Oral Care Basics During Cancer

Managing the oral side effects of cancer treatment.

The cells of the human body

The human body is a network bound by trillions of cells. New cells are made through a process called cell division where one cell becomes two, two cells become four and so on. There are hundreds of types of cells in the human body: brain cells, muscle cells, skin cells, fat cells and blood cells, just to name a few.

When cells divide, they make a copy of all their genes into the new cell―much like a photocopy. To ensure all the genes copied are identical, there are checkpoints to check the quality of the copy. If the checks fail, normal cells will stop dividing until the conditions preventing a perfect copy are corrected. However, abnormal (cancer) cells created due to heredity or environmental conditions do not always obey the rules of the checkpoints, so these cells can continue to grow and divide even if the copy is damaged.

Cancer occurs when damaged or abnormal cells grow and multiply uncontrollably, forming a lump (tumor). Sometimes these abnormal cells move to and grow in different parts of the body (metastasize). Some growths are not cancer; they don't invade nearby tissue or spread to other parts of the body and are called benign.

How does cancer affect oral health?

Certain cancer treatments, such as radiation and chemotherapy, can cause mouth sores, also known as oral mucositis. The sores may occur inside your cheeks or on your:

• Gums
• Tongue
• Roof of the mouth
• Floor of the mouth

Oral complications may be mild or severe and may impact your ability to eat (causing weight loss) and your day-to-day life. Be sure to talk with your doctor or dentist about any oral complications that you may have during your cancer treatment.

Lower your risk

Your risk of developing oral mucositis depends upon the type of treatment you have and the dose. It is impossible to predict if you will experience mucositis, but you can reduce your risk. It is vital to see your dentist before beginning cancer treatment to address any existing issues with your mouth, such as tooth decay or gum disease. Your dentist may also monitor your teeth, gums and surrounding tissues during your cancer treatment.

• Tell your doctor or dentist if you have a history of cold or canker sores. They may suggest a medication to prevent them from happening during your treatment.
• Brush after every meal and before bed with a soft bristled toothbrush, replacing the toothbrush every 3-4 months, or as needed.
• Floss daily.
• Stop using tobacco products or vaping.
• Talk to your dentist about the need for an oral rinse or oral irrigation.

How to manage symptoms in the mouth during cancer treatment

The most common side effects during cancer treatment are:

• Dry mouth. Manage dry mouth by taking sips of water throughout the day, use a humidifier in your room or chew sugar-free gum.
• Painful/sore areas in the mouth or throat. Your doctor may prescribe a numbing agent for relief.
• Difficulty swallowing. Many with this condition choke on their food or on liquid while eating or drinking and, as a result, they may avoid eating, lose their appetite or skip meals. The following are suggestions to help with swallowing:
  • Incorporate sauce into the meal.
  • Dip dry foods into soup, broth or other liquids.
  • Puree the food.
  • Drink water, milk or juice with the meal.
  • Avoid consuming alcohol.
  • Seek emergency care if you are having trouble breathing, notice pale/bluish skin or feel faint.
  • If you are alone and choking, try to free the object by coughing it out. If this does not work, you can perform the Heimlich Maneuver on yourself.
    • Form a fist with your strongest hand and clasp your other hand around it.
    • Place the thumb side of your fist just above your belly button.
    • Thrust your hands inward and up (repeat several times if necessary).
    • You can add additional force with a stable object nearby if your hands aren't enough. Look for a stable object that is about waist high (chair, table or countertop). Bend over on the object with your hands still in position and drive your body against it.

Contact your dentist or doctor if you have a fever, new sore areas in the mouth and throat or bleeding of your gums and mouth while brushing, flossing or eating.

Things to avoid during cancer treatment

If you are experiencing mouth pain during cancer treatment, avoid:

• Foods that are too spicy, salty, citrusy, hard, coarse, dry, cold, hot or strong in spices
• Mouthwash that contains alcohol
• Over the counter drugs that are not recommended
• Hot or cold foods. Eat foods that are slightly warm

To effectively manage your treatment, follow the directions from your doctor and dentist. Call them if your mouth hurts and you are unable to resolve the symptoms.

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Note: The information in this article is not meant to replace the advice of your dentist or another licensed healthcare professional. Talk to your dentist for any specific dental advice.