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Your Mouth During Oral Cancer Treatment

Each year, many people are treated for oral cancer. Chemotherapy treatments for cancer and radiation treatment for head and neck cancer often cause oral complications. About half of chemotherapy patients experience oral complications, particularly those being treated for leukemia and those who receive bone marrow transplants.

These oral cancer complications significantly decrease quality of life and can lead to serious systemic problems, complications, septicemia, eating difficulty, nutritional deficiencies, and dehydration. The following are descriptions of oral problems that can occur with cancer treatment:

Infections of the oral cavity can be caused by the usual organisms found in the mouth or by opportunistic organisms not usually found in the mouth. These infections can lead to serious systemic infections. The risk is higher for individuals who have reduced numbers of circulating white blood cells (leukopenia).

Candidiasis is the overgrowth of candida albicans, a fungal organism that normally is found in the mouth.

Musositis is painful and causes problems with eating and speaking. Soft tissues are red, ulcerated, and inflamed. The oral cavity is susceptible to mucositis because of its high cell turnover.

Hemorrhage or bleeding of the oral cavity can occur when clotting factors are affected and during bone marrow suppression.

Xerostomia or dry mouth is associated with decreased, sticky, or thickened saliva. Dry soft tissues are more susceptible to pain, infection, and irritation. Dry mouth is associated with a high number of dental caries.

Altered taste or loss of taste is common and is related to the reduced saliva volume, as well as its altered consistency.

Developmental abnormalities such as altered craniofacial growth and dental/tooth deformities occur with cancer treatment during developmental periods.

Trismus, fibrosis, and scarring of the chewing muscles and temporomandibular joint (TMJ, the joint that moves the lower jaw) that were in the radiation field may make opening the mouth difficult and limited.

Osteoradionecrosis (soft tissue and bone necrosis) can be spontaneous or secondary to trauma, extractions, or dental prostheses. The radiated tissues have reduced blood vessels, decreased cells, and decreased oxygen that predisposes the tissues for years after the radiation therapy to this compromised state that makes oral surgical procedures risky. Therefore, prior to and post oral surgery, patients who have had head and neck radiation may require hyperbaric oxygen treatments and antibiotic therapy to prevent osteoradionecrosis.

Radiation dental caries is a term used for rapid tooth demineralization and severe cavities that occur with head and neck radiation, particularly when the parotid, submandibular, submental, or submaxillary salivary glands are in the radiation field.

Pain accompanies oral infection, mucositis, xerostomia, trismus, dental caries, osteoradionecrosis, candidiasis and dental caries.

To reduce risk for oral cancer complications, a dentist should perform a pretreatment oral examination, as well as necessary dental treatment before initiating chemotherapy or head and neck radiation. It is important that the dentist consult with the physician or oncologist before dental treatment because people who are about to undergo treatments for cancer may be immunosuppressed or thrombocytopenic (blood clotting disorder).

The goals of the dental examination and dental treatment are to eliminate existing or potential oral infection and potential for trauma. Infection, potential infection, and trauma can be associated with soft tissue lesions, decayed or broken teeth, dental implants with poor prognosis, periodontal disease, and poorly fitting full or partial dentures. The oral examination consists of hard and soft tissue examinations, periodontal assessment, and necessary radiographs. Since long-term effects of head and neck cancer radiation treatments will be harmful to the bone in the radiated area (field), patients who undergo head and neck radiation treatment should have teeth and implants with potential for future problems considered for extraction before the cancer treatment begins.

The patient's ability and interest in maintaining oral health, as well as the ability to comply with an oral cancer prevention routine, should be factors that are considered as the dentist develops and discusses dental treatment recommendations with the patient.

By Denise J. Fedele, DMD, MS

Oral Health Care And Menopause

When women enter menopause, changing hormone levels bring about a variety of symptoms and raise new oral health issues. Women and their doctors must consider the entire range of physical and emotional health implications, including their oral health.

Bone Loss and Oral Health

As natural levels of estrogen decline, women may find themselves at risk for loss of bone density. Jawbones are no different; these structures hold our teeth in place, and loss of jawbone density can lead to tooth loss.

When women lose teeth, there are other immediate considerations. One is the potential loss of nutrition, as people with fewer teeth or with problem teeth tend not to eat well. Second is the loss of confidence or self-esteem that results from any cosmetic changes to our bodies. And third, the financial cost of replacing one or more teeth can stretch even the best-planned budget.

Gum Disease and Tooth Decay

Hormonal changes also can have an impact on the health of gums and teeth. Women may find that their gums become inflamed and bleed easily, and may discover that their teeth are more cavity-prone. Both gum disease and tooth decay can result in losing teeth, another good reason to consider your oral health during this significant time of your life.

Signals of Change

Women may notice a burning sensation or dryness in their mouths. They also may discover that these changes cause food to taste different, leading to a loss of appetite. Be alert to an appetite loss that persists, particularly if you begin to lose weight.

If gums become inflamed or bleed easily, alert your dentist who will check for early signs of gum disease. A receding gum line may indicate bone loss in your jaw, so ask your dentist to examine your mouth and jaw carefully.

Preventive Medicine

Both you and your doctor should discuss prevention techniques, including calcium and vitamin D supplements, and replacement therapy for hormones. These are personal decisions that vary from woman to woman, and your doctor is best equipped to advise you.

What you can do is pay attention to your nutritional needs. Make sure you eat a wide assortment of healthy foods. Fruits and vegetables provide essential vitamins, minerals, and other nutrients. Exercise also is important to maintain your oral health and a healthy lifestyle.

Finally, keeping tabs on your emotional health as you enter menopause is important. A healthy outlook on life enables women to value themselves and seek the care required including: maintaining good oral health, seeing the doctor and dentist regularly, and focusing on healthy eating and exercise.

By Brian J. Gray, DDS, MAGD, FICO