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See your family
dentist BEFORE
your radiation treatment!
If you
are being treated with radiation or chemotherapy for cancer of your head or neck there are some
side effects that could cause you to delay or stop treatment.
Oral
complications include salivary gland dysfunction, which leads to dry
mouth; rampant dental decay and mouth sores which are painful, diminish
the quality of life and can lead to significant compliance problems.
According to figures from the National Institutes of Health (NIH),
oral complications occur in almost all patients receiving radiation for
head and neck malignancies, in more than 75 percent of bone
marrow transplant recipients and in nearly 40 percent of patients
receiving chemotherapy. ***
Radiation is used to
kill cancer cells but it can harm normal cells also leading to problems with
your teeth and gums; the soft, moist lining of your mouth; glands that make
saliva and jaw bones. These side effects can:
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Hurt or make it hard to eat, talk and
swallow.
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You have a higher incidence of getting an
infection which can be dangerous when you are receiving cancer treatment.
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You may have to cut back on treatment or even
stop it due to these side effects.
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Mouth problems from
radiation are :
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Dry mouth
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Loss of taste
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Candidiasis
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A lot of cavities
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Sore mouth and gums
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Infections
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Jawbone changes
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Jaw stiffness
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Poor wound
healing
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Nutritional
deficiencies leading to malnutrition
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So check your mouth EVERY DAY
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To help
prevent these
problems:
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See a dentist at least 2 weeks before
starting radiation. This visit can help
prevent serious mouth problems. Side effects often happen because a person's
mouth is not healthy BEFORE radiation starts.
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Be sure to give your dentist your doctor's
phone numbers so they can talk to each other.
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If you have not gone to see your dentist and
have started radiation treatment, make an
appointment as soon as possible.
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The dental staff will check
your teeth, take x-rays, take care of
your mouth problems, show you how to care for your mouth to PREVENT side
effects.
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Ethyol (amifostine) is an agent that
reduces damage to the salivary glands and resultant dry mouth during
radiation therapy. (Dentistry Today pg 38 June
04) |
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Er laser after
EMLA and "erase" the mucositis. Wait 30 sec. ... relief.
IDF Dr.Ash 10/05 |
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MI Paste with
the free Calcium and Phosphate for recalcification, especially
any exposed root surfaces.
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How can you
keep you mouth
health:
Cancer patients
have different needs and require different types of treatments
depending on where there cancer is, their stage of the disease, and what
type of treatments they will be receiving. ie: chemo, radiation, etc.
When you have lack
of saliva you also have lack of important enzymes and mineral ions that
aren't present to help in the defense of both oral infections and
caries.
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See your dentist BEFORE you start cancer
treatment...because Prophys can
not be resumed until 6-8 weeks
after the 21-28 day cycle of chemo.
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Look in your mouth everyday for changes like
sores.
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Keep you mouth moist by drinking allot of
water; suck on ice chips; use sugarless gum; use a saliva substitute to help
moisten your mouth.
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Clean
you mouth, tongue and gums:
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Use an extra soft toothbrush and soften the bristle
in warm water
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Use a fluoride toothpaste
and brush after every meal and before going to bed.
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Use fluoride gel
in a mouthpiece at night, try
Omni-Gel, Gel-Kam,
and/or
Prevident 5000
Plus toothpaste or
Germiphene 1.1% neutral
Sodium Fluoride gel to
be placed in the trays
worn & for 10 minutes
each day |
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Don't use mouthwashes with alcohol, use BreathRX
or
use Chlorhexidine to
help control oral
bacteria, however do not
use
Peridex
because it contains
11.6%
alcohol
and alcohol can
cause mucositis problems
with radiation patients.
You can
than use a fluoride
rinse to rinse with on
an alternating basis
with the Chlorhexidine
when ever you can. |
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Xylitol
gum to help prevent
cervical decay |
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Meticulous
home
care. |
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Floss every day, if
they bleed and hurt contact your dentist. |
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Rinse your mouth several times a day with a solution
of 1/4 teaspoon baking soda and 1/8 teaspoon of salt in one cup of warm
water. Follow with a plain water rinse.
Ask your dentist for alcohol-free
chlorhexidine
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Dentures that
don't fit can cause problems, have them adjusted,
relined
or replaced. |
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Use
of ice chips for oral sores. |
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Acupuncture
may aid cancer
patients' dry
mouth: acupuncture
to the ear
and index finger
improved dry mouth
in a majority of
patients7,
although the
length of their
responses varied.
During the
acupuncture
treatments, which
involve three
needles placed on
the ear and one on
the index finger,
patients also get
sugar-free candy
to help stimulate
salivation,
"frothy
salivation"
usually gets
started within 15
to 20 minutes.+ |
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Cancer Backup-Helping people with cancer |
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Here are tips to help with caries
prevention and dry mouth: |
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1.) Have
Fluoride Varnish ( reapply in 3-4 months)
Come in
3 times in one week before the radiation is commenced for
application of fl varnish. The uptake of fl into the tooth surface
is far greater than any foam, gel, or rinse.
Then fix the Calcium and Phosphate with the Fl.
2.) Use Biotene Dry Mouth Toothpaste to help replace those enzymes
and add Calcium and Fluoride to help prevent demineralization due to
lack of saliva.
http://www.biotene.net/products/toothpaste.asp
3.) Brush-On 1.1% Sodium Neutral Fluoride - brushing on and do not
rinse after its and than use Biotene Toothpaste withCa.
4.) Drink LOT of water and fluids to keep from getting dehydrated.
Bee very gentle when brushing as not to cause any trauma to the
tissues. Very careful when flossing as well.
5.) Mucocitis Mouthwash that can be made by a pharmacy:
Mucocitis Mouthwash
1 gr Amoxicillin
30cc Nystatin
60 gm Hydrocolosone
30 cc Zylocaine 2%
fill to 120 cc Benadryl
Swish as 2- 3 times a day and expectorate. Or try: |
Nystatin Suspension, 100,000 u/ml, 30 mL. or Nysatin Powder 3
Million Units
Hydrocortisone 60 mg.
Diphenhydramine HCL Syrup q.s. ad. 240 ml
6.) Obtain a FREE Biotene sample packet that you can get at
the following web site.
https://secure.biotene.com/login.asp
7.
Researchers at the University of Alabama found that
patients who “pushed themselves to swallow through treatment” had an
easier time swallowing after treatment was completed. Using a speech
pathologist to help patients exercise can stretch the tissue to
avoid scarring and assist with swallowing.
2/06
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I am not aware of any scientific
evidence that would justify removal of a well-done endodontic-
treated tooth because of cancer or cancer treatment. If the tooth is
chronically infected, cancer chemotherapy may decrease the immune
system to such an extent that would allow the chronic low-grade
infection to become acutely infected. If the patient has chronic
periodontitis and receives chemotherapy, again the infection may
become acute. That is why cancer patients must have optimal oral
health prior to chemotherapy. Additionally those receiving oral
radiation therapy for oral cancer must also try to maintain perfect
oral health. |
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Here is an excellent website with
usual dental health information:
Oral Oncology |
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Omni Plaque
Fighter Spray ® contains 1.2% poloxamer 407/dimeticone, an agent
that coats and protects the mucosa for several hours, especially
when used at bedtime. You may find that using these agents before
bedtime negates the need for pilocarpine, thus avoiding side effects
such as sweating during the night. These products may also be
beneficial if you wear dentures. Lightly coat the internal surface
of the
denture to assist in moisturizing the mucosa and reduce denture
irritation.
Finally if the cancer patient is being administered any drug in the
intravenous bisphosphonate class as part of chemotherapy (to
decrease serum calcium levels), extraction of a tooth is the very
worst option imaginable, as necrosis of the mandible is a terrible
complication. Joel M. Weaver DDS, PhD Dentist
Anesthesiologist Ohio State University |
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If your mouth is sore,
watch what you eat:
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Choose foods that are good for you and easy
to eat and swallow.
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Take small bits of food.
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Chew food slowly.
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Sip liquids
with our meals.
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Eat moist, soft foods like cooked cereals,
mashed potatoes and scrambled eggs.
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Soften your food with gravy, sauces, broth, yogurt
or other liquids to help in swallowing.
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When your mouth hurts call your doctor to
help find medicines to help control the pain.
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Choose lukewarm foods and drinks instead of
hot or icy-cold.
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Avoid:
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Sharp, crunchy foods, like chips that can
scrape or cut our mouth.
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Foods that are hot, spicy or high in acid,
like citrus fruits and juices that can irritate your mouth.
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Sugary
foods that can lead to decay.
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Toothpicks that can cut your mouth.
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| ALL tobacco
products. People who quit smoking or chewing tobacco have fewer mouth
problems.
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Alcoholic drinks.
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| Topical agents for discomfort:
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Benzydamine 15 ml 0.15% oral
rinse, rinse for 2 minutes 4-8 times a day before, during and
for 2 weeks after radiation therapy |
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Sucralfate Aluminum salt rinse;
10ml qid or every two hours if not swallowed. |
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Viscous lidocaine 2.0% 450 ml
bottle. Swish with 15-20ml every 3 hours. |
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Triple mix: 1.5 ml(50 mg/ml
disphenhydramine; 45 ml 2.0% lidocaine; 45 ml Maalox.
Swish 5.0 ml hold for 30 seconds once day |
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Lortab "R" elixir: 12.5
mg hyudrocodone, 120 mg acetaminophen; 7.0% alcohol, One teaspoons
30 minutes before meals |
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Prostaglandins PGE2 0.5 mg/day
lozenge qid during chemo/radiation therapy. |
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Children can get the
same side effects as adults, depending on their age.
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Permanent teeth
may be slow to come in and may look different.
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Teeth may fall out.
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They must go to the dentist BEFORE treatment
starts to check their mouth, pull loose
teeth and help with oral health education.
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(This information is courtesy of National Oral Health
Information Clearinghouse)+SOURCE:
Cancer
2002;94:1151-1156
Management Following Cancer Therapy
Oral Complications of Chemotherapy and Head/Neck Radiation
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Updates
Comprehensive
Approaches to Cancer Control Tool Kit
Actiq
If you have been
given Actiq (oral transmucosal fentanyl citrate) to help with pain
...this is a sucker for slow-releases pain med throughout the day. It
contains inactive ingredients: Hydrated dextrates, citric acid,
dibasic sodium phosphate, artificial berry flavor, magnesium stearate,
modified food starch, and confectioner's sugar.
This can cause rapid decay at the gum line throughout your mouth
which can lead to very expensive dental repair through the mouth.
Please see your dentist as soon as possible to prevent this condition
from occuring.
www.actiq.com
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Periodontal
Changes in Patients Undergoing Radiotherapy
The purpose of this study was to evaluate changes in the
periodontiumin patients who received head and neck radiation therapy.
Periodontal clinical parameters (probing depth, clinical attachment
level, gingival recession, plaque index, and bleeding on probing) were
assessed on 27 patients before and 6 to 8 months following
radiationtherapy in the head and neck area.
The greatest changes occurred in clinical attachment level: overall,
70.3% of the patients showed a loss, with 92% evincing loss in the
mandible. Attachment loss was directly related to the field of
radiation and was greater when the jaws were actually included in
theirradiated area.
Periodontal status should be evaluated prior to and following
radiation therapy in the oral-maxillary-facial region to help ensure
that periodontal health is maintained in oncology patients.
[Alvarez M, Marques C, Dib L
Periodontal Changes in PatientsUndergoing Radiotherapy J
Periodontol 2004;75(9):1178-1187.]
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Visit Dentist Before Radiation Therapy to
Prevent Oral Problems
More than one million Americans will be diagnosed with
cancer each year, and about 40 percent will develop serious mouth
problems as the result of head and neck radiation therapy and
chemotherapy. Severe oral complications, such as the patient's inability
to eat and drink, often force doctors to delay or stop the radiation
treatment.
To give you the best chance to fight cancer, your
dentist must be added to the cancer treatment team and the you must
visit your dentist before beginning radiation therapy, according to a
new report in the November/December
2003 issue of General Dentistry .
The goal of head and neck radiation is to kill cancer
cells while limiting damage to adjacent healthy tissue and structures
like salivary glands, jawbones and tissues lining the mouth. However,
damage to healthy tissue is unavoidable.
During treatment, your dentist can work with the
patient to monitor any changes in their mouth that may occur, such as
dry mouth, increased cavities and painful mouth sores.
The less oral problems a patient experiences, the
more likely the patient will stay on the treatment program. So
schedule a visit with your dentist one month before starting radiation,
doing so may help prevent serious complications.
Oral complications from neck and head
radiation
| Dry mouth
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| Cavities
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| Oral yeast infections
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| Taste loss
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| Inflammation and ulceration of mouth lining
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| Non-healing wounds
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| Limited mouth opening
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| Nutritional deficiencies |
Pretreatment strategies for cancer patients
| Contact a general dentist for examination before
therapy begins
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| Schedule oral examination before initiation of
cancer therapy |
| Have all pre-existing oral disease treated
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| Extraction of hopeless and questionable teeth
should be accomplished three weeks prior to treatment |
Oral Complications of Chemotherapy and Head/Neck
Radiation
EMLA is 2.5% prilocaine and 2.5% lidocaine in a
eutectic mixture. It may be ordered in 30 gram tubes from Southern
Anesthesia.
1.800.624.5926
http://www.southernanesthesia.com/.
The item number is 11W151601 for a 30 gram tube and
price is $49.50.
Oral Complications in Radiation Therapy; Dr. Harrison, Dr. Dale, Dr.
Haveman, Dr. Redding; General Dentistry pg 552-561, Nov Dec 2003
***AGD Cancer Therapy Caused Devastating Oral Complications AGD 2000.
Reed's Topical will be sold in one ounce
containers (prettyclose to 30 grams) for $25.00 each, making it roughly
half the price of EMLA. We have the following flavors available:
Raspberry, Mint, Bubble Gum & Piña Colada. Tom Reed at:
Reed's Compounding Pharmacy 2729 E. Speedway Tucson, AZ. 85716
520.318.4421 1.877.REEDSRX 520.318.1054 FAX
Academy of General Dentistry 12/03
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Surgeon General's Report
states: More than 400,000 patients undergoing cancer treatments will develop
oral complications annually.
11th Report on
Carcinogens
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