Dental Care

Taking care of your mouth is so important before, during, and after cancer treatment.

The dentist is probably one of the first appointments you will make after diagnosis. It is essential to see a dentist with expertise in dental care for irradiated patients prior to initiation of radiation and/or chemotherapy.

My dentist was specifically called a dental oncologist. He took x-rays of my mouth and performed an oral examination. It is important to have any necessary dental procedures taken care of prior to treatment. This will reduce the severity of oral complications. Certain mouth problems could cause you to delay or stop treatment. If you need any teeth pulled or cavities filled etc...it is best to take care of those things before treatment begins. Radiation can cause Osteonecrosis which is blood vessel compromise and necrosis of bone exposed to high-dose radiation therapy. This results in decreased ability to heal if traumatized. Having teeth extracted after radiation is risky due to the possibility of losing bone. Oral complications can also lead to serious systemic infections. Medically necessary oral care before, during, and after cancer treatment can prevent or reduce the incidence and severity of oral complications, enhancing both survival and quality of life.

After my dental oncologist gave me the green light indicating that my oral health was fine, I made an appointment with my regular dentist. Per my dental oncologist’s recommendations, they took molds of my mouth to create fluoride trays for my top and bottom teeth. They also prescribed Colgate PreviDent fluoride gel. I was instructed to squeeze the gel into the trays and wear them for 10 minutes every night...forever. After removing and rinsing off the trays you shouldn't rinse out your mouth or eat and drink for at least 30 minutes. I do my treatments after I brush my teeth at night, before I go to bed. Sometimes the trays make me gag. When this happens, I just brush my teeth with the fluoride gel instead of my regular toothpaste. I do not rinse afterwards, I just do my best to spit out the excess so that the fluoride remains on my teeth.

Over the counter fluoride rinses are not good enough to prevent tooth demineralization. This prescription fluoride gel is much more potent.

During treatment my mouth was very sore and irritated. Radiation side effects took about 2 weeks to begin. I had blisters inside my mouth and eating and drinking became more and more difficult. Eventually I had to be placed on a feeding tube. Even water was painful to drink. It felt like I was swallowing shards of broken glass. I had some pretty extreme side effects due to the Erbitux drug I was also getting once a week. Everyone is different and I met a few other head and neck patients whose side effects weren't nearly as bad as mine.

My doctors and I decided to discontinue my fluoride treatments until my mouth healed. The fluoride gel irritated my open sores and started to burn so badly that I was in tears.

I learned that the sores in my mouth were called mucositis which is defined as inflammation and ulceration of the mucous membranes; can increase the risk for pain, oral and systemic infection, and nutritional compromise.
To clean the sores, I used a baking soda and salt solution, followed by a plain water rinse several times a day. (Use 1/4 teaspoon each of baking soda and salt in 1 quart of warm water.) Omit the salt if this burns. I also used Clōsys mouth rinse to clean my mouth and to wet my toothbrush to clean my teeth. Toothpaste irritated and burned my mouth too much so I stopped using it temporarily.

I also used toothettes to clean my teeth. They are little sponges on a stick. When my saliva turned into snot like goo, these were very helpful in cleaning in out. I struggled to spit after my tongue flap surgery so these things were very helpful.

I was also able to rent a machine through my insurance. It was basically an air compressor with a hose and a straw called a suction aspirator machine. It's a lot like the suction at the dentist except for home use. Hospitals have these in the patient rooms too. The snot like saliva was difficult to spit out and/or swallow so this machine really helped me out by allowing me to suck it out manually. I called it "mister thirsty."
I tried to use my Waterpik on the lowest setting for as long as I could tolerate it before I had to discontinue use. My mouth became too sore to use it. I also switched to a manual toothbrush because my electric toothbrush was causing me pain due to the irritation in my mouth.

After treatment oral care remains an important part of your life as an oral cancer survivor. It was recommended that I should go to the dentist for a cleaning and checkup at least 3 times per year from now on. Insurance does not pay for the third visit. After getting this bill, my advice is to ask if you can get a cleaning only without seeing the dentist on your third visit (unless you have concerns for them to address). This will save you money.

Here are some recommendations I have:

• Invest in a Waterpik. I love mine and use it several times per day.
• Try GUM brand soft picks to get food out of your teeth. I keep them in my car and purse to help clean food shrapnel from my teeth after I eat.
• Once your mouth has healed, resume using the fluoride trays every day.
• I prefer an electric toothbrush but as long as you brush your teeth at least 2 times per day, any toothbrush will do. Ideally you should try to brush after every meal and snack. Your teeth are more vulnerable now and you will produce less saliva to wash food away so it will remain on and in-between your teeth longer than before.
• Find a gentle fluoride toothpaste such as Clōsys or Biotene.
• Avoid mouthwashes with alcohol. It burns! Try Clōsys mouth rinse.
• See the products section for more information about these products. (Click here for Products)

Radiation causes dry mouth, otherwise known as Xerostomia/salivary gland dysfunction. This is defined as dryness of the mouth due to thickened, reduced, or absent salivary flow. It also increases the risk of infection and compromises speaking, chewing, and swallowing. Persistent dry mouth increases the risk for dental caries.

Radiation dental caries is a lifelong risk of rampant dental decay that may begin within 3 months of completing radiation treatment if changes in the quality or quantity of saliva persist.

Dry mouth causes my mouth to be more sensitive and easily irritated. Radiation also gave me 3rd degree burns inside my mouth which resulted in nerve damage. This also causes my oral tissue to be sensitive to most oral hygiene products.

I deal with this every day. I wake up with a completely dry mouth. Over the counter dry mouth patches help a little but there's not much I can do about dry mouth while I sleep. During waking hours, I carry a water bottle with me everywhere I go. I also have to modify my diet with more sauces and gravies so that I can swallow my food. Dry or sticky foods are impossible for me to eat. They cling to the roof of my mouth and the back of my teeth like wallpaper. Frequent drinks of water or milk while I eat are helpful since I don't have adequate saliva production. I swish it around like mouthwash to loosen food from my teeth so I can swallow it. Even when dry or sticky foods are freed from my teeth and the roof of my mouth, I find them impossible to swallow without some sort of gravy, sauce, or several drinks of water to saturate the bolus of food and moisten my mouth before I swallow it. Artificial saliva is available, but I have not found it very useful. It is much easier to just modify the foods you are eating. I talk about this in the Speech Therapy section.

My swallow is more effortful and is no longer as thoughtless as blinking my eyes. Because of this, my saliva pools and thickens in my mouth. Drinking lots of water throughout the day helps to thin my saliva and forces me to swallow more often.

Dry mouth causes me to be more sensitive to spices, food, and drinks. Foods I hadn't considered spicy before now feel like super-hot peppers in my mouth such as ketchup and mustard. Carbonation in sodas and alcohol also burns my mouth so I avoid them.