November is Oral Cancer Awareness Month
October was National dental hygiene and breast cancer awareness month. November is oral cancer awareness month. Today, we will discuss oral health complications for cancer patients and treatment guidelines that you need to know.
How much do you know about cancer therapies unless we have experienced it?
Hopefully, this podcast will help educate and guide us to understand what patients with cancer, pre, and post-treatment, may face.
Different guidelines are recommended for cancer patients that start with an interdisciplinary relationship with the oncologist. We want to make sure that we are on the same page as the patient, the oncologist, and the oncology team to ensure a cohesive plan on overall health. There will be side effects with different medications that play a significant role in patients’ long-term oral health conditions. Cancer treatment and therapies are recommended and prescribed to patients based on their tolerance.
Breast Cancer
For breast cancer, the hormone status is key. There are different protocols recommended for patients with breast cancer that are dependent on if you are in pre-menopause or post menopause, that play a role in how your breast cancer treatment will begin. Besides major surgery, your systemic treatment pre and post will be dependent on these two factors. A premenopausal patient will more than likely be treated with anti-estrogen therapy medications and systemic therapies such as chemo or hormone therapy, common anti-estrogen therapy such as tamoxifen, and hormone therapies, also known as Lupron. This is supposed to help reduce and block estrogen production, so it doesn’t allow the receptors to stimulate or signal new tumor growth. This highly reduces the risk of breast cancer reoccurrence in patients. If a patient is post-menopausal, they don’t have estrogen being produced by their ovaries anymore because they’re in menopause. Still, your body may have one last attempt to make estrogen. Aromatase does release small amounts of estrogen in patients who are post-menopausal and going through breast cancer treatment. This is why they are often prescribed systemic medications such as AI as API’s are known as aromatase inhibitors. Often these medications are combined with bisphosphonate because AI medications put patients at risk for bone density issues. Patients lose their bone density and the mass in their bones when on aromatase inhibitors. Bisphosphonates put patients at a higher risk for osteoporosis. So that’s why these medications and understanding the mechanism makes a big difference in the dental treatment of patients with breast cancer. We want to be able to see them back more frequently. Every three months is recommended to monitor, assess and treat any significant oral health concerns.
Now that we’ve discussed the medications and the mechanism of action of patients with breast cancer let’s talk about the oral complications and side effects of these medications. Breast cancer treatments often put a big damper on patients’ oral health conditions. Most patients will report they have dry mouth and oral and pharyngeal mucositis, gingival bleeding, or gingivitis; due to patients’ immunocompromised bodies. They are also at higher risk for fungal and bacterial infections, including periodontal diseases. There are different things that we need to know to look out for, and are common side effects and oral complications of being on these systemic medications. Tamoxifen does have side effects; patients report increased jaw pain due to bruxism and clenching. We also want to look out for any changes in patients’ oral health conditions during treatment: Mouth breathing, dry mouth, bad breath, bleeding, sores in the mouth or throat, clenching, grinding headaches, Jaw soreness, and muscle aches.
Oral Complications
So now that we talked about oral health complications let’s talk about dental guidelines for our patients who are about to start undergoing or after breast cancer treatment. So ideally, it is good to know that we have a guideline in place to better communicate and work with our patients before, during, and after their breast cancer treatments. So ideally, we want to get medical clearance from the oncology team or any instructions that the oncology team would like us to provide for our patient. This helps us work cohesively together so that we can provide outstanding results during their entire treatment process. Sometimes we want to ask for a neutropenia count, the white blood cell count, to make sure that our patients are in a good position to have any dental work done. Also, sometimes patients receiving chemotherapy or any intravenous treatment through a port cat or intravenous cat will revert and will require a prevent, so the premedication will help reduce any risk of having any infections due to being immunocompromised. Also, another important that that is good to know is that breast cancer-related meta Stacy’s can present as radiolucency in the mandible in the next cell, so taking the appropriate amount of X rays at the appropriate time will help us stay ahead of any changes. So taking x rays can help us detect and look for any job changes, especially AI patients. Who are at risk for bone density changes? Patients who also have had any lymph nodes removed from their underarm, the axillary area, are at risk for lymphedema. So it’s good to know that in the dental office if a patient is getting ready to have a procedure done, that we don’t take blood pressure readings on the arm that the patient has had lymph nodes removed, so we don’t want to put them at risk for having any lymphedema. And sometimes dental offices will still do traditional blood pressure cuffs, so it’s good to know to do either a risk of or take the blood pressure cuff on the other arm. Hopefully, this video will help dental professionals and breast cancer patients who are undergoing any therapies know what to look out for to feel more confident in their treatment and be more hands-on when it comes to dental care in the office for breast cancer patients. So if you have any questions or if you have any comments regarding breast cancer treatment and oral complications in the dental office, if you have experienced anything different than what I’ve talked about today, I’d love to hear about it in the comments.
Common Side Effects
Oral side effects are common in most cancer patients. Therefore, preventing and controlling potential oral side effects helps them the most as they prepare and journey through this challenging season. In addition, cancer patients are more likely to continue their treatment as prescribed when the side effects are addressed early and prevented whenever possible. This preparation provides a better quality of life during this timeframe.
Complications of Chemotherapy
- Inflammation
- Easy bleeding in the mouth
- Inflamed mucous membranes in the mouth
- Infections that happen in the mouth can travel through the bloodstream and reach cells all over the body
- Taste changes
- Dry mouth
- Pain
- Malnutrition
- Dehydration
- Tooth decay and gum disease
- Slow healing and infection. Chemotherapy and radiation stop cells from dividing, slowing the healing process in the body and the mouth
- Decrease in white blood cells, weakening the immune system
- Oral Mucositis
- Fungal Infection/ Candidiasis
Dry Mouth
Dry mouth occurs when salivary glands don’t produce enough saliva. Salvia is essential and is needed for eating, swallowing, tasting, and chewing. It also contains enzymes, minerals, and nutrients that bathe and protect the teeth.
- Salvia washes the mouth, cleans the teeth and gums, preventing acid from pooling and eroding teeth.
- Radiation therapy can damage salivary glands, causing them to function less or not at all.
- A stem-cell transplant can also damage salivary glands.
- When saliva is absent or drastically reduced, the mouth can quickly get sores and irritation, inflammation, and swelling.
- The risk of tooth decay rises when someone has a dry mouth.
Oral Mucositis
Oral mucositis is swelling and damage of the mucous membranes that line the inside of the mouth and affect other parts of the gastrointestinal tract. Oral mucositis induced by chemotherapy will self heal in 2 to 4 weeks when no infection is present.
- Oral mucositis appears red, like a burn-type of sore or ulcer. Swelling the other tissues in the mouth like the gums, the tongue, the roof of the mouth, the floor of the mouth, the lips, and inside the cheeks can also occur.
- Mucositis can cause pain, infection, and unusual bleeding, making oral care challenging or ineffective.
- Clean your mouth every 4 hours and more often if the mucositis worsens.
- Use a soft-bristled toothbrush
- Replace your toothbrush often and keep a bulk supply available to make this process easier to do.
- Use water-soluble mouth gels to help keep the mouth moist; an example of this would be Xyligel.
- Theragel is what I used during this challenging time. For mouth sores.
- Pain Relief for Mucositis Theragel See link below
- Topical therapies for pain.
- Rinse before putting medicine on the gums or lining of the mouth.
- Wipe the mouth and teeth gently with saltwater-soaked gauze to remove food debris.
When the mouth lining is damaged and perforated, infections can occur more quickly when in conjunction with a weakened immune system. Oral mucositis damages the lining of the mouth, which provides a gateway for bacteria and viruses to get into the bloodstream quickly. In addition, chemotherapy weakens the immune system, so even good bacteria is a potential problem when wounds and open sores are in the mouth. Finally, infections occur more often during chemotherapy as white blood cell counts get lower. Those with low white blood cell counts for long periods have a higher risk of serious infections—treating oral disease before chemotherapy is vitally important.
For patients who experience gum disease while also receiving chemotherapy, treatment may include:
- Using medicated mouth rinses.
- Using peroxide mouth rinses.
- Brushing and flossing.
- Monitoring closely until a deep cleaning is a viable option.
Fungal Infection
The oral environment of the mouth typically contains fungi that can live in harmony there without causing significant issues. However, when the immune system changes the mouth too rapidly, fungi can overgrow and become an infection to be treated.
- Antibiotics and steroid drugs are utilized often when a cancer patient has a low white blood cell count.
- Antibiotics and steroid drugs rapidly disrupt the oral microbiome, making it easier for fungi to overgrow.
Candidiasis is a fungal infection common in cancer patients receiving chemotherapy and radiation.
Symptoms include
- Burning.
- Pain.
- Taste changes.
Treatment includes
- Antifungal mouthwash.
- Antifungal palatal lozenges.
- Prescription drugs are used when oral therapeutics don’t work.
- All oral appliances must be included to treat the fungus: dentures, mouth guards, or removable partials.
Malnutrition
Loss of appetite can lead to malnutrition. With any cancer treatment, there is a risk of malnutrition. When the side effects are severe enough, patients may completely lose their desire to eat or find eating too painful or be plagued with nausea and vomiting that render food an unappealing afterthought.
Hiring a nutritional counselor may be the most practical option during this challenging season of therapy.
Every patient is different, and so is everybody. So many factors affect how a person can handle cancer therapy—their environment, mentality, physicality, and spirituality all play significant roles in active care and recovery. If you or anyone you know is going through the throes of chemotherapy or radiation, be sure they have a solid support team because when they are at their weakest physically, they will need help the most.
If you were looking for effective and healthy ways to establish oral care routines with your family, you found the right place.
Oxygen plays a vital role in energy production via an electron transport chain (ETC) system, an essential component of cellular respiration. Oxygen acts as a final electron acceptor that helps move electrons down a chain that results in adenosine triphosphate production to help in repairing cells.
We will talk more about this in future podcasts—so much information. I like to learn in 10 -15 segments, so we will be covering taking Ownership of your health and what that means to you and your family over the next few months. Stay tuned for our next episode about oxygen what you need to know! I feel it all starts with knowledge and your mouth. Thanks for listening if this was helpful, leave a comment and share
A Healthy Mouth is a Healthy Body and a Happy Healthy Life.
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