Berks County, PA -
Dear Dr. Reitz: My husband was diagnosed with lung cancer and is beginning chemotherapy and radiation treatment. He was told to expect dental problems as a result of treatment and to visit his dentist to discuss how to care for his mouth. What dental problems are likely to occur and is there anything additional he can do to prevent them from happening? - A Concerned Wife, Morgantown
Dear Concerned Wife: Your husband is one of the 14 million people living with cancer in the United States today. Fortunately, current treatments have increased cancer patient's survival rate.
Cancer treatment usually involves a combination of chemotherapy and radiation therapy. Both forms of treatment have negative oral side effects that can be minimized with preparation. Chemotherapeutic drugs attack the rapidly dividing cells of a tumor. Unfortunately, bone marrow, hair and the lining of the entire digestive system from the mouth through the intestinal track are composed of rapidly dividing cells that also are affected.
Both radiation and chemotherapy have the potential to damage salivary glands. There are two types of saliva glands: serous glands and mucus glands. The first salivary glands to be destroyed are the serous glands, which are responsible for producing thin watery saliva. The remaining mucus glands make a more acidic and thick saliva that is stringy and hard to clear. The reduction in the type and amount of saliva usually results in tooth decay and gum disease because it promotes the overgrowth of bacteria.
Saliva changes can also result in oral fungal infections. The pain caused by oral fungal infections is often described as burning or scalding, and can result in loss of appetite and malnutrition. I suggest you ask the oncologist if he plans on utilizing a medication like Amifostine as part of the drug regimen in the IV to reduce dry mouth.
Your husband must continue to visit the dental hygienist during his cancer treatments. In addition, in order to prevent decay, it's advisable to apply a calcium phosphate paste (MI Paste) to the teeth at home utilizing custom trays made by the dentist.
Mucositis, which often occurs 10 days into treatment, is a painful ulceration of the oral tissue caused by both chemotherapy and radiation attacking the rapidly growing oral mucosa. One of the best treatments for mucositis is sucking on ice to reduce inflammation. In addition, your dentist my prescribe topical antibiotics or prescription mouth rinses to help prevent bacteria and yeast from colonizing the ulcers.
The Dentist's Chair appears Saturdays. Dr. John Reitz answers questions from readers. Email them to email@example.com or mail to John Reitz, DDS, 30 Commerce Drive, Wyomissing PA 19610.