Tips for Maintaining Oral Health through Cancer
If someone you know is fighting cancer and dealing with oral health issues, such as mouth sores, they’re not alone. Oral mucositis is a complication that can result from cancer itself or from its treatment.
Oral problems are common in people with cancer, particularly head and neck cancers. Most head and neck cancers begin in the cells that line the mucosal surfaces in the head and neck area (i.e., nasal cavity, sinuses, lips, mouth, salivary glands, throat or voice box). In addition, cancer treatments, such as chemotherapy and radiation therapy, can contribute to oral complications.
What is oral mucositis?
Oral mucositis is an inflammation of mucous membranes inside the mouth. These membranes become reddened, swollen and painful. For some, this leads to mouth sores, small cuts and/or ulcers in the mouth, gums or on the tongue. The sores may be bright red or have small white patches in the middle.
Possible causes of oral mucositis, or mouth sores, include:
- Some cancers (e.g., oral, throat, esophageal and laryngeal)
- Some cancer treatments (e.g., chemotherapy, radiation to the head and neck, stem cell transplant)
- Some medications
- Infection in the mouth
- Xerostomia (dry mouth)
- Poor oral hygiene
- Poor diet (lack of protein and/or vitamins)
- Excessive use of alcohol and/or tobacco
- Autoimmune disease
With chemotherapy, mucositis may occur three to 10 days following treatment and heal by itself within two to four weeks. Mucositis caused by radiation therapy sometimes lasts six to eight weeks or longer, depending on the treatment regime.
Other Oral Health Complications
In addition to oral mucositis, other health problems can develop from cancer and/or its treatment. Dry mouth, or xerostomia, occurs when the salivary glands don’t produce enough saliva. Symptoms of xerostomia may include thick or stringy saliva, taste changes, cracked lips, sore tongue, and/or changes in your ability to speak clearly.
Also, pain or difficulty swallowing, or dysphagia, is another complication. Symptoms include pain while swallowing, inability to swallow, choking or coughing while eating, a sensation of food getting stuck in the throat, and soreness, pain and/or swelling in the throat or mouth.
A serious oral health complication which can result from a high dose of radiation to the mandible (lower jaw) is called osteoradioneucrosis. This occurs when the supporting bone around the teeth loses vitality as a result of radiation therapy to the head and neck region.
Why is Good Oral Health Important for People Fighting Cancer?
The side effects of cancer and its treatment can significantly impact quality of life. Cancer and its treatment can weaken the immune system and damage the cells lining the mouth, making the cancer patient more susceptible to infections in the mouth. Additonally, chemotherapy drugs may affect the ability of blood to clot and cause bleeding.
Mouth sores can be painful and make it difficult to chew, swallow and talk. These difficulties can lead to poor nutrition, weight loss and dehydration. When oral mucositis becomes severe, it can also cause bleeding or infection.
Dry mouth can also cause additional complications. Since saliva is needed for chewing, tasting, swallowing and speech, dry mouth can cause difficulty talking or eating. Saliva also helps neutralize acid in the mouth and clean the teeth and gums, thereby helping to prevent infection, mouth sores, tooth decay and gum disease.
Thus, good oral health, including the management of mouth sores, plays an important role during cancer treatment. Sometimes oral mucositis can become severe enough to modify or delay treatment so your mouth can heal. By learning good oral hygiene, a cancer patient can help decrease the severity of mouth sores and other problems.
Tips for Managing Mouth Sores During Cancer Care
If you’re supporting or ministering to a cancer patient, here are some tips to share for maintaining good oral health:
- Visit a dentist. Do this before beginning treatment, particularly if you’re going to receive radiation therapy to the head and neck region. The dentist can check the health of your mouth and teeth and help you understand the oral side effects of cancer treatment. He or she can also help lessen the severity of oral complications like infection, and provide guidance on how to safely keep the mouth clean when blood counts are low. Your dentist can also provide rinses to fight infection in the mouth, medication to increase saliva production, and fluoride treatments to prevent tooth decay.
- Check your mouth daily. It’s important to check your mouth daily to look for any changes. Use a small flashlight and padded popsicle stick to check the inside of your cheeks, the roof of your mouth, your lips, gums and under your tongue. Look for red areas or white patches, which often become sores. Inform your healthcare team if your mouth looks or feels different or if you notice changes in your taste.
- Stay hydrated. Try to drink plenty of fluids (e.g., 8-10 glasses of water) each day to moisten the mouth and avoid dehydration. If swallowing is difficult, sip water or suck on ice chips to keep your mouth and throat wet. You can also chew sugarless gum or suck on sugarless candies to help increase saliva flow. Drinking with a straw may help bypass sore areas in the mouth. Avoid drinking fluids that are very hot or cold, as well as acidic drinks (e.g., orange juice, grapefruit juice) which can irritate mouth sores.
- Eat right. A well-balanced diet can help the body tolerate cancer treatments, fight infection and rebuild tissue. Try easy-to-swallow bland and lukewarm/cool foods. Moisten dry foods with gravy, broth, or milk, or puree food in a blender to make it softer and easier to eat. Ask your doctor if there is a solution you can rinse with to numb your mouth sores or a pain medication you can take before meals. Avoid hard, dry, or crusty foods, or foods that are hot, spicy, or salty. Also, stay away from alcohol, caffeine and tobacco. Avoid acidic or high-sugar fruits and juices, which can make you more susceptible to tooth decay. A registered dietitian can offer advice on maintaining a balanced diet.
- Maintain routine oral hygiene. Good dental hygiene during and after cancer treatment, including proper cleaning of the mouth and teeth, can help reduce complications, such as mouth sores, infections and cavities.
· Tooth brushing. Gently brush your teeth, gums and tongue with a soft bristled toothbrush in the morning, after meals and before bedtime. Before brushing, rinse your toothbrush with warm water to help soften the bristles. Make sure you rinse your toothbrush well after each use and store it in a cool, dry place. Choose mild-tasting, non-abrasive toothpaste with fluoride. Avoid whitening toothpastes.
· Flossing. Floss gently once a day. However, if you don’t usually floss, talk with your doctor before you start. He/she may also give you some guidelines about flossing. Tell your doctor if flossing causes bleeding or other problems.
· Lip care. To prevent dry or cracked lips, keep your lips moist with lip moisturizer or mild lip balm. Avoid petroleum jelly, as the oily base may promote infection.
· Rinsing. Rinsing may help remove bacteria from the mouth, prevent infections and improve healing of mouth sores. Try rinsing with sterile water, or a bland, non-irritating solution, several times a day, particularly after meals and at bedtime. Avoid mouthwashes and other products that contain alcohol. A solution of salt (1/8 teaspoon), baking soda (1/4 teaspoon), and water (one cup) may help clean the mouth, provide moisture for the membranes, neutralize acid, and dissolve thick saliva. Make sure you get your doctor’s approval before trying any rinses.
· Dentures. If you have dentures, remove and clean them whenever possible, such as after meals and at bedtime. Don’t wear loose-fitting dentures that may irritate the mouth and gums. If mouth sores are severe, or dentures fit poorly, don’t wear them.
· Stay on top of pain. It’s important to address pain caused by mouth sores so you can eat well, sleep well and maintain your quality of life. Ask your doctor about topical medications for pain. Some common pain methods for mucositis include creams that dull pain and medications to numb the mouth and/or reduce inflammation. A cool mist humidifier at night can also help keep your mouth and throat moist while sleeping.
· Seek supportive therapies. Various complementary medicine therapies may help you cope better with mouth sores and other oral complications. For instance, a speech and language pathologist can help teach you to swallow more easily. A naturopathic clinician may be able to recommend natural therapies to help with mouth sores, dry mouth and/or difficulty swallowing. In addition, mind-body medicine can help you relax with techniques like distraction, guided imagery, stress management, acupuncture, etc.
Note: This information isn’t intended nor implied to be a substitute for professional medical advice. Please suggest to the cancer patient you work with that they always seek the advice of a physician.