Chemotherapy and Oral Health
Chemotherapy is the administration of drugs which effect the high turnover cancer cells and stop their production as a side effect the drugs also effect the normal high turnover cells in our bodies, this includes the surface cells in our mouth.
Completing dental care before chemotherapy is recommended. If emergency treatment is required for pain or infection it should be carried out right before the next cycle is about to start when white blood cell counts are back up again. This needs to be done with consultation with the patients oncologist.
1 Oral Mucositis.
This has variable occurrence and grades in chemotherapy patients. It is the result of the chemotherapy agents affecting the high turnover cells in the mouth and results in inflammation, and ulceration. This will often lead to pain and difficulty with eating and swallowing. Because the protective mechanisms of the mucosa are reduced there is also an increase chanced of infections both fungal and bacterial. Its severity is determined by age, oral health, sex, type of chemotherapy used, type of tumour(blood neoplasms being more likely to cause mucositis), and frequency of administration. of the chemotherapy.
Prevention. There is little support for any major preventative tactics however excellent oral health and hygiene will reduce the incidence of secondary oral infections
Treatment. Use of palliative modalities such as rinsing with bland solutions for example sodium bicarbonate, biotene and salty mouthwashes helps reduce subsequent infections. Use of alcohol free chorohexidine based mouthwashes (Savacol) throughout the treatment is recommended in patients with periodontal disease. Their effect on the prevention of mucositis is controversial but it does help with secondary infections. The use of Difflam, which has an anaesthetic and anti-bacterial effect has also been effective. Candida infections are also common and should be treated with anti-fungal lozenges. Making sure oral hygiene is continued as much as possible during this time is very important. If a toothbrush cannot be tolerated swabbing with 50/50 Savacol alcohol free can help maintain until the mucositis subsides.
As discussed infection is more likely but also the clinical appearance of infection is changed. There is greater likli-hood of progression of periodontal disease when undergoing chemotherapy and the symptoms are masked. The gingiva may appear normal but the disease progresses rapidly. Patients with periodontal disease also have increased risk of fevers. Where white blood cell count is low prohylactic antibiotics may be necessary. Renewing your toothbrush as often as possible and definitely before each chemotherapy session is excellent way to stop re-introduction of pathogenic bacteria.
Chemotherapy can also reduce the patients ability to clot so a platelet count should be taken or known before treatment is carried out. This does not include routine home care practices where a small amount of bleeding may occur. Brushing with a soft brush and with fluoride toothpaste twice to three times a day is recommended. Platelet count recovers quite quickly after the cessation of chemotherapy.
4. Xerostomia (Dry Mouth)
Chemotherapy agents can have a variable effect on the salivary glands and the production of saliva. About 40% of patients suffer from dry mouth. This can result in an increase in dental caries, increase in periodontal disease, difficulty in swallowing and eating. Treatment with saliva replacing supplements such as Biotene, avoiding spicy or dry chewy foods and using a fluoride mouthwash can help the situation. Sugar free chewing gum such as Recaldent helps to stimulate saliva flow and prevent caries. Lanolin based lip care is also advised. GC mousse has also proved effective in boosting resistance to decay.
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