Late effects: Dental care

Dental problems

Problems that may be a result of chemotherapy or radiation to the mouth and/or salivary glands include:

• Increased risk for cavities
• Early loss of teeth
• Increased tooth sensitivity to hot and cold
• Xerostomia (dry mouth due to decreased production of saliva)
• Alteration in taste
• Trismus (limited ability to fully open the mouth)
• Temporomandibular joint dysfunction (causing pain in front of the ears)
• Periodontal (gum) disease
• Osteonecrosis (problem with healing of the jawbone after dental surgery or extraction of teeth)

What can be done for these problems?

Taking care of teeth and gums is always important, and it is even more important if you have had radiation or chemotherapy. If your gums are not healthy, they can shrink away from your teeth, causing infection in the bone supporting the roots. This bone can dissolve away slowly, causing the teeth to become loose. This condition is called periodontitis (inflammation surrounding a tooth). Periodontitis can be prevented be proper brushing of your teeth and gums and by flossing between your teeth at least once a day.

Taking good care of your teeth and gums, combined with routine visits to your dentist, can prevent the development of cavities and gum disease  Radiation can sometimes make it difficult to open your mouth fully (trismus), or cause some scarring and hardening of the jaw muscles (fibrosis). Stretching exercises for the jaw may reduce fibrosis and improve your ability to open your mouth. Your dentist will be able to instruct you or refer you to occupational therapy to learn these exercises.

If you had an allogeneic bone marrow or stem cell transplant (from a donor other than yourself), it is important to let your dentist know, so that the dentist can check for changes indicating chronic graft versus host disease.

What is xerostomia and what should I do if I have it?

Dry mouth, also called xerostomia can occur after radiation to the head or neck or as a result of chronic graft versus host disease. Other problems related to xerostomia include persistent sore throat, burning sensation in the mouth and gums, problems speaking, difficulty swallowing, hoarseness, or dry nasal passages. Dryness of the mouth is a result of decreased saliva and/or thickening of the saliva, and can lead to the development of cavities.

Drinking liquids frequently and the use of artificial saliva can help relieve the symptoms of xerostomia. Sugar-free candy stimulates salvia production. Proper brushing habits are very important for people with xerostomia, as is limiting the intake of lollies and other sweets. Your dentist may recommend application of a fluoride gel to your teeth at least once a day. The fluoride acts on the enamel of your teeth to make it more resistant to decay. Ask your dentist about whether you should use daily fluoride.

What is the risk of developing oral cancer?

People who have had radiation to the head and neck, or who have chronic graft-versus-host disease after bone marrow or stem cell transplant, may be at increased risk for oral cancers. Using tobacco in any form greatly increases this risk. Your dentist should perform an oral cancer screening exam during each visit.

If you notice any of the following, notify your dentist immediately:

• A sore that does not heal or that bleeds easily
• A change in the colour of your mouth tissues
• A lump, thickening or rough spot in the mouth
• Pain, tenderness or numbness anywhere in the mouth or on the lips

Most of the time, these symptoms do not indicate any problem, but a dentist can tell if they are the sign of a serious problem.

What should I do to keep my teeth and mouth as healthy as possible?

See your dentist regularly at least every six months

• Make sure that your dentist knows your health history and the treatment you received (ask your doctor for a summary of your treatment) 
• Be sure that your visit includes an oral cancer screening, and be sure to notify your dentist if you notice any warning signs of oral cancer

Brush your teeth at least twice a day

• Use fluoride-containing toothpaste to help prevent tooth decay
• Place your brush at a slight angle toward the gum when brushing along the gum line
• Use a soft-bristle toothbrush, as recommended by your dentist
• Clean all surfaces of the teeth
• Brush your tongue to remove bacteria that can cause bad breath

Floss your teeth once or twice a day

• Floss carefully between teeth because brushing alone does not remove plaque between teeth
• Use a gentle touch to avoid injury to gums
• It is normal to have a small amount of bleeding when flossing, but if the bleeding increases or your gums are red and puffy, this may be a sign of infection and you should notify your dentist
• Use antibacterial, alcohol-free fluoride mouth rinses (your dentist can recommend the best ones for you)

Be careful with what you consume

• Drink liquids frequently and/or use artificial saliva (available at most pharmacies without a prescription)
• Limit sweets and carbohydrate-rich foods
• Do not use tobacco products and use alcohol only in moderation