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Daniel C. Doyle, DMD, PC Romina T. Doyle, DDS Dennis C. Doyle, DDS

172 Route 311 Carmel, NY 10512 Phone #: (845) 225-3406 Fax#: (845) 225-7302

Email: info@

Dear Patient: This note is to inform you of oral/dental changes that may occur before, during and after your cancer treatment. Although these guidelines are standardized, please remember that your individual needs may differ. Having a discussion with your dental team is important to develop an effective daily routine and implement preventative strategies to suit your individual needs. For any questions about pretreatment care or care following cancer therapy, and to integrate with the oncology plan, please contact the treating oncologist or an expert who is affiliated with your cancer center. This is particularly important for dental conditions that may require surgical management.

Goals of Oral Care Prior to Cancer Treatment:

• Treat conditions causing pain and swelling, and at risk of infection during treatment.

• Treat dental conditions that may require surgery in the future if you are to receive head and neck radiation therapy to the jaw area.

Oral Self-Care during Cancer Treatment:

• Important: Caring for your oral health during therapy is critical, as the side effects of treatment (listed below) affect more than just your mouth. They may cause pain, affect your nutrition, and, in turn, your overall well-being.

• Basic Guidelines

• Brushing: twice per day with an ultra-soft toothbrush

• Flossing: once per day; be gentile in order to avoid floss cuts

• Rinsing: avoid mouth rinses that contain alcohol. Or use this mouth rinse recipe: 1 teaspoon (5 ml) salt, 1 teaspoon (5 ml) baking soda, 4 cups (1 L) water. Mix, store in an air tight container at room temperature, discard at the end of each day.

• Supplements: Your dentist make recommend the use of xylitol products, mouth-wetting products and fluoride therapies.

• Hygiene Recall

• Have your teeth cleaned before cancer therapy

• Once cancer therapy is completed and you are cleared to return for dental treatment, more frequent hygiene recall visits may be recommended than prior to cancer treatment.

Common Oral Side Effects of Cancer Treatment

• Dry Mouth: decreased salivary flow

• Effects: Ropey saliva, sticky sensation, less saliva, chapped lips, etc.

• Managing Side Effects: Sip water, xylitol products (available as mints, lozenges, gums and mouth rinses), and mouth-wetting agents. Avoid alcohol-containing mouth rinses, and course, spicy, or acidic foods. Sugar substitutes should be used instead of sugar, as your teeth may be more susceptible to decay. Prescription treatments may be indicated.

• Mucositis: Oral pain

• Effects: Mouth ulcers (sores) can occur in any location in your mouth and throat

• Managing Side Effects: Use homemade mouth rinse recipe to sooth oral tissues, chlorhexidine rinse (available by prescription only), regular brushing and flossing. Avoid the same things as with dry mouth. Review oral treatment and pain medications (as needed) with a professional.

• Fungal Infections: Yeast

• Effects: White or red changes on tongue or oral tissues, taste change and mouth odor

• Managing Side Effects: Adequate at-home oral self-care, which should include brushing the tongue, antifungal medication (available by prescription only), and daily denture cleaning (avoid wearing dentures overnight)

• Taste Change:

• Effects: Lack or altered taste sensation

• Managing Side Effects: Ensure you are maintaining a balanced diet regardless of taste alteration, which would increase or decrease your appetite

• Review dietary instructions and treatments as needed with an experienced professional.

• Preventing Cavities:

• Ask your dental provider about oral hygiene, dry mouth products, remineralizing products, chlorhexidine and diet

• Dietary Recommendations:

• Soft diet (atraumatic food); supplements if needed

• Trismus:

• Limited jaw opening: Ask your dental provider about jaw exercises, active therapy, and possible prescription medications

• Jaw Bone Health:

• Local Jaw radiation and a number of medicines used in cancer therapy can affect bone health; in turn, this can affect decisions to preform or avoid surgery. (If bone damage has occurred, case management can become more complex)

• Note: Some of the oral considerations and treatments are complex, and may require special expertise and consultation with the oncology team.

Published in Decisions in Dentistry May 2016 Volume 2, #5.

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