Chemotherapy Recommendations
Patients undergoing Chemotherapy can have unusual dental problems. Here are some suggestions to help deal with side effects from Chemotherapy.
Toothbrush
Use a soft small-headed toothbrush like Oral-B 30 or 35, Colgate Diamond Head or Sensodyne Search. The Biotene Supersoft toothbrush has a large head; however, the configuration of the bristles has created an extremely soft toothbrush, ideal for sensitive mouths. The Butler Gum Activital extra-soft sonic brush is inexpensive and effective.
Brushing
Brush teeth twice a day following meals, using small circular strokes. Avoid vigorous and horizontal brushing at the gum line of teeth as this may damage the gum and cause root surfaces to be exposed which can then decay rapidly.
Toothpaste
Most toothpastes contain the foaming agent sodium lauryl sulphate, or SLS, which has been found to cause irritation in sensitive mouths. Toothpastes containing SLS should be avoided if you have sore mouth (mucositis), oral ulcers or dry mouth. Biotene ‘Dry Mouth Toothpaste’ is SLS free, contains fluoride and important salivary enzymes. CTX4 is also SLS free, as is MI paste, and both are good for sensitive mouths. These can be bought at cost at our office for our existing patients.
Mouthwash
A warm salt water or sodium bicarbonate (Baking Soda) mouth rinse may improve oral comfort for mild irritation with sore mouth. It is important to only use an anti-bacterial mouthwash which does not contain alcohol or phenol if there are symptoms of dry mouth or sore mouth as alcohol has a drying effect on oral tissues. Peridex is an antiseptic and disinfectant mouthwash and is effective against a wide range of oral organisms. Superficial staining of teeth however, has been reported in some people. Be aware that most other chlorhexidine containing mouthwashes contain alcohol.
Biotene mouthwash is anti-bacterial, alcohol-free and like the ‘Dry Mouth Toothpaste’ contains salivary enzymes. Carifee maintenance rinse contains xylitol and fluoride, and is pH balanced to help reduce decay. We can order this for you. If during treatment your mouth still becomes very sore and you feel that the mouthwash is too strong try diluting it with warm water.
We can also provide Ozonated Water to rinse with. This is highly effective and soothing, but has a 1-day shelf life even if kept cold in a thermos.
Flossing
Use dental floss or dental tape between teeth at least once daily.
Denture Care
The acrylic resin from which dentures are fabricated has microscopic holes or pores. It is essential that dentures are cleaned thoroughly at least daily with a toothbrush or denture brush. They should not be worn at night and always left to soak in warm water or a denture cleaner such as Dr B’s Cleanadent Crystals (We can order these for you) when not being worn. They should also be left out as often as possible during the day, whenever a mouthwash is used and during radiation therapy sessions.
The gums and areas under a denture should also be brushed on a regular basis and the mouth rinsed after all meals. Brushing stimulates the gums and helps keep them firm and less likely to harbour the microorganisms which may lead to irritation or infection. Removing accumulated food debris limits irritation, staining and bad breath. Oralbalance moisturising gel can be used on the tissue fitting surface of the denture to minimise irritation and may also improve retention.
At first sign of discomfort, the denture should be removed and checked by a dentist as adjustment or relining may be required.
Topical Fluoride
MI paste should be applied nightly to teeth after regular brushing, immediately before going to bed. Dry the toothbrush and cover the bristles with MI or use cotton buds if gums are sore. Brush on to all tooth surfaces for one minute, then vigorously swish for one minute forcing the gel into the spaces between the teeth. Spit out, do not swallow or rinse and go to bed with the Gel-Kam or MI residue on the teeth. The same should be repeated in the morning immediately after regular brushing.
MI paste can be applied with a fingertip, and is safe to ingest. You should not have anything to eat or drink for at least 20 minutes afterwards. Should your mouth be very dry it may be necessary to have mouthguards constructed and place the MI paste in the guards. These may have to be worn for at least 5-10 minutes each night immediately before going to bed.
In severe cases with heavy decay, we may recommend using Gel-Kam or other strong fluoride toothpaste like Prevident 5000 or CTX5000, and placing fluoride gel in the trays overnight.
Saliva Substitutes
Saliva substitutes may help keep the mouth moist and allow for easier eating, swallowing, talking and sleeping. Many patients have reported significant relief from the effects of dryness by using ‘Oralbalance’ moisturising gel. It is also suitable to place under dentures. We can also give you XyliMelt xylitol lozenges that stick on your gums and slow-release over long time.
Maintenance
You should see a dentist at least three times a year for cleaning and early treatment of cavities. If there is decreased saliva there is likely to be an increase in the amount of tooth decay.
Diet
Should you have significant oral discomfort, small regular meals and snacks may help you obtain adequate nutrients and prevent weight loss. Carry a toothbrush with you and if you have your own teeth you can reduce the impact of tooth decay by limiting sweet, sticky, sugary foods or anything with a high acid level such as grapefruit, tomato or orange. Always brush immediately after eating. If it is not possible to brush, swish and swallow with water as soon as possible.
Suggestions to relieve dryness and preserve soft tissue
Take frequent sips of water.
Use a water spray bottle to wet your mouth.
Chewing sugarless chewing gum such as Spry or Xylichew (Available at health food stores or our office) helps stimulate salivary flow.
Suck sugarless hard candies, especially ones with Xylitol like PUR or Spry mints.
Suck on ice blocks.
Keep a glass or carafe of water by your bed for sipping during the night or on awakening.
Drink frequently while eating. This will make chewing and swallowing easier and may improve taste.
Use bland, non-spicy sauces and gravies as accompaniments to meat dishes.
Moisten foods with butter
Pasta dishes with creamy sauces may be easier to swallow.
Limit caffeine-containing coffee and tea. Many patients report increased dryness after drinking beverages containing caffeine.
Where to buy the mentioned products
The electric toothbrush may be purchased at Rexall stores or through our office. The other products are all available from pharmacies or from our office. Shopper’s Drug Mart and London Drugs carry Xyli-melts.
PET WARNING- products containing Xylitol are toxic to dogs, although safe for humans.