Oral Health, Cancer Care, and You

Fitting the Pieces Together

Chemotherapyand Your MouthChemotherapyand Your Mouth

Oral Health, Cancer Care, and You is anawareness campaign sponsored by theNational Institute of Dental andCraniofacial Research (NIDCR) throughits National Oral Health InformationClearinghouse (NOHIC). Thiscampaign is being conducted inpartnership with the National CancerInstitute, the National Institute ofNursing Research, the Centers forDisease Control and Prevention, andthe Friends of the NIDCR. For moreinformation about the campaign,please contact NOHIC. Campaignpublications are also available online athttp://www.aerie.com/nohicweb.

National Oral HealthInformation ClearinghouseAttn: OCCT1 NOHIC WayBethesda, MD 20892–3500Phone: 1–877–216–1019 (Toll-free)Fax: 301–907–8830E-mail: nidr@aerie.com

Oral Health, Cancer Care, and You

Fitting the Pieces Together

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Are You Being TreatedWith Chemotherapyfor Cancer?If so, this booklet can help you. Whilechemotherapy helps treat cancer, it canalso cause other things to happen in yourbody called side effects. Some of theseproblems affect the mouth and couldcause you to delay or stop treatment.

This booklet will tell you ways to helpprevent mouth problems so you’ll getthe most from your cancer treatment.

To help prevent serious problems, seea dentist at least 2 weeks before start-ing chemotherapy.

A dentist can help prevent mouthproblems.

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How DoesChemotherapy Affectthe Mouth?Chemotherapy is the use of drugs totreat cancer. These drugs kill cancercells, but they may also harm normalcells, including cells in the mouth. Sideeffects include problems with yourteeth and gums; the soft, moist lining ofyour mouth; and the glands that makesaliva (spit).

It’s important to know that sideeffects in the mouth can be serious.

• The side effects can hurt and makeit hard to eat, talk, and swallow.

• You are more likely to get an infec-tion, which can be dangerous whenyou are receiving cancer treatment.

• If the side effects are bad, you maynot be able to keep up with yourcancer treatment. Your doctor mayneed to cut back on your cancertreatment or may even stop it.

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You can see or feel most of theseproblems. Check your mouth every day.

What MouthProblems DoesChemotherapy Cause?You may have certain side effects inyour mouth from chemotherapy. An-other person may have different prob-lems. The problems depend on thechemotherapy drugs and how yourbody reacts to them. You may havethese problems only during treatmentor for a short time after treatment ends.

• Painful mouth and gums.

• Dry mouth.

• Burning, peeling, or swellingtongue.

• Infection.

• Change in taste.

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Why Should I Seea Dentist?You may be surprised that your dentistis important in your cancer treatment.If you go to the dentist before chemo-therapy begins, you can help preventserious mouth problems. Side effectsoften happen because a person’smouth is not healthy before chemo-therapy starts. Not all mouth problemscan be avoided but the fewer sideeffects you have, the more likely youwill stay on your cancer treatmentschedule.

It’s important for your dentist andcancer doctor to talk to each otherabout your cancer treatment. Be sureto give your dentist your cancerdoctor’s phone number.

When Should I See a Dentist?

You need to see the dentist at least 2weeks before chemotherapy begins.If you have already started chemo-therapy and didn’t go to a dentist, seeone as soon as possible.

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The dentist will do a complete exam.

What Will the Dentistand Dental Hygienist Do?• Check your teeth.

• Take x-rays.

• Take care of mouth problems.

• Show you how to take care of yourmouth to prevent side effects.

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What Can I Do To KeepMy Mouth Healthy?You can do a lot to keep your mouthhealthy during chemotherapy. Thefirst step is to see a dentist beforeyou start cancer treatment. Onceyour treatment starts, it’s important tolook in your mouth every day forsores or other changes. These tips canhelp prevent and treat a sore mouth:

Keep your mouth moist.

• Drink a lot of water.

• Suck ice chips.

• Use sugarless gumor sugar-free hardcandy.

• Use a salivasubstitute tohelp moistenyour mouth.

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Clean your mouth, tongue, and gums.

• Brush your teeth, gums, and tonguewith an extra-soft toothbrush afterevery meal and at bedtime. Ifbrushing hurts, soften the bristles inwarm water.

• Use a fluoride toothpaste.

• Don’t use mouth-washes with alcoholin them.

• Floss your teethgently everyday. If yourgums bleedand hurt,avoid the areas thatare bleeding or sore, but keepflossing your other teeth.

• Rinse your mouth several times aday with a solution of 1/4 teaspoonbaking soda and 1/8 teaspoon saltin one cup of warm water. Followwith a plain water rinse.

• Dentures that don’t fit well cancause problems. Talk to your can-cer doctor or dentist about yourdentures.

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If Your Mouth Is Sore, Watch WhatYou Eat and Drink.

• Choose foods that are good for youand easy to chew and swallow.

• Take small bites of food, chewslowly, and sip liquids with yourmeals.

• Eat soft, moist foods such as cookedcereals, mashed potatoes, andscrambled eggs.

• If you have trouble swallowing,soften your food with gravy, sauces,broth, yogurt, or other liquids.

Sipping liquids with your meals willmake eating easier.

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Call Your Doctor or Nurse When YourMouth Hurts.

• Work with them to find medicinesto help control the pain.

• If the pain continues, talk to yourcancer doctor about strongermedicines.

Remember To Stay Away From

• Sharp, crunchy foods, liketaco chips, that couldscrape or cut yourmouth.

• Foods that are hot,spicy, or high inacid, like citrusfruits and juices,which can irritateyour mouth.

• Sugary foods,like candy orsoda, that could cause cavities.

• Toothpicks, because they can cutyour mouth.

• All tobacco products.

• Alcoholic drinks.

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Your child has special dental needs.

Do Children GetMouth Problems Too?Chemotherapy causes other side effectsin children, depending on the child’s age.

Problems with teeth are the most com-mon. Permanent teeth may be slow tocome in and may look different fromnormal teeth. Teeth may fall out. Thedentist will check your child’s jaws forany growth problems.

Before chemotherapy begins, take yourchild to a dentist. The dentist will checkyour child’s mouth carefully and pullloose teeth or those that may becomeloose during treatment. Ask the dentistor hygienist what you can do to helpyour child with mouth care.

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Remember:• Visit your dentist before your

cancer treatment starts.

• Take good care of your mouthduring treatment.

• Talk regularly with your cancerdoctor and dentist about any mouthproblems you have.

Call your cancer doctor or dentist ifyou have any mouth problems.

AcknowledgmentsThe individuals listed here provided assistance in developing,reviewing, and field testing all of the campaign publications.The campaign sponsors would like to thank them for theircontributions.

Scientific CommitteeGerry Barker, R.D.H., M.A.University of Missouri-Kansas CityKansas City, MOSusan L. Beck, R.N., Ph.D., A.O.C.N.University of UtahSalt Lake City, UTMarylin Dodd, R.N., Ph.D.University of California, San FranciscoSan Francisco, CAJoel Epstein, D.M.D., M.S.D., F.R.C.D.British Columbia Cancer Agency and Vancouver Hospitaland Health Sciences CentreVancouver, CanadaPhilip Fox, D.D.S.National Institute of Dental and Craniofacial ResearchBethesda, MDDeborah McGuire, R.N., Ph.D.Emory UniversityAtlanta, GADouglas Peterson, D.M.D., Ph.D.University of ConnecticutFarmington, CTMark M. Schubert, D.D.S., M.S.D.University of WashingtonSeattle, WAJohn Wingard, M.D.University of FloridaGainesville, FL

Field TestersOlubunmi Abayomi, M.D.Howard University HospitalWashington, DCAlice Bass, B.S.N., O.C.N.Greater Southeast Community HospitalWashington, DCBetsy Bischoff, R.N., M.S.Georgetown University Medical CenterWashington, DCAndrea Bonnick, D.D.S.Howard UniversityWashington, DCDorothy Chesley, R.N., Ph.D.Texas Nursing FoundationAustin, TXNancy E. Leupold, M.S.Support for People with Oral andHead and Neck Cancer (SPOHNC)Locust Valley, NYAlice Mahan, B.S., R.T.T.Howard University HospitalWashington, DCMiKaela Olsen, R.N., M.S., O.C.N.UCSF Stanford Health CareStanford, CAPeter Passero, D.D.S.Prizm Dental Partners and Management GroupMcLean, VAK. Vendrell Rankin, D.D.S.Baylor College of DentistryDallas, TX

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Publication No. 99-4361