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  • Oral health during cancer treatments

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    Cancer treatments and your mouth

    The aim of treatment for cancer is to destroy or remove cancer cells. The most common treatments are surgery, chemotherapy and radiotherapy. These can be used either alone or in combination.

    Chemotherapy

    Chemotherapy interferes with the way the cells of the body divide and reproduce themselves. Both healthy cells and cancer cells are affected by chemotherapy. Cells that rapidly divide and grow are most affected. The lining of the mouth has many cells that are constantly dividing and making new cells. Chemotherapy can kill these normal cells.
    The cells that help with fighting infections can also be lowered with chemotherapy. Your body is prone to infections if this happens, including your mouth.

    Radiotherapy

    When radiotherapy is given to the local area of the head and neck, problems can occur with damage to the cells in the mouth and the salivary glands.

    Surgery

    Surgery to remove cancers in the head and neck area can affect the structures in the mouth and the control of saliva.

    Damage to the cells lining the mouth is usually temporary. The chance of developing a sore mouth depends on the treatment you have. Talk to your doctors and nurses about your treatment.

    It is important to see a dentist before you start treatment. All dental work must be planned carefully. Talk with your specialist before having any dental work during your treatment, as there will be times during your treatment that will place you at risk of infection and bleeding.

    What can happen to your mouth?

    These treatments can lead to a number of side effects:

    • soreness and ulcers in the mouth
    • mouth infections 
    • bleeding gums
    • dry mouth
    • taste changes.

    How to keep your mouth healthy?

    There are things you can do to help to keep your mouth healthy. Inspect your mouth daily for any signs of redness, swelling, sore spots, white patches or bleeding. Ask the nurse at the hospital to show you how to do this.

    Helpful hints:

    • clean your teeth or dentures gently after each meal
    • use a soft small toothbrush and replace it regularly as recommended to prevent infection
    • use a fluoride toothpaste
    • avoid the use of toothpicks
    • rinse the mouth with alcohol free mouthwash after cleaning your teeth
    • if dentures are worn, leave out overnight soaking in a denture preparation
    • avoid foods that may irritate your mouth i.e alcohol, salty foods, vinegar, spicy foods and tobacco
    • try to drink at least one to two litres of fluid a day i.e. water, tea, apple juice
    • avoid acidic drinks i.e. orange or grapefruit juice.

    Remember: Let your doctor or nurse know if you have any pain, redness, sore spots or problems with your mouth, gums or lips. The sooner problems are dealt with, the better the outcome.

    Dealing with problems

    Soreness/ulceration of the mouth

    • Use a soft toothbrush and an alcohol free mouthwash 3–4 times a day after meals
    • Sucking on ice chips/ice blocks can help ease the soreness
    • If pain is stopping you from eating and drinking you may need pain relief medication, talk with your doctor about pain relief.

    Infection (thrush/candida) appears as white patches on the tongue or inside the mouth. This can be treated with a liquid anti-fungal medication; speak with your specialist about suitable medication.

    Dry mouth

    • Regular mouth care after each meal (cleaning teeth, alcohol free mouthwash)
    • Sucking sugar free sweets or chewing gum can encourage saliva production
    • Sips of water during the day can help keep the mouth moist, drink fluid with meals including gravy or sauces
    • Avoid dry foods such as biscuits, crackers, dry snacks, toast
    • Avoid smoking, alcohol (alcohol is drying to the mouth) and drinks containing caffeine
    • Artificial saliva products can be brought from pharmacies and are best used before meals and at night to prevent a sleepless night from dry mouth
    • Keep a glass of water beside your bed at night.

    Taste changes

    • Eat small frequent meals
    • Choose foods that look and smell good to you
    • Eat in pleasant surroundings, avoid bad odours
    • See hints for dry mouth – as these also help dealing with any taste changes
    • Chew flavoured gum or suck mints.

    Bleeding gums

    This could mean that your platelet count is low. Platelets are cells that clot the blood together and prevent bleeding. You will need to contact your doctor/treatment centre.

    Your mouth will return to normal after treatment is finished. These problems are temporary. The exception to this may be those having treatment for head and neck cancers.

    Problems in your mouth can usually be prevented, treated and relieved. Seek help from your doctor or nurse as soon as symptoms occur. Dentists, dieticians, speech pathologists and other specialists are available to help you. These services are available at hospitals and community health centres.

    Want to know where this information comes from? Click here.

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