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An article on this topic is available in this issue of AFP.

Protecting Oral Health During Cancer Therapy

How is cancer treated?

Cancer is treated with radiation therapy (high-energy x-rays that kill or harm cancer cells), chemotherapy (medicine used to kill cancer cells), surgery and bone marrow transplantation (replacement of the spongy tissue inside bones that is killed or harmed by chemotherapy or radiation). Which treatment you have depends on the type of cancer you have.

How do chemotherapy and radiation affect the mouth?

Many different medicines are used in chemotherapy to kill cancer cells. These medicines also harm normal cells, including those in your mouth. Radiation therapy to the head and neck area kills cancer cells along with normal cells in the mouth. Chemotherapy or radiation therapy to the head and neck area can affect your gums, teeth, the soft tissue lining of your mouth and glands that make saliva.

What are some oral problems caused by chemotherapy and radiation?

Chemotherapy has different types of oral side effects depending on the person and the types of medicine used to treat the cancer. These side effects include sore mouth and gums (eating, swallowing and talking may become hard to do), burning or swelling of the tongue, dry mouth, infection and foods not tasting the same as they usually do.

Radiation can cause dry mouth, serious tooth decay, loss of taste, sore mouth and gums, infections and changes in the jawbone. The lining of the mouth can become inflamed and ulcers might form during chemotherapy and radiation therapy. Most patients who have bone marrow transplants have the same oral problems.

How can I prevent adverse oral side effects?

It is important to see your dentist about two weeks before your cancer treatment starts. Tell your dentist that you will be starting cancer treatment. Any major dental work, including removing teeth, should be done before you start treatment. Your dentist should talk with your doctor.

What can I do to keep my mouth healthy?

You should check your mouth every day to look for any changes. The best way to do this is to look in a mirror. Look for sores and gums that bleed easily after brushing.

You can relieve dry mouth, which may cause your mouth to burn or feel sore, by drinking plenty of water. Chewing gum or sucking on ice chips and sugarless candy may also help. You can also use a saliva substitute that can be bought at a drug store. Two saliva substitutes are called Optimoist and Salivart.

It is very important to take good care of your teeth. You should brush your teeth, gums and tongue gently with an extra-soft bristle toothbrush. Brush in the morning after waking up, after every meal and at bedtime.

It is helpful to soften the brush in warm water. You should use toothpaste that contains fluoride. You should also floss your teeth daily. If flossing causes bleeding or soreness, you should avoid that area but continue to floss all of your other teeth.

You should avoid using alcohol and tobacco products. Do not use a mouthrinse that has alcohol in it. You can find out which ones contain alcohol by reading the label on the bottle. Some of the mouthrinses that have alcohol in them are Listerine, Scope and Cepacol. Using these mouthrinses will make a dry mouth worse.

It is helpful to rinse your mouth several times a day with a mixture of one-fourth teaspoon of baking soda and one-eighth teaspoon of salt in one cup of warm water. Afterward, rinse your mouth with water. If you wear dentures, your dentist should make sure they fit right so you do not get any mouth sores. Your dentist may prescribe a fluoride gel.

Where can I get more information?

This handout provides a general overview on this topic and may not apply to everyone. To find out if this handout applies to you and to get more information on this subject, talk to your family doctor.

Visit familydoctor.org for information on this and many other health-related topics.