Dental issues when doing chemo or having head and neck radiation

Wheaton family dental practice

 Solutions to common dental issues during chemo or radiation treatment

This post is for patients that are or are about to undergo chemo and/or head and neck radiation.

Pre Cancer Treatment=dental examination for clearance
This is an exam to document and remove all pre-existing conditions that could lead to complications during cancer therapy.
  1. The biggest issues are gum disease and infected teeth.
  2. It is important to get a cleaning prior to treatment.  Those that are prone to getting cavities will get a fluoride varnish
  3. Everyone will be made custom fluoride trays to start wearing with NaF gel at night.
  4. People that get cold sores will start with a prophylactic oral antiviral regimen throughout treatment, that’s Valtrex.
  5. Any teeth that need to be removed or any infection that needs treating needs to be done 2 weeks prior to the head and neck radiation or chemo.
  6.  A custom radiation guard may be asked for by the oncologist but I’ve never been asked for one to be made.

During Cancer Treatment (most of these rules are here to help prevent cavities that occur.  stomach acid from vomiting can destroy the teeth very quickly and the dry mouth that occurs eliminates the bodies natural defense of saliva)  The stomach acid and dry mouth will cause a massive amount of cavities if something is not done.

  1. Alcohol free CHX rinse 2-3 times a day
  2. 5000ppm Fl toothpaste at night or fluoride tray.
  3. Rinse mouth with solution of baking soda and saltwater, especially after vomiting to reduce pH from stomach acid. That’s .5 tsp salt .5 tsp baking soda 1 quart water.  This can be used every 2 hours to help sooth tissue if mouth sores develop.
  4. Teeth should be professionally cleaned every 8 weeks during cancer treatment, although mouth sores may make this impossible.
  5. Chew xylitol gum!!!

 Chemo mouth sores!!

Chemo induced mucositis/stomatitis (mouth sore) is inflammation and ulceration of the mucous membranes in the mouth and will be painful, increase your risk of infection, and comprise your nutrition intake. This is a common side effect of chemo for gastrointestinal cancer, head and neck cancers, and leukemia. (similar info here)
  1. Individuals with mucositis should avoid tobacco, alcohol, and caffeine.
  2. Eat a soft bland diet; avoiding hot (temperature), acidic, spicy, course, and dry foods.
  3. Pain can be extrutiaing and hopefully can be managed with Tylenol with codeine or stronger when necessary
  4. Fungal infections often occur on top of the mucositis and will require taking both oral and topical antifungal medication.
  5. Finally a “Magic Mouthwash” or mucositis cocktail should definitely be used.  These are made by specially trained pharmacists.  Different pharmacists use different drugs, but almost all have a combination of an anesthetic to numb the mouth, a coating agent to soothe the tissue, an antifungal, and occasionally a topical steroid. Caphosol is another rinse that is used.  We often use Rincinol and have had patients say they prefer this to the Magic Mouthwash.  OraMagic RX is similar.

Fungal infections and chemo or radiation

When treating a Candida infection, both the patient and the denture should be treated, when applicable.

  1. Fluconazole 100 mg, twice a day, is an effective means of treating a yeast infection in the patient that can be used long term, if necessary.
  2. Nystatin suspension is not recommended due to its high sugar content.
  3. Clotrimazole 10 mg troches, five times per day for two weeks
  4. Mycostatin 200 mg oral pastilles, four times per day for two weeks, can be used.
  5. Dentures can be treated using bleach diluted in water (2 teaspoons per 1 cup water) for 30 minutes each day.

Good Luck and stay positive!  If there is ever anything we can do to help ease your pain and suffering please let us know.

Additional information.  Only emergency dental work will be done when ANC is below 1000/mm3 and antibiotic prophylaxis if between 1000-2000/mm3.  No dental surgery can be done if platelet count is below 50,000/mm3.  A normal platelet count ranges from 150,000 to 450,000.  I am considering recommending these Antioxidant products from perioscience.