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Caring for patients undergoing chemotherapy treatment

30th January 2013

Last year our dental hygienist team Jen and Viv – based at our Glasgow dental clinic – penned a series of columns for the Dentistry Scotland magazine.

Here in the column they touched on a sensitive topic – caring for patients undergoing chemotherapy treatment.

There’s some useful information in this column and we’re happy to answer any questions in relation to what’s included.

“When we were asked to write a column in Dentistry Scotland our plan was to keep it light hearted and chatty, informal and fun.

However over the last few months we’ve both had some young patients who are undergoing chemotherapy, seeking advice on how to take care of their mouths during treatment. We decided that a more serious topic is the order of the day for this issue.

Prevention of oral problems during chemotherapy begins before treatment even starts. A doctor should suggest the patient sees a dentist and dental hygienist a few weeks before chemotherapy begins. They may refer the patient to a dentist that has a particular focus in caring for patients undergoing treatment.

Chemotherapy kills or slows cancer cells by interfering with cell growth processes in rapidly growing cells. Cancer cells grow at an uncontrolled rate even faster than healthy cells in your body, hair, nail, skin, blood, and mucus membrane that are supposed to grow quickly.

The mouth and digestive system are made of cells that normally renew themselves at a fairly swift pace and this makes then very susceptible to temporary damage by chemotherapy.

Jen and Viv our dental hygienists who
penned this blog post
– Jen and Viv – our dental hygienist team at Glasgow
dental clinic

If you encourage your patient to work with your dental team, hygienist and oncologist to help prevent and treat oral side effects, you will give your patient a better chance of getting through cancer treatments smoothly resulting in a better quality of life.

Oral Side Effects of Chemotherapy

Not everyone will have the same side effects, but many patients may have some of these problems during treatment. If the patient develops an oral problem during treatment, here are some suggestions that may help…

Infections in gums or mouth lining

You should always encourage your patient to inspect their mouth including their lips and tongue in good light every day. Advise them to look for any abnormalities in colour or texture.

Dry mouth

After treatment and using painkillers this may make your patient’s mouth dry. This can be extremely unpleasant and can interfere with talking, eating and holding dentures in place.

Always ensure your patients keep their mouth and dentures as clean as possible and to seek advice quickly if they think there is any infection.

They should keep a bottle of water handy and drink plenty throughout the day.

Sucking on sugar free sweets or chewing sugar free gum can help keep their mouth moist.

You can also suggest to them to try a swish-and-spit solution. Mix ½ to 1 teaspoon of salt or baking soda with a glass of water, four to five times daily or more often if required.

We did find one other solution that was recommended. Either olive oil or vegetable oil, which helps, lubricates the mouth but apparently hardly anyone can tolerate this – we wonder why?

There are some saliva substitutes available by prescription and your patient should refer to their GP for more information.
Ulceration can often be eased by regularly using a mouthwash containing –
Chlorhexidine (products such as Corsodyl Chlorohex or Eludril ), which will help, ease infection and give pain relief from ulcers. You can also explain that it will help prevent build up of plaque, but may cause some staining, which can easily be removed.
Benzydamine mouthwash (a product such as Difflam) can be helpful as a local anaesthetic and again can ease discomfort and aid eating.
There are protective gels, which can be applied directly to the sore areas in the mouth (a product such as Orabase) which people find soothing.

Taking good care of your patient’s mouth is paramount and we recommend you advise them on the following points:
· use a soft toothbrush
· use mild or unflavored toothpaste with fluoride
· choose alcohol–free mouthwash
· floss gently to avoid irritation
· keep your toothbrush clean and dry between uses
· apply non-petroleum lip balm to keep lips moist

We considered the pros and cons of using natural toothpaste. Firstly, Kingfisher (Holland and Barrett) is BDHA approved and contains fluoride but contains SLS (a binding agent which can cause adverse reactions in the mouth).
Aloe Dent toothpaste (Holland and Barrett) contains aloe vera and Co Q10 which is great for soft tissue and aids repair (antimicrobial/antibacterial) and xylitol (not fluoride but has been shown to help reduce decay) is SLS free.
Tom of Maine (H&B) again contains xylitol. No fluoride but contains SLS.

Corsodyl Daily contains fluoride, lots of various plant extracts and essential oils to keep gums and tissue healthy. It is SLS free but is an acquired taste.

Losing the sense of taste
As we know there are four main types of taste, so taste changes during chemotherapy are common. The exact reasons for taste change are unclear at least 50% experience taste change.
Most people report changes involving a lower threshold for bitter tastes and higher for sweet there are a few things you can encourage your patient to try so they can manage the changes…
– as always maintain good oral hygiene and rinse with a fluoride containing mouthwash after meals
– avoid cigarette smoking
– increase fluid intake
– chew ice to mask the bitter or metallic taste
– once again eat sugar free sweets and chewing gum
Taste changes may occur during treatment and can last hours, days, weeks or even months. There’s no magic solution for taste change that will suit each and every patient. Finding the right foods that taste appealing may involve a process of trial and error.

Going forward
Having chemotherapy is never easy or pleasant so as dental professionals it’s our job to aid our patients in every way to make our side of caring for them as informative and as helpful as possible.
Then we’ll help them to make that difficult journey just that little bit easier and more comfortable for our patients.”

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