Pre-cancer treatment

Today I would like to provide a supplement of information to those that are pre-treatment cancer patients. The dental implications prior to chemotherapy or radiation are extremely important and need to be understood prior to treatment. The team of doctors including the dentist, oncologist, primary care physician, radiologist, and caregivers need work together as a team. The following is a list of typical symptoms associated with head and neck cancer treatment:

• Dry mouth.
• A lot of cavities.
• Loss of taste.
• Sore mouth and gums.
• Infections.
• Jaw stiffness.
• Jaw bone changes.

In addition to proper maintenance and oral hygiene instruction,  extractions prior to head and neck radiation are often recommended to reduce the risk of osteonecrosis of the jaws after radiation.
The proper removal of decay, susceptible fracturing of large fillings, wisdom teeth, root canal therapy, and crown restorations also need to try to be completed before cancer treatment. Then it is important to allow a minimum of 14-21 days of healing prior to the initiation of radiation therapy.
Adjunct procedures that are very important are the use of fluoride trays and prevention of dry mouth.  Either 0.4% stannous fluoride (Gel Kam) or 1.1% sodium fluoride (Prevident) may be used. According to the University of Florida and several other teaching institutions, head and neck radiation patients should begin using fluoride in the custom trays no longer than one week after radiotherapy is completed. Then, it is advisable to repeat this daily indefinitely.  Remember that tooth decay can occur in a matter of weeks if the fluoride is not used properly.
Dry mouth (xerostomia) can also be a troubling side effect and can be caused by a number of factors that persons being treated for cancer can be exposed to such as:

• Medications: Chemotherapy, pain medications, anti-depressants, diuretics (water pills).
• Radiation therapy can cause dry mouth when the salivary glands have been exposed to radiation. The salivary glands produce saliva - the moisture in your mouth or spit. Sometimes, over a period of time, the salivary glands will start to work again but they rarely return to normal function. Dry mouth caused by radiation to the salivary glands can be a life long problem.
• Conditions such as dehydration, or fungal infection of the mouth (candiasis) may lead to xerostomia.

Treating dry mouth may be treating the underlying cause such as dehydration or infection. In cases where medications that can cause dry mouth and the benefits of taking the medication outweigh the side effects - measures to relieve the dry mouth symptom are used. Dry mouth caused by damage to the salivary gland may be a life long problem and requires patience for treating. There are many treatments that may assist in alleviating xerostomia and many of these can be tried on your own.
Things you can do for treating dry mouth:
Keep mouth and lips moist:

• Rinse mouth with water frequently
• Use saliva substitute. 
• Biotene^® products can be purchased without a prescription. Products available for treating dry mouth are: mouthwash, toothpaste, as well as, chewing gum.  
• Apply lip moisturizer often.
• Use a cool mist room humidifier at night in the bedroom.
• Increase fluids.

We can prescribe medications but they will have side effects to consider.
If dehydration is present then treating of the condition leading to dehydration such as nausea, vomiting or diarrhea would be in order. Depending on the degree of dehydration, your doctor may recommend intravenous (IV) fluids. Sometimes this may be done as an outpatient. In severe cases, hospitalization could be required.
If dry mouth is due to infection, medications for treating the infection may be prescribed such as:

• Antifungals: nystatin,clotrimizole, fluconozole
• Antibacterials: Mouthwash antiseptic rinses are the basis of the oral decontamination regimen.
• Antivirals: acyclovir or famciclovir

The key to success is a team approach to the dental health of the patient including prevention, maintenance, and awareness.