Friday, September 5, 2014

Oral Cancer - Part 2: Treatment and Dental Care

Because cancer treatment can affect the oral tissues it’s important to know about the various side effects and how these conditions can be managed. Often preexisting conditions can complicate treatment and will require an organized and systematic approach to therapy.

Oral complications from radiation to the neck and head areas can compromise quality of life and sometimes can be so debilitating that treatment is postponed, moderated at lower doses or even cancelled all together.

There are some things that can be accomplished prior to chemotherapy that will help to increase the success and comfort level of treatment but first it’s important to understand how chemotherapy and radiation work.

Chemotherapy works by stopping or slowing the growth of cancer cells which grow and divide quickly. But it also affects the other cells of the human body that divide quickly: blood producing cells, hair cells, cells of the mucous membranes of the mouth area and of the digestive system. These can have short term effects like hair loss, anemia, nausea, vomiting, diarrhea and infections in the mouth. The severity of chemotherapy will vary individual to individual and sometimes can be less severe. The most important thing to realize is that hair, mucous membranes, and blood production will all repair themselves after treatment. The adverse effects of chemotherapy can present themselves later on, particularly for younger people. Because sperm and eggs can be damaged from treatment it’s important to practice oral contraceptive use.


Radiation therapy will work in two ways
  • It will stop or slow the growth of a tumour
  • It will shrink the size of the tumour, reduce some symptoms and relieve pain.

Doctors want to provide the right amount of radiation while protecting the healthy cells around the area so the size of the beam and the strength is determined on a case by case basis.

Oral complications that are common to both chemotherapy and radiation:

  • Infection: These can include bacterial, fungal and viral infections resulting from xerostomia (dry mouth), myelosuppression and damage to the mucosa.
  • Xerostomia and salivary gland dysfunction: Dryness can effect chewing, speaking and swallowing. Saliva can cleansing and anti-microbial properties and if it’s effect is diminished the number of dental caries can increase rapidly for those succeptible.
  • Taste Alteration: The changes in taste can cause food to be anywhere from tasteless to unpleasant
  • Nutritional Compromise: Because of the difficulty eating food, loss of taste the quality of nutrition can become compromised
  • Oral mucositis: Inflammation, tissue sloughing and increased sensitivity
  • Abnormal dental development: If younger than the age of 9 then this becomes a major concern in jaw bone development and tooth development.
  • Radiation caries: cavities that result because of changes in either the quantity or quality of saliva
  • Trismus and tissue fibrosis: When the muscles of the masticatory system restrict the normal ability to open the mouth.
  • Osteonecrosis: Blood vessel compromise and necrosis of the bone

Proper planning and preventative measures will increase the likelihood that a patient will complete their treatment and decrease the severity of oral complications while minimizing pain.

The role of Pretreatment dental care:
  • Identify and treat existing infections, both periodontal and tooth related. Including a cleaning and treating tooth decay.
  • Remove teeth that have excessive bone loss associated with deep pockets around the gums to prevent future related bone necrosis from tooth removal at least 2 weeks prior to treatment.
  • Conduct a prosthodontic evaluation of any removable appliances and make sure they are well fitting to prevent “tissue burn” from the prosthesis rubbing aggressively. Ideally the prosthesis should not be worn at all.
  • Remove orthodontic bands and brackets
  • Supplemental fluoride using custom made trays and a daily 10 minute application of 1.1% neutral fluoride gel.
  • Obviously the cessation of alcohol and tobacco products will reduce the chance or current and future complications
  • Use an extrasoft toothbrush and avoid brushing aggressively
  • Avoid mouthwashes containing alcohol
  • Avoid candy and gum unless they are sugar free
  • The use of an appliance, like the therabite, will help to prevent the stiffening of jaw muscles
  • Avoid spicy foods
  • Sip water frequently
  • Suck ice chips or sugar-free candy
  • Use a saliva substitute rinse or spray if needed

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