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Oral Implications of Cancer Treatment

About 1,600 Americans with oral cancer die every day, and 1,660,290 new oral cancer cases will be diagnosed during this year. The number is greater worldwide with over 12 million new cancer cases. The risk of being diagnosed with cancer increases with age. In fact 77 percent of all cancers are found in individuals 55 or older. Cancer can be caused by tobacco, infections, chemicals and radiation, which are environmental factors. Internal factors of inherited mutations, hormones and immune disorders are also causes.

Risk Factors Affecting Cancer

More than half of all cancers worldwide can be prevented by eliminating exposure to tobacco and other factors. Cancers due to obesity, heavy alcohol use, poor nutrition, exposure to ultraviolet rays from the sun, physical inactivity, and tobacco can be prevented through education, avoiding excess exposure to the sun and regular screening tests.

Cancers due to Human Papilloma Virus (HPV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV), and H. pylori can be prevented with vaccines, antibiotics and education. Cancer prevention starts in childhood by helping your children adopt a healthy lifestyle. This includes good eating habits, plenty of exercise, sunscreen that blocks UVA and UVB rays and vaccines for HPV and HBV.

Cancer Survival Rates and Treatment Options

The good news is that the five-year survival rates for all cancers are improving. The survival rates between 1975-1977 were 49 percent, but they were 68 percent for 2002-2008. The survival rates worldwide are lower than in the United States due to the differences in screening and treatment.

The treatment of choice and prognosis is determined by the staging of the cancer. The stage of the cancer, otherwise known as the TNM system, describes the size and spread of the cancer to other areas. The “T” stands for the size of the cancer. The “N” stands for the presence or absence of spread into the lymph nodes. The “M” stands for the presence or absence of distant metastases. Once that is determined, a stage of 0 through IV can be assigned. The higher the stage, the poor the prognosis and the more treatment required.

Cancer can be treated with surgery, chemotherapy, radiation, hormones and immunotherapy. There are many different chemotherapeutic regimens. They can be alkylating agents, anti-metabolities, anti-tumor antibiotics, steroid and hormonal agents, plant alkaloids and bisphosphonates. Newer agents are also available that target cancer-specific proteins.

Cancer treatment can affect the oral tissues. Oral complications common to both chemotherapy and radiation include oral mucositis, infections, dry mouth, inability to eat, taste alterations, painful swallowing, burning pain, bleeding, restricted ability to open the mouth and jaw bone necrosis.

Oral Implications of Cancer Treatment

Due to the fact that oral complications occur in most patients, a thorough oral exam with X-rays should be performed prior to cancer treatment. The dental team can then identify and treat any problems that can contribute to oral complications. This comprehensive exam should ideally be performed one month before treatment starts. The pretreatment exam should include examination of all hard and soft tissues. All sources of infection and pathology must be eliminated. One must allow two weeks of healing for any oral surgery that is required. Supplemental fluoride should be started several days before radiation treatment.

It is also important that the dental team provide education on the specific oral hygiene required. Patients are advised to utilize ice chips in the mouth 5 minutes before and during the first 30 minutes of chemotherapy. This can reduce mucositis.

The following can protect your mouth during cancer treatment:

  • Brushing the teeth and tongue gently with an extra soft toothbrush after every meal and before bedtime.
  • Flossing your teeth every day.
  • Use the fluoride gel and avoid mouthwashes with alcohol.
  • Rinse your mouth with a solution of baking soda and salt water.
  • Suck on ice chips or sugar-free candy, chew sugar free gum; use a saliva substitute if your mouth is dry.
  • Choose soft or easy to chew foods but If chewing is too painful, a liquid diet should be prescribed.
  • Avoid alcohol and tobacco.

Severe oral complications can delay or even stop cancer treatment. Your cancer care team should include your dentist. The dentist plays an important role in the overall treatment of the cancer patient by minimizing the possiblility of treatment interruption from oral complications. Proper pre- and post-cancer treatment dental care will enhance the quality of life and survival of the cancer patient.