Oral Care During Treatment
Regular oral assessment and care are necessary during cancer therapy. Planning and communication between the oncology and dental teams can minimize the risk of oral complications and maximize the efficacy of dental and supportive care. Specific oral health considerations to remember when treating patients with chemotherapy or radiation include the following:
Treat infections and ulcerations. Ulcerations and dry, friable tissues are prone to trauma and infection. Culture suspected infections and work with the dentist to manage the condition.
Provide dietary counseling. Instruct the patient on the importance of healthy eating to maintain nutritional status, emphasizing the need to avoid foods that irritate sore tissues or cause dental decay.
Teach exercises to reduce trismus. Fibrosis may develop if the chewing muscles are in the direct field of radiation. Work with the dentist to teach patients how to exercise and stretch these muscles properly.
Consider oral causes of fever. Fever of unknown origin may be related to an oral infection; dental consultation may be appropriate.
Schedule dental appointments carefully. Have the patient schedule appointments for times when blood counts will be at safe levels. If oral surgery is required, it should be performed at least 7 – 10 days before the patient receives myelosuppressive chemotherapy.
Determine hematologic status. Conduct blood work 24 hours before dental treatment to determine whether the patient’s platelet count, clotting factors, and absolute neutrophil count are sufficient to prevent hemorrhage and infection.
Evaluate need for prophylactic antibiotic treatment. If the patient has a central venous catheter, determine if antibiotic prophylaxis (www.americanheart.org) is needed before dental treatment.
Follow-Up Oral Care
Once all complications of chemotherapy have resolved and blood counts have recovered, most patients may resume their normal dental care schedule. It is essential that the dentist know the patient's hematologic status before initiating any dental treatment or surgery. Advise the dentist if a patient has received intravenous bisphosphonate therapy due to its association with osteonecrosis of the jaw.
Once radiation therapy has been completed and acute oral complications have abated, the patient should be evaluated by a dentist every 4 to 8 weeks for the first 6 months. Thereafter, the dentist can determine a schedule based on the needs of the individual patient.
Long-Term Problems Following Head and Neck Radiation Therapy
Radiation therapy to the head and neck can cause oral complications that continue or emerge long after treatment has ended. Although patients may no longer be under an oncologist's care at that time, what they learn about oral health during their treatment will affect how they deal with subsequent complications. Patients receiving radiation therapy need to know about its risks:
Radiation treatment carries a lifelong risk of osteonecrosis, xerostomia, and dental cavities.
Because of the risk of osteonecrosis, people who have received radiation should avoid invasive surgical procedures (including extractions) that involve irradiated bone.
Radiation to the head and neck may permanently reduce the quantity and quality of normal saliva, so ongoing oral care is crucial to optimize oral health. Daily fluoride tray application, good nutrition, and oral hygiene are especially important.
Radiation may alter oral tissues, so dentures may need to be reconstructed after treatment is completed and the tissues have stabilized. Some people may not be able to wear dentures again.
Craniofacial and dental structures may develop abnormally in younger children who receive high-dose radiation to those areas.
Helping Patients with Xerostomia
Encourage patients to sip water often.
Suggest using liquids to soften or thin foods.
Recommend using sugarless gum or sugar-free hard candies to help stimulate saliva flow.
Suggest using a commercial saliva substitute.
Consider prescribing a saliva stimulant.
Helping Patients with Mouth Pain
Prescribe topical anesthetics and systemic analgesics.
Detect and treat oral infections early.
Encourage patients to avoid eating irritating or rough-textured foods.