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     While chemotherapy and radiation therapy help treat cancer, it can also cause other things to happen in your body called side effects.
     Chemotherapy is the use of drugs to treat cancer. Radiation Therapy is when radiation is used to treat cancer. These methods kill cancer cells, but they may also harm normal cells, including cells in the mouth. Side effects include problems with your teeth and gums; the soft, moist lining of your mouth; and the glands that make saliva.
It’s important to know that side effects in the mouth can be serious. The side effects can hurt and make it difficult to talk and swallow.

It is important to see your dentist before any chemo or radiation therapy. If you go to the dentist before cancer treatment begins, they can help prevent serious mouth problems. Side effects often happen because an individual’s mouth is not healthy before cancer therapy starts. Dental care providers will provide the following services.

• Take X-rays
• Take care of mouth problems
• Show you how to take care of your mouth to prevent side effects
• The dentist will do a complete exam.
• What can you do to keep my mouth healthy?
• Check your teeth

                          To avoid dry mouth symptoms and complications during treatment

• Use sugarless gum or sugar-free hard candy
• Use a saliva substitute to help moisten your mouth
• Drink a lot of water
• Suck ice chips

  To prevent plaque build up and different fungal or bacterial infections, clean your mouth, tongue, and gums.

• Brush your teeth, gums, and tongue with an extra-soft toothbrush after every meal and at bedtime. If brushing hurts, soften the bristles in warm water.
• Use a fluoride toothpaste
• Don’t use mouthwashes with alcohol in them
• Floss your teeth gently every day. If your gums bleed and hurt, avoid the areas that are bleeding or sore, but keep  flossing your other teeth
• Dentures that don’t fit well can cause problems. Talk to your cancer doctor or dentist about your dentures

  

If your mouth is sore, watch what you eat and drink

• Choose foods that are good for you and easy to chew and swallow
• Take small bites of food, chew slowly, and sip liquids with your meals
• Eat soft, moist foods such as cooked cereals, mashed potatoes, and scrambled eggs
• If you have trouble swallowing, soften your food with gravy, sauces, broth, yogurt or other liquids
• Sipping liquids with your meals will make eating easier

                          Remember to stay away from:

• Sharp, crunchy foods, like taco chips, that could scrape or cut your mouth
• Foods that are hot, spicy, or high in acid, like citrus fruits and juices, which can irritate your mouth
• Sugary foods, like candy or soda, that could cause cavities
• Toothpicks, because they can cut your mouth
• All tobacco products
• Alcoholic drink

Many medications cause the adverse reaction of dry mouth (xerostomia). In fact up to 1800 different drugs are known to have this as a side effect. And 80% of the leading drugs cause dry mouth. It is important to know if you are taking any medications that may have this side effect due to the oral problems it can lead to. Below is a list of common medications that may cause dry mouth symptoms:

Actonel, Accutane, Allegra, Atropine, Atrovent, Benadryl, Cipro, Claritin, Dicyclomine HCL, Diet Drugs, Ditropan Elavil, Exedrin, Fentanyl, Flagyl, Hydrochlorothiazide, Lipitor, Lisinopril, Lovastatin, Midol, Nexium (Esomeprazole magnesium),Prevacid (Lansoprazole), Prilosec (Omeprazole), Simvastatin(Zocor), Sleep medications, Spririva inhaler, Sudafed, Zyrtec.

When you have severe dry mouth, that means there is less saliva to wash food particles away. Bacteria is able to multiply faster in a drier environment because these food particles are left behind and there are less salivary components around to fight the bacteria off, and prevent bacterial growth.

Dry mouth may also cause problems with swallowing and tasting your food, both in which saliva is an aid to. Along with the basic discomfort of dry mouth, severe burning sensations may arise. This is called burning mouth syndrome, and is extremely uncomfortable. Burning mouth syndrome is usually a result of severe dry mouth or combining dry mouth with acidic or salty foods. However, burning mouth syndrome has no known etiology, and may develop on its own without dry mouth needing to be present.

To treat dry mouth, an OTC (over the counter) method may be used at first; Biotene is a company that has developed a toothpaste, mouth rinse, tongue ointment, and tissue spray, all to treat dry and burning mouth symptoms. However, if this is not helping speak to your doctor about either reducing or changing your medications. There are also salivary stimulants such as Pilocarpine (Salagen), or Cevimeline (Evoxac) that can be prescribed.

Teeth don’t just fall out because of old age. With good oral hygiene and regular professional care, your teeth are meant to last a lifetime. However, if left untreated,  periodontal disease can lead to tooth loss. It is the primary cause of tooth loss in adults 35 and over.

 Research links periodontal disease to other health problems including heart and respiratory diseases, preterm or low birthweight babies, stroke, osteoporosis, and diabetes.

Bleeding when you floss should  be noted; bleeding gums are not normal. Think of gum tissue as the skin on your hand. If your hands bled every time you washed them, you would know something was wrong.

Other signs of gum disease include: red, swollen or tender gums; sores in your mouth; gums that have pulled away from the teeth; persistent bad breath; pus between the teeth and gums (leaving bad breath); loose or separating teeth; a change in the way the teeth fit together; and a change in the fit of partial dentures.

Stannous fluoride:

A history:

In the mid-1950′s stannous fluoride (aka Fluoristan), was first incorporated in toothpaste by the company Procter and Gamble. The idea behind this was caries prevention, and the ADA was excited to provide their seal of approval. However, the trick was to make the stannous fluoride compatible with other ingredients in the toothpaste.

Stannous fluoride reduces tooth decay and at the same time decelerates the break down of tooth enamel; as does sodium fluoride. Stannous fluoride converts the calcium mineral apatite to fluorapatite which makes tooth enamel more resistant to bacteria generated acid attacks. Sodium fluoride and sodium fluorophosphate, on the other hand, become biologically inactive when combined with calcium.Researchers knew it had potential beyond sodium fluoride therefore, they continued to look for solutions for better application.

The main complications with stannous fluoride were the taste and its staining properties. Eventually a formula was produced that allowed stannous fluoride to be used in toothpaste including sodium hexametaphosphate, a extrinsic whitening agent.

Gum disease is caused by chronic inflammation. The body reacts to bacterial toxnis, causing gums to bleeding.

Gum pockets increase and bone holding teeth slowly recedes.

The initial phase of treating gum disease consists of reducing the inflammation. Healthy habits are important to success.

The periodontist can help you brush and floss well. Regular visits to the periodontist and his/her hygienist help maintain dental health

Gum disease is often treated using scaling and root planning, a conservative non-surgical procedure. But to maintain non-bleeding gums after treatment, regular maintenance is necessary. The dental hygienist, at the general dentist or periodontist, can assess gum pockets regularly.

Yet, a recent study published in the Journal of Periodontology reports that compliance to maintenance is low. At periodontist offices, about 30% of patients do not return after the active treatment. Various psychological factors are reported, including life events and stress.

Dr. David Sarment, DDS, MS

Periodontics, Dental implants

Alexandria, Virginia