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Oncology Guide

Oncology Reference Guide to Oral Health


Head and Neck Radiation Therapy

Patients receiving radiation therapy to the head and neck are at high risk for developing oral complications. Because of the risk of osteonecrosis in irradiated fields, the only opportunity to perform oral surgery may be before radiation treatment begins. Before treatment, we will consider extracting all potentially problem teeth.


Before Head and Neck Radiation Therapy

  • See us for a pretreatment oral health examination.
  • Tell us the treatment plan and timetable.
  • Help prevent tooth demineralization and radiation cavities by making sure you have a good oral hygiene program and you have received instruction on fluoride gel application.
  • Allow at least 14 days of healing for any oral surgical procedures.
  • Surgical procedures are contraindicated on irradiated bone, so make sure pre-prosthetic surgery is done before treatment begins.


Before Radiation Therapy

  • Make sure you follow the recommended oral hygiene regimen, whether at home or in the hospital.
  • Monitor your jaw for trismus.
  • Check for pain or weakness in masticating muscles in the radiation field.
  • Exercise jaw muscles 3 times a day, opening and closing the mouth as far as possible without pain; repeat 20 times.


After Radiation Therapy

  • After mucositis subsides, consult with the oral health team about dentures and other appliances. Patients with friable tissues and xerostomia may never be able to wear them again.
  • Make sure that you follow up with us for fluoride gel/home care compliance and trismus management. Lifelong, daily applications of fluoride gel are needed for patients who are severely xerostomic.
  • Advise against oral surgery on irradiated bone because of the risk of osteonecrosis. Tooth extraction, if unavoidable, should be conservative; use antibiotic coverage and possibly hyperbaric oxygen therapy.
  • For pediatric patients, consult us to monitor irradiated craniofacial and dental structures for abnormal growth and development.



Pre-Cancer Treatment Oral Health Examination

Objectives

  • Dental decay
  • Periodontal disease
  • Endodontic disease
  • Mucosal lesions


Identify and eliminate sources of oral trauma and irritation such as ill-fitting dentures, orthodontic bands, and other appliances.


Educate and train patients in preventive oral hygiene:

  • Brush gently after every meal and at bedtime; floss daily.
  • Use special brushing techniques if the mouth is sore.
  • For xerostomia, drink liquids and suck ice chips or sugarless candy.
  • Rinse with 1/4 teaspoon baking soda and 1/8 teaspoon salt in 1 cup warm water solution, followed by a plain water rinse.
  • Keep dentures clean by soaking them daily in antimicrobial solutions and clean water.
  • Remove prostheses if any irritation, mucositis, or ulceration occurs.
  • Evaluate dentition and loss of primary teeth in children. Remove loose primary teeth as well as those expected to exfoliate during treatment.



Chemotherapy

The oral complications of chemotherapy depend on the drugs used, the dosages, the degree of dental disease, and adjuvant radiation therapy.


Before Chemotherapy

  • Schedule an appointment with us for a pretreatment oral health examination.
  • Tell us the treatment plan and timetable.
  • If oral surgery is needed, allow 7 to 10 days of healing before you begin myelosuppressive therapy.
  • In patients with hematologic cancers, we need to check for immunosuppression or thrombocytopenia before any oral procedures.


During Chemotherapy

  • Consult with the oral health team to schedule dental treatment.
  • When fever is of unknown origin, consult us to explore a possible oral source of infection.
  • Conduct blood work 24 hours before any dental procedure.


Postpone if the

  • platelet count is less than 50,000/mm3, or abnormal clotting factors are present.
  • neutrophil count is less than 1,000/mm3.


After Chemotherapy

  • Resume a regular dental recall schedule when chemotherapy is completed and all side effects, including immunosuppression, have resolved.



Oral Complications of Cancer Treatment

Oral mucositis/stomatitis: Culture infections to identify fungal, bacterial, or viral origin. Work with us on the best control measures.

  • Xerostomia/salivary gland dysfunction: Soften or thin foods with liquid, chew sugarless gum, or suck ice chips and sugar-free hard candies. Suggest using commercial saliva substitute or prescribe a saliva stimulant.
  • Mouth pain: Prescribe topical anesthetics and systemic analgesics. Prescribe antimicrobial agents for known infections. Report oral problems early and to avoid irritating and rough-textured foods.
  • Damaged tooth enamel: To protect enamel, rinse teeth with baking soda and water solution after vomiting.
  • Taste changes: Refer to a dietitian.

Specific to Chemotherapy

  • Neurotoxicity: Persistent, deep pain mimics a toothache, but with no dental or mucosal source. Provide analgesics or systemic pain relief.
  • Bleeding from neutropenia: Clean teeth thoroughly with a toothbrush softened in warm water. Avoid flossing the areas that are bleeding but to keep flossing the other teeth.

Specific to Radiation Therapy

  • Radiation cavities: Rapid tooth structure breakdown follows radiation therapy, even when the teeth are out of the radiation field. Consult us to prescribe daily fluoride gel applications before treatment begins.
  • Trismus/tissue fibrosis: Do stretching exercises for the jaw to prevent or reduce the severity of fibrosis.
  • Osteonecrosis: Avoid oral surgery that involves irradiated bone.



Blood and Marrow Transplantation

Most blood and marrow transplant patients develop acute oral complications, especially patients with graft-versus-host disease.


Before Transplantation

  • Schedule an appointment with us for a pretreatment oral health examination.
  • Schedule oral surgery at least 7 to 10 days before myelosuppressive therapy begins.
  • Make sure you follow the prescribed oral hygiene regimen and fluoride gel application schedule.
  • Watch for infections on the tongue and oral mucosa. Herpes simplex and Candida albicans are common oral infections.


After Transplantation

  • Follow up with us for control of plaque, tooth demineralization, dental cavities, and infection.
  • Delay elective oral procedures for 1 year.

Toothpaste Ingredients

June 10, 2024
Toothpaste Ingredients Looking at the label on most toothpaste, it would seem that you need an advanced degree in biochemistry to decipher the ingredient names.Propylene glycol, sodium bicarbonate, sodium pyrophosphate, anhydrous dicalcium phosphate and dioctyl sodium sulfosuccinate are all listed. Are you sure you want to put this stuff in your mouth? Fear not. Here is an explanation of which ingredients do what in various types of toothpaste: Hydrogen Peroxide This is one of the few ingredients actually proven to whiten teeth. It is, in essence, a bleach. H.P. is found in the kits dentists can prescribe to bleach your teeth, as well as in over-the-counter bleaching kits. The American Dental Association advises that you should bleach your teeth only under the recommendation and supervision of your dentist. Sodium Bicarbonate It sounds high-tech, but it's actually nothing more than old-fashioned baking soda. It's function in toothpaste is questioned by the ADA, although some dentists say it can help to remove coffee and food stains from your teeth. It is a mild abrasive, so it scours your teeth, helping to eliminate plaque. And it does make your teeth feel clean and smooth. Other abrasives you'll often find in toothpastes are dicalcium phosphate, kaolin, bentonite, silica and calcium carbonate (chalk). Sodium Pyrophosphate This is the active ingredient normally found in tartar-control toothpaste. It has been shown to prevent the formation of plaque when used regularly. However, once tartar hardens onto your teeth, it can't be removed at home. Only a professional cleaning will get rid of it. Propylene Glycol This is a widely-used humectant - an ingredient that keeps the toothpaste moist, and prevents the solid and liquid ingredients from separating. Other common humectants in toothpaste are sorbitol, pentatol and glycerol. Dioctyl Sodium Sulfosuccinate This is a detergent-type ingredient that causes toothpaste to foam in your mouth. You may also see ingredients such as sodium stearyl fumarate and sodium lauryl sulfate. Some believe that the latter (SLS) induces canker sores in people sensitive to this ingredient. As with any product, if use causes discomfort, stop using it and consult your dentist or doctor. Sodium Saccharin This is the least-expensive sweetener, so it is the one you are most likely to see in most toothpastes. It is 600 times sweeter than table sugar, so only a small amount is used to sweeten your toothpaste. Other common toothpaste sweeteners are aspartame and ammoniated diglyzzherizins. Desensitizing Ingredients These are used in toothpastes specially formulated for sensitive teeth. Strontium chloride and potassium nitrate are the two ingredients recognized by the ADA to reduce discomfort if your teeth are sensitive to hot or cold foods. How do they work? They block the transmission of pain to the nerves in your teeth. They don't work immediately - it takes 4-6 weeks for these ingredients to desensitize your teeth. Triclosan This is an antibacterial agent that was recently approved for use in toothpaste by the FDA. It has been used for years as the active ingredient in antibacterial soaps, lotions, sponges and cutting boards. In toothpaste, triclosan has been clinically proven to fight gingivitis in adults by inhibiting the growth of plaque-causing bacteria. Colgate Total, manufactured and distributed by Colgate-Palmolive Co., is the only toothpaste that currently contains the disinfectant triclosan. Other toothpaste manufacturers are expected to follow suit, but since triclosan is considered a drug, all toothpastes that contain it will have to obtain FDA approval before going on the market.

Tooth Sensitivity

June 10, 2024
Tooth Sensitivity Do you have or do you know someone who has sensitive teeth? If your answer is yes, you will have a true appreciation for the content of this page. What Is Tooth Sensitivity? It can be defined as a painful reaction in one of more teeth triggered by hot, cold, sweet, or sour foods and drinks. This pain can be sharp, sudden and shoot deep into the nerve endings of your teeth. Apart from a cavity or a missing filling, the most common cause of tooth sensitivity is exposed dentin on the roots of your teeth. Normally, the dentin (the second, more sensitive layer of the tooth) is surrounded and protected by your enamel, cementum (special root covering) and gums. The cause or mechanism of dentinal sensitivity is still not well understood. It is believed that the little tubes that connect the dentin to the nerve or pulp serve as sensory conductors. That sensation may be one of pain. OUCH!! Causes Of Exposed Root Surfaces Which May Result In Dentinal Sensitivity: Brushing too hard - Over a period of time, brushing too hard or using a hard-bristled toothbrush may wear away enamel or cementum and cause the dentin to be exposed. Recession of the gums - Movement of gums away from the tooth due to periodontal disease will expose the root surface. Gum disease - Inflamed and sore gum tissue may also cause sensitivity due to the loss of supporting ligaments which exposes root surface. Other Causes Of Sensitive Teeth: Cracked teeth - Chipped or broken teeth may fill up with bacteria from plaque and enter the pulp causing an inflammatory reaction. Grinding your teeth - Grinding or clenching your teeth may wear down the enamel and expose underlying dentin. Plaque - The presence of plaque on the root surfaces can cause sensitivity. What To Do At Home: Maintain good oral hygiene - Continue to clean all parts of your teeth and mouth thoroughly. Use a soft bristled toothbrush -This will result in less toothbrush abrasion of the tooth surface. Use desensitizing toothpaste - There are many on the market. With regular use you should feel a decreased sensitivity. Try spreading a thin layer on the exposed roots with your finger or a Q-tip before you go to bed. You'll need to find the product that works for you, likely through trial and error. Consider what you eat - If you frequently eat foods high in acids, such as citrus fruits (example: sucking on lemons), they can gradually dissolve the enamel over time, leading to dentin exposure. The citric acids may aggravate the hypersensitivity and initiate a painful reaction. Use fluoridated dental products - As an example, with a daily application of a fluoridated mouthrinse, hypersensitivity usually decreases. Ask us about a daily fluoride rinse for your home use. Professional Care: Ask us what may be used to help reduce sensitivity. Some of the most common treatments are: White fillings to cover exposed root surfaces Fluoride varnish applied to the exposed root surface Dentin sealer applied to the exposed root surface

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