Cancer patients are found to face oral health problems like dryness of mouth, change in sense of taste, mouth sores, difficulty in swallowing, breaking of teeth and pain in gums, especially as they undergo chemotherapy, radiation and surgery. These are often neglected leading to problems like gum diseases and oral complications, which are addressed at a much later stage. Any damage to the lining of the mouth due to the weakened immune system must be addressed early, state experts, insisting that a maxillofacial surgeon must be in the panel which decides treatment modules.
The side effect of chemotherapy and radiotherapy leads to several oral manifestations which are very debilitating for the patients. In case of cancers in the head and neck region, the complications are even more severe. Radiation therapy causes a large amount of inconsistency in the patient’s saliva, leading to increased risk of dental decay.
Strong dosages of chemotherapy lead to temporary dysfunction of the body’s ability to produce infection-fighting cells. High doses of chemotherapy leads to dry mouth, decreased saliva, mouth sores, sensitivity to spicy or acidic foods and difficulty in swallowing. It also increases the risk of tooth decay.
Dr Dinesh Sharma, chief maxillofacial surgeon at Sunshine Hospitals explains, “Taste changes are common side-effects of chemotherapy. About half the people receiving chemotherapy and radiation therapy experience taste changes. It also causes changes to the sense of smell, which in turn affects the taste of the food.”
He adds, “After three to four weeks, this problem is rectified but those who are on repeated cycles of chemotherapy have a tough time. For those undergoing eight to 10 cycles of chemotherapy, salivary glands are damaged and the sense of taste does not entirely return to the way it was before treatment.”
Dr V. Venkatesh, head of the department of oral and maxillo-facial surgery at Apollo Hospitals, comments, “Surgical side-effects are of deformity leading to poor oral hygiene and nutritional deficiency. The patient is put on juices and there is problem in swallowing, absorption of food and non-chewing of food, leading to indigestion. Before cancer treatments, patients must be counselled to visit a dentist so that the decayed teeth can be removed and also oral health hygiene be advised.”
Medications such as bisphosphonates and other newer drugs are used to prevent osteoporosis and other types of bone loss caused by cancer.
Due to bone loss, there is pain, swelling and infection of the jaw and also loss of healthy teeth.
Dr V. Venkatesh
Various complications arising out of cancer treatments
Oral mucositis: It is inflammation and ulceration of the mucous membranes in the mouth region leading to infection and also inability to eat food leading to nutritional deficiency.
Infection in the mouth: Viral, bacterial, and fungal infections as the cells in the mouth region are damaged.
Dryness of the mouth: Due to thickened, reduced, or absent salivary flow, there is an increase in the risk of infection and compromises speaking, chewing, and swallowing. Persistent dry mouth increases the risk for dental caries.
Functional disabilities: Patient’s ability to eat, taste, swallow and speak decreases because of mucositis, dry mouth, trismus, and infection.
Taste alterations: Leads to changes in taste perception of foods, ranging from unpleasant to tasteless.
Bleeding: Occurs due to decreased platelets and clotting factors associated with the effects of therapy on bone marrow.
Before going for cancer treatments pre-operative dental and oral cavity evaluation is a must for all cancer patients. Removal of decayed teeth and oral prophylaxis before the commencement of chemo-radiaton therapy would definitely minimise the damage.
Tips to take care of
Cancer patients are advised to take intermittent sips of water at regular intervals to keep the mouth wet to prevent dryness of the mouth.
Oncologists must ask the patient to take dental opinion before starting the treatment so that the damage to the oral cavity is less. In present practice, many patients are coming after the treatment which leads to too many complications and even treatment is restricted as there is already a lot of damage to the mouth region.
Dr Dinesh Sharma
Mutli-vitamin therapy is advised for healing of ulcers, soreness of the mouth.
Juices must be given regularly and if the person is able to chew, he/she must be encouraged to chew slowly so that the food is properly absorbed in the body.
