Put on a Happy Smile!

Chemotherapy targets and kills rapidly growing cells. The cells in your mouth normally grow rapidly and, like cancer cells, they may be damaged during treatment. Chemotherapy also suppresses your immune system which makes it very difficult for your body to fight disease and, as the mouth is home to numerous germs and bacteria and their harmful by-products, chemo increases the risk of dental infections due to immune system suppression.

Chemotherapy has many unpleasant side effects – especially in the mouth. Preventative measures BEFORE chemotherapy will reduce problems during and after chemo. Oral side effects may include: painful gums and mouth (mucositis), mouth and throat ulcers, dry mouth (xerostomia), root resorption, receding gums and loss of taste. Side effects usually start during chemo and can continue for a while afterward. Eating and swallowing often becomes difficult which may lead to nutritional deficiencies and further perpetuate the problem. The dry mouth may also be long term as chemo sometimes damages the salivary glands. A medicated mouthwash can assist in disinfecting, numbing and lubricating the mouth. If your oncologist prescribes a medicated mouthwash please remember to allow at least 30 minutes between the use of toothpaste and using a mouthwash like Andosept©. Chemotherapy may also cause toothache, even when your teeth and roots are fine!

Replacing fillings and crowns or completing root canal treatments during chemotherapy is unpredictable as the immune system is suppressed. The body does not react the way it normally does, and a small, routine procedure can have dire consequences. Ensure that any problems with your teeth and gums are fixed at least two weeks before starting chemotherapy. If possible, all dental work should be completed before the first chemo treatment.

It’s also wise to initiate a preventative and maintenance program for your gums and teeth before that first chemo.

• Your dentist should perform a cleaning and a full check-up of your teeth, gums and mouth with x-rays of your roots.

• Fillings should be checked for leakage and fracture, and crown and bridge margins should be evaluated. Any suspect fillings and crowns or tooth decay should be repaired.

• Root canal treatments at this stage are not advisable, unless the dentist is confident of a good result. If not, the tooth should rather be removed.

• Older root canals should be checked and, if in doubt, removed.

• Unhealthy teeth should be removed and a bridge placed to fill the gap before treatment starts, alternatively a dental implant or denture can be placed once your chemo is completed.

• Dentures (false teeth) must be cleaned and checked for rough areas. Ill-fitting or rough dentures can cause ulcers during chemo as they cause irritation of the fragile and thin gums.

• Teeth should also be professionally cleaned. This is a four-step process:

• The first step is cleaning the teeth with an ultrasonic instrument to remove and loosen plaque and calculus. NB!! If you have a pacemaker, a hand-scaler must be used so as not to interfere with the pacemaker frequency.

• The second step is flossing of the teeth to remove tartar (calculus) and plaque from between the teeth.

• Third is the polishing of the tooth surfaces

• The fourth and final step is a fluoride treatment.

If you have any dental problems during your chemotherapy you should consult your oncologist before seeing your dentist. Blood tests will confirm whether your white cell count and clotting factors allow for a visit to the dentist.

Written by Dr Carina van der Linden

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