Thursday, January 8, 2015
MSK dentist Sae Hee Kim discusses how cancer treatment can affect the teeth and gums and offers tips on how people with cancer can care for them.
After a cancer diagnosis, few people probably immediately consider the potential effects of treatment on their dental health. But the mouth, gums, and teeth are particularly vulnerable to chemotherapy used to treat many types of malignancies, as well as to radiation or surgery treatments for head and neck cancers.
Fortunately, many oral reactions to cancer therapies are temporary, and Memorial Sloan Kettering doctors can teach patients what to expect during their own treatment and explain ways to minimize problems. Strategies can include frequent brushing and flossing; using fluoridated toothpastes and rinses; and, of course, getting regular dental checkups.
“Good oral health is probably not one of the first things people think about when going into cancer treatment,” says Sae Hee Kim, an MSK dentist who specializes in dental oncology. “But pretreatment evaluation and intervention are key in preventing or managing any dental complications associated with chemotherapy or radiation therapy. I can’t stress that enough.”
We asked Dr. Kim to detail the most common oral side effects of cancer treatments, both short and long term, and to offer suggestions to reduce their impact.
Which patients are most at risk for dental problems?
Our team typically evaluates patients before they receive high-dose chemotherapy or a bone marrow or stem cell transplant. We also evaluate patients undergoing radiation therapy for head and neck cancers.
A pretreatment evaluation establishes a good baseline dental status and allows us to take care of teeth with extensive cavities and/or periodontal disease by providing cleanings, restorations, root canals, and extractions as needed. We also eliminate or adjust anything that might cause trauma to the mouth during treatment, such as sharp teeth and ill-fitting dentures. We often work in conjunction with the patient’s local dentist to complete all necessary procedures prior to cancer treatment.Back to top
What types of oral side effects might occur during cancer treatment?
Some of the most common consequences of chemotherapy or radiation to the head and neck area include mucositis, which is inflammation or ulcers in the mouth; mouth infections and bleeding stemming from suppressed immune function; salivary gland dysfunction resulting in dry mouth; taste changes; and pain. These side effects, however, are usually temporary and may resolve on their own after treatment is complete.Back to top
What long-term dental problems can occur?
One common chronic or permanent effect prevalent among people who’ve been treated with radiation for head and neck cancers is dry mouth. Also known as xerostomia, dry mouth can lead to increased risk for tooth decay because of changes in the quantity and quality of saliva. Saliva helps clear food from teeth, plays a role in maintaining the balance of bacteria in the mouth, and helps teeth to “re-mineralize,” or re-harden.
For those with dentures, a lack of saliva may cause difficulty or discomfort in wearing them. Also, we advise patients to avoid extractions or other invasive surgery in jaw areas that received a certain level of radiation therapy to avoid potential healing complications.Back to top
How can the effects of chronic dry mouth be diminished?
Since we can’t prevent the drop in saliva production during chemotherapy or especially radiation, we prescribe prescription-strength fluoride toothpaste to make teeth more resistant to decay. We also recommend patients avoid moistening their mouths with sugary or acidic drinks and do this with water instead.
We suggest patients avoid sugar-containing gums or candy, opting instead for products that are sugar free or made with xylitol, which inhibits tooth-decaying bacteria. Watching between-meal snacks is a smart idea, since teeth become more cavity-prone with greater exposure to sugary foods and drinks. Patients should brush after every meal when possible and avoid alcohol-based mouth rinses. Lastly, various over-the-counter saliva substitute products can also help relieve dry mouth.Back to top
How can surgery for head and neck cancer impact oral health?
Depending on the nature of the surgery, patients may have some muscle and joint stiffness, with reduced ability to open their mouth. Maintaining adequate oral hygiene may become more challenging, but we can review ways to assist with that. After head and neck surgery, dentures or another prosthesis may be made to help patients chew and swallow better.Back to top
Do you have any general advice for patients to help maintain their dental health after they’ve completed their cancer treatments?
We emphasize the importance of routine dental exams, brushing a minimum of twice a day, flossing regularly, using fluoridated toothpaste, and being mindful about healthy diet choices. For patients with chronic dry mouth, we advise more frequent checkups and the use of prescription-strength fluoridated toothpaste.Back to top
How do you convince patients to prioritize their mouth, gum, and tooth care after a cancer diagnosis despite the many demands on their time and attention?
We highlight that timely management of dental health after diagnosis is especially important in avoiding cancer treatment delays and minimizing potential complications. Oral health greatly influences their ability to maintain adequate nutrition, so they’re able to eat well; speech, so they can articulate their words; and appearance, so they can smile with confidence. It positively impacts their overall health and sense of well-being.Back to top