Oral Health Maintenance for Patients with Breast Cancer

DISCLOSURE: Noelle Copeland RDH is an Oral Care Specialist and Dental Consultant who provides content for Brilliant Oral Care and Baby Buddy.

Cancer is the "One Thing" that shuts down the conversation in a room immediately. The air feels heavier all of a sudden as your mind begins to search for the right words to say to someone who has just shared "The News" with you. As a professional who has seen patients clinically for 25 years, I have experienced this type of "room shift" more times than anyone ever should, professionally and personally.

Me:Let's first go over your medical history today, and then I will take your blood pressure before we start. Have there been any changes to your health since you were last here to see me?

Patient: Actually, Yes! A few months ago, a lesion was noted at my annual appointment, and to make a long story short; I have breast cancer. I have a surgery scheduled, then I start chemotherapy, and when that's finished, I do radiation too. So I need help preparing for this.

Cancer therapy is prescribed depending on the type, the stage, and the patient's personal history. The circumstances will help determine how aggressive or expansive treatment will be: therapy usually encompasses more than one treatment. I've had patients on active chemotherapy who maintained their regular oral care appointments by driving themselves to see me. Additionally, I've also had patients so sick they were either hospitalized or bedridden with full-time home help. There is no one-size-fits-all for patients with breast cancer. I do know that.

Different treatments for Breast Cancer

• Chemotherapy: The use of specialized medicine cocktails that kill or aim to shrink cancer cells. This can be in the form of a chemo pill taken orally. It can be administered intravenously, and sometimes they use both.
• Radiation: High-energy rays are used to target the specific location of cancer.
• Surgery: Sedative operation where the doctor carefully cuts and burns away cancer tumors and tissues.
• Hormonal Therapy: Utilizes drugs to block cancer cells that increase from hormones, making the hormone unavailable for the cancer cell to grow.
• Biological Therapy: Meant to complement the immune system, help fight cancer cells, and control side effects from other treatments.
• Complimentary and Alternative Medicine: Complementary medicine is used along with standard cancer treatment, while Alternative medicine is used instead of traditional cancer treatment.

You can see how complex treatment can get. Multiple rounds of chemo, multiple surgeries, in combination with radiation and any hormonal therapies, that's a lot, and it affects the overall function of the body, including the mouth. Not only is the body's microbiome disrupted and often destroyed, so is the oral microbiome. Side effects happen when the treatment being administered damages healthy cells, tissues, or bodily functions. These effects can be mild to severe. Searching for Gastrologists near me then you have a right place

Side Effects from Cancer Therapy and Oral Care maintenance

• Neutropenia: Decrease in the number of white blood cells, the body's defense against infection. Common after receiving chemotherapy. Chemo works by killing fast-growing cells in the body—cancer cells and healthy white blood cells, so you're more likely to get an infection.
• Maintenance: Treat all oral infections before starting cancer therapy, see the dentist more often than usual, keep a regular oral care routine as much as possible.
• Nausea and Vomiting: Cancer treatments can cause nausea and vomiting.
  Maintenance:
  1. Rinse the mouth with plain water after vomiting. Brush 1-hour post any acidic event, not before 1 hour. Use oral ph stabilizers like plain flavored xylitol in a rinse, gel, or paste.
  2. Use fluoride to protect the teeth.
  3. Be cautious of dry mouth due to anti-nausea medicine, stay hydrated and keep the mouth moist.
• Dry mouth and mouth sores: It happens when the salivary glands don't excrete enough saliva to keep the mouth moist; this can lead to mouth sores, trouble eating, swallowing, and talking. Chemotherapy and radiation cause dry mouth by damaging salivary glands.
  Maintenance:
  1. Rinse the mouth with plain water often, use ph stabilizers like plain flavored xylitol in a rinse, gel, or paste.
  2. Use fluoride to protect the teeth.
  3. Avoid anything with alcohol in it, like mouthwash. Alcohol-based oral care products should be eliminated entirely.

*NOTE: Chemotherapy can make saliva thicker, causing dry mouth, usually temporary. Clearing up 2 to 8 weeks after the treatment ends.
*NOTE: Radiation to the head, neck, or face can cause dry mouth. This is especially true if radiation was directed at the salivary glands.
*NOTE: Drugs like antidepressants, pain medicine, diuretics are often utilized during cancer therapy and cause dry mouth.

Regular Oral Care Maintenance

• Visit your dentist. Before you begin treatment, check the health of your mouth and teeth. All oral surgical care should be done at least 3 weeks before cancer treatment so your mouth can heal. Some dentists will prescribe medication to increase saliva or rinses to treat infections in the mouth during your treatment period.
• Maintain your oral health. Brush your teeth twice daily. Use a soft-bristle toothbrush, fluoride toothpaste, and xylitol rinse. Floss at least once daily.
• Rinse your mouth. Rinse your mouth regularly, especially after meals; aim to rinse five to six times daily.
• Stay hydrated. Drink water throughout the day, and use saliva stimulators to moisten your mouth. Always keep water nearby to help you drink enough.
• Avoid alcohol. Many dental products often contain alcohol. This can make dry mouth worse. Alcohol-free mouthwashes and other products are available; ask your dentist for help when navigating new products.
• Use a cool-mist humidifier. Running a humidifier as much as possible, especially during the winter, helps keep the air moist, which helps keep the nose and mouth moist.
• Maintain good health. Avoid alcohol, too much caffeine (like coffee, tea, and soda), and acidic juices. Avoid foods that can burn your mouth, like spicy, acidic, and sour. Do not smoke or chew tobacco. Avoid sticky, sugary foods and drinks.

Oral Maintenance Caution

Some medications carry higher oral care risks than others; specifically, bone-modifying drugs are of particular concern. Bisphosphonates and other drugs are sometimes used to reduce the spread of cancer cells to the bone. These drugs are also used to treat breast cancer that has spread to the bone. Another use if tor to treat osteoporosis in breast cancer survivors.

A severe side effect of these medications is medication-related osteonecrosis of the jaw, which causes weakening and loss of bone in the jaw. This can lead to pain, infection, loose teeth, and exposed bone around the jaw. To lower your risk of medication-related osteonecrosis of the jaw, visit a dentist before and during cancer treatment, mainly if that treatment includes bone-modifying drugs.

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Be sure to check out our specialty toothbrush for special needs and our silicone toothbrushes that make oral care easy to start. Sometimes the best toothbrush for sensitive gums and teeth is a specialty toothbrush, and sometimes a baby toothbrush is the best place to start, even for an adult.

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