Keep on Smiling

In the launch issue we discussed the importance of visiting the dentist before starting with chemotherapy. Let’s look now at how to maintain the mouth and teeth during treatment.

If you are experiencing oral side effects such as: painful gums and mouth (mucositis), mouth and throat ulcers, dry mouth and a loss of taste, please discuss this with your oncologist. Regular rinsing with warm salt water will sometimes help but, if not, your doctor can prescribe a medicated mouthwash, such as Andosept, to  disinfect, numb and lubricate the mouth. Medicated mouthwashes should be used at least 30 minutes before (or after) brushing with toothpaste.

Maintaining good oral hygiene, brushing your teeth twice a day and regular flossing, is even more important during treatment. A toothbrush with soft bristles is recommended as it may prevent irritation and bleeding of the gums. If it hurts when you brush try softening the bristles in warm water first.

Severe gum disease causes at least one third of adult tooth loss. The reason we clean our teeth is to remove plaque and tartar build-up.

Plaque is the sticky white/yellow substance that builds up on teeth during the course of the day. It consists of millions and millions of bacteria which release acid that attacks tooth enamel and gums. The acid irritates the gum and causes inflammation (gingivitis).

Gingivitis is characterised by red, tender gums which bleed easily when brushing or flossing. The constant bacterial acid attack weakens tooth enamel and makes it brittle, allowing for cavities to develop and teeth to fracture.

Plaque that is not removed from tooth surfaces becomes hard (mineralized or calcified), due to the minerals in our saliva, and forms tartar. Tartar, also known as calculus, is a cement-like layer on tooth surfaces, especially behind the lower incisors (front teeth in bottom jaw) and, as it consists of plaque – which in turn consists of bacteria, causes gingivitis. Tartar is a natural process and can’t be prevented, only delayed.

It is very difficult to remove tartar with a toothbrush or floss. If it remains under the gums, it causes the gums to loosen and pull away from the teeth, creating a space for bacteria and puss to inhabit.

This results in periodontitis. Periodontitis is always preceded by gingivitis and results in bone loss – causing the teeth to loosen and, eventually, tooth loss. The good news is that both gingivitis and periodontitis are avoidable if you go for a professional cleaning and flouride treatment every six months.

Brushing technique is also important as “scrubbing” (brushing teeth using a back and forth motion) leads to receding gums and tooth sensitivity.

Scrubbing causes friction on the gums. The toothbrush bristles, and the fine silica granules in the toothpaste, irritate and hurt the gums causing them to recede. This exposes the sensitive area of the tooth (dentine) and leads to temperature and touch sensitivity.

The safest brushing technique is to brush using a circular motion, as this massages and stimulates the gums. There is a natural space between the tooth and the gum which is called the sulcus. It is 1-3mm in depth in healthy gums but in teeth affected by periodontitis, the sulcus depth can extend to beyond 10mm.

Bacteria and plaque situated in the sulcus area are the main causes of gum disease (gingivitis), as they are protected from normal tooth brushing. By tilting your toothbrush at a 45O angle, you can clean the sulcus area using a circular motion.

Manual toothbrushes are very effective when used correctly but an electric toothbrush is ideal for cleaning teeth. The electric toothbrush has a small brush-head, allowing you to clean the hard-to-reach areas of your mouth. The toothbrush head rotates and therefore eliminates any scrubbing effect.

A Sonic Toothbrush is a superior electric toothbrush, and a useful tool for removing and delaying calculus build-up.

Written by Dr Carina van der Linden