Those suddenly faced with the need to undergo chemotherapy are often already aware of side effects such as nausea and hair loss. Many may be less aware of the impacts to oral health and what, in general, can be done to manage those.
Dental Care Before Chemotherapy
As soon as you are aware that you’ll be undergoing chemotherapy, it’s a good idea to contact your dentist. One of the best ways to avoid or minimize some of the symptoms you might experience is to have your teeth and gums in as healthy condition as possible before chemotherapy begins. If you aren’t already, start brushing and flossing your teeth regularly. At a minimum, you’ll want to have your teeth clean and free of plaque a couple of weeks before treatment begins. Also, make it a point to discuss your normal oral care routines with your dentist and doctor to see if adaptations might be in order to help you preserve your oral health and avoid complications.
Special and more extensive care is warranted for those who have periodontal issues, or are in need of restorative work. That’s why seeing your dentist as soon as possible is a good idea. Your doctor and dentist can work together to determine what treatments should precede treatment, and which need to be deferred. For some types of high-dose chemotherapy or stem cell transplants, it may be necessary to remove braces or other appliances from your mouth before the treatment begins.
Dental Care During Chemotherapy
Because chemotherapy reduces the number of white blood cells in your body, you are more prone to infection, including oral infections, until your white cell count returns to normal. That’s why you want your gums as healthy as possible before chemotherapy starts; infection loves to attack inflamed gums. Different types of chemotherapy are more likely than others to cause mouth sores to develop. If you do develop sores, ask your doctor about the best method of treating them, rather than trying to treat them on your own.
Dry mouth (xerostomia) often develops during chemotherapy, and it can cause its own painful side effects as well as tooth decay. Your dentist or doctor can provide tips on a number of ways to minimize dry mouth, such as avoiding alcohol (in mouthwash and beverages), hard foods, and acidic beverages.
Regularly cleaning your teeth will be important, but you may need to modify your routines. You may need to use a softer toothbrush, use dental floss very gently, and avoid toothpicks if and when your mouth tissues become sensitive and more likely to bleed. It’s also advisable to discuss the need to potentially change the type of toothpaste you use, or how frequently you use it. Your doctor may prescribe a special type of mouthwash for you. Rinsing your mouth can be very helpful, especially to quickly remove stomach acid that can harm your teeth should you experience problems with keeping down food or drink.
In general, you don’t want to have elective (cosmetic) dental work done while undergoing chemotherapy, simply because of the added risk of infection. However, there are situations where restorative dental work is necessary. If you do need to have dental work done during your chemotherapy, your doctor and dentist should work together to determine the best timing. There are certain stages in chemotherapy where you will be more prone to bleeding and infection than others.
Dental Care After Chemotherapy
Many of the oral health issues you may experience will begin to subside on their own after chemotherapy, but they usually will not go away immediately after your last treatment. You may also have new conditions developing (e.g., tooth decay) that have resulted from chemotherapy side effects, such as dry mouth. It is important to resume regular dental care after chemotherapy, but even regular dental treatments (cleaning and polishing) should wait until your oncologist says that your immune system has returned to normal and it is safe to resume treatment.
It can sometimes take as long as 6 to 12 months for your immune system to recover from high-dose chemotherapy. Don’t make your own assumptions about when it is appropriate to have treatment again. Ask your oncologist for specific recommendations on when you can resume your regular dental visit routine, or if you should arrange for a special visit just to have your dentist check the condition of your teeth. Always make sure that your dentist knows that you have undergone chemotherapy when you schedule and attend your next follow-up visit. Your dentist can be a good ally in helping you to restore and maintain your oral health.