Chemotherapy and Your Oral Health
By Jeffrey W. Cash, DDS
Chemotherapy and Your Oral Health: Things You Should Know
If you or a loved one are fighting cancer, chances are that chemotherapy will impact oral health. There are things you should know and be aware of so the journey through this challenging time can be easier. One of the key aspects of modern dentistry is prevention. If you know what to look for and expect, there are things you can do to help.
What is Chemotherapy?
Chemotherapy is modern medicine’s way to treat cancer and other diseases. In the case of cancer, one or more medicines are given to a patient to slow, shrink, and kill the cancer cells. These medicines are taken up by cells and, once inside, they disrupt how a cell lives and grows. The ultimate goal is to have the faster growing cancer take up more of the medicine than healthy cells so the cancer dies.
BUT…. notice I said “taken up by cells”… which means ALL cells.
The Challenges of Chemotherapy
Without a doubt, hematologists and oncologists have a challenging job. The medicines used in chemotherapy are toxic. With some, their sole purpose is to cause cells to die. Because cancer tends to grow faster than healthy cells, the hope is that the fast growing cancer will suck up these medicines greedily and cause their own demise. Yet, ALL cells need nutrients to grow. Some healthy cells do take up these medicines as well, so timing the chemotherapy is critical. You don’t want these drugs present for any longer than necessary to lower side effects.
Because fast growing cells are more likely to take up the chemotherapy medicines, the oral cavity is a prime place to see side effects. The tissues that line our mouths are epithelium and mucosa. They replace themselves very frequently which means: they need nutrients. Studies show that every 14-21 days your mouth’s tissue is replaced with new layers.
So, What Happens?
When growing cells encounter these medications, they die and the mouth is a very active area. Things like eating and talking cause rubbing on this tissue. So, cells here grow relatively fast.
Within a week or so of beginning chemotherapy, soreness and ulcers usually begin to appear in the mouth. These can be on the tongue, cheeks, under the tongue, and even in the throat. It happens because the body cannot replace the older cells as they wear away. Many people refer to what happens in the mouth as “Chemo Mouth” but the medical term is “Oral Mucositis”, and it is a big problem.
Often these areas become so sore that it becomes painful to talk, swallow, and eat. Some people also report changes in their ability to taste food. If this happens, it becomes a real struggle for people to get the nutrition they desperately need as they fight the cancer. In some cases, an oncologist will recommend having a feeding tube placed to help with this. Unfortunately, this may involve surgery and is often needed for head and neck cancer patients who are taking chemo AND receiving radiation therapy.
The “good news” is that once the chemotherapy is finished, most people have their ulcers heal. The body can now make the new cells it needs again. However, taste changes may persist for a longer time.
What can I do?
The MOST IMPORTANT THING is to talk with your treating doctors and dentists. If the health care professional does not know what you are experiencing, they can’t help. Some things that can assist patients are:
- Prevention: Avoid foods that can scratch, rub or irritate your mouth. This includes food that has strong spices. Focus on cool soft foods like yogurt, smoothies, pasta and protein shakes.
- Caution: Keeping the mouth clean is vital during this time but don’t “over do it.” Daily brushing, flossing, and rinsing should be done slowly, methodically, and DELICATELY. Aggressive flossing and brushing can cause trauma that contributes to ulcer formation.
- Medications: There are many palliative medications available to address oral mucositis. Coating, numbing, and anti-inflammatory agents can help protect ulcerated tissue from irritation and pain. Some of them are combinations of several medications like “Magic Mouthwash.”
Managing Chemo Mouth (Mucositis) Should Be a Team Effort!!
Although it is a very challenging, difficult, and uncomfortable time, always keep in mind: “This too, shall pass.” You are not alone on this journey. Rely on your health team because they are there for YOU.