important to do the following for patients:
a)Complete necessary treatment prior to cancer therapy
b)Prevent and reduce the oral side effects of cancer treatment.
c) Reinforce the need for meticulous oral hygiene and supportive dietary habits.
d) Empower your patient with the knowledge and tools to achieve the best possible oral health outcomes.
How you can help your patients
- Educate the patient
- Encourage frequent visits
- Provide advice that help avoid and reduce oral discomfort
- Prevent and manage caries
- Be a compassionate ally
You will often find that patients undergoing cancer treatment don’t realize that it can impact their oral health, so it’s up to you to educate them about the connection between the two. As you discuss the various potential side effects, it may help to refer them to patient-friendly resources like the following from the American Dental Association (ADA):
- Oral Effects of Head and Neck Cancer Treatment
- Oral Care During Cancer Treatment
It’s more important than ever for your patient to maintain regular dental visits. Explain that oral health status can change quickly during cancer treatment, but seeing the patient regularly means that you can detect any potential problems quickly. The earlier you can do this, the better the likelihood of preventing dental caries, periodontal disease, infection, tooth loss and other treatment complications.
Xerostomia and mucositis can cause serious discomfort to the patient and interfere with eating, talking and swallowing. You can help by advising your patient to avoid certain foods and drinks like:
- Caffeinated, carbonated or alcoholic drinks
- Acidic foods and drinks
- Spicy foods
- Dry, coarse, crunchy or hard foods
Instead, recommend water, milk, and soft, moist foods with simple textures and mild flavors.
Xerostomia and mucositis can make oral hygiene more difficult. Your patient may be more comfortable brushing with a soft toothbrush like the Colgate SlimSoft, with ultra-slim bristles for a gentle clean.
You can also recommend a mouth rinse specially formulated to hydrate and soothe irritated soft tissues. Colgate Hydris Mouthwash is made with gentle, plant-based ingredients and is proven to lock in hydration for up to four hours after use, providing comfort for patients with xerostomia. Additional options can also be recommended, such as sugar-free non-acidic chewing gum.
It’s important that your patient is practicing good oral hygiene and dietary habits. To help prevent and manage dental caries, recommend a high-level prescription fluoride toothpaste like Colgate PreviDent® 5000 Dry Mouth or Colgate PreviDent 5000 Booster Plus, which both contain 5000 ppm fluoride for advanced caries protection. Patients with xerostomia can benefit from PreviDent 5000 Dry Mouth, as it offers the same high-fluoride protection with no SLS and is formulated to appeal to patients with xerostomia. Additionally, you can periodically apply a 5% sodium fluoride varnish, like Colgate PreviDent Varnish. This is recommended up to 4 times per year for patients at increased risk for caries.
Chlorhexidine gluconate mouth rinses can help to treat gingivitis. However, many commercial preparations contain alcohol, which can irritate the oral mucosa in patients undergoing therapy. Instead, you can prescribe an alcohol-free product like alcohol free Colgate PerioGard.
Cancer treatment is incredibly demanding, both physically and emotionally, so your patient needs to feel that you understand this and you’re in their corner.
Keep in mind that even “small” tasks like daily oral care can feel overwhelming during cancer treatment. Support your patient with regular check-ins and lots of positive reinforcement. If they fall behind on oral hygiene, empathize and support, rather than scold.
During such a difficult time, reminding your patient that they have a caring team standing behind them can make a big difference.
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