Maintaining good oral health before, during and after chemotherapy treatment is important to prevent unnecessary complications related to chemotherapy side effects. These side effects involve the teeth, gums and mucous membranes of the mouth. They are distressing and can affect the patient's ability to tolerate and complete chemotherapy treatment. Oral chemotherapy side effects can be minimized with appropriate dental care.
Before Chemotherapy
Chemotherapy side effects that involve the mouth are numerous and alter the ability to eat. The National Cancer Institute lists many oral chemotherapy side effects. Mucositis and stomatitis involve painful inflammation and ulceration of the mucous membranes and tissues of the mouth. Xerostomia is dry mouth caused by damage to the salivary glands. Xerostomia changes the texture of the tongue, allows cuts and cracks to occur in the corners of the mouth, and thickens saliva. Other oral side effects include bleeding gums, ill-fitting dentures, infection, tooth decay and taste alterations.
While it is sometimes overlooked, a thorough dental exam before chemotherapy begins is optimal to minimize side effects. During this initial exam, the dentist treats cavities, infections and any necessary oral surgery. Potential sites of infection, and teeth that are unstable, are identified and possibly extracted. Patient education is another important aspect of this initial dental exam. Patients are instructed to brush and floss teeth gently after every meal and before bed. They should avoid mouthwash containing alcohol. It is important to avoid alcohol, tobacco and foods that have a high sugar or acid content. These substances break down the teeth. Rinsing the mouth several times daily with a salt and baking soda solution helps prevent mucositis and stomatitis.
During Chemotherapy
Good oral care before chemotherapy begins will reduce oral side effects but may not eliminate them entirely. Frequent contact with the oncology doctor and dentist is vital to control oral side effects. Medications are prescribed to treat mucositis, stomatitis, pain and infections. If a routine or invasive dental procedure is necessary during chemotherapy treatment, it is important to consider the patient's platelet and white blood cell counts. According to the National Institute of Dental and Craniofacial Research, blood work should be drawn 24 hours prior to the scheduled dental procedure. Platelets allow the blood to clot and should be 75,000 or greater. White blood cells fight infection and should be 1,000 or greater. Dental procedures are postponed if the platelet or white blood cell count is too low. There may be a need for antibiotics to prevent infection prior to dental procedures regardless of the white blood cell count.
After Chemotherapy
Oral side effects of chemotherapy can persist for months to years after completion of treatment. According to the National Institute of Dental and Craniofacial Research, regular dental visits are necessary to evaluate for long-term side effects. The dentist will evaluate the fit of dentures following treatment, because chemotherapy can change mouth structure. It remains important to consider platelet and white blood cell count prior to dental procedures because abnormal values may persist. Patients should continue good oral care indefinitely.
