Dental Care for Cancer Patients

Cancer treatments can have side effects that affect a person’s mouth, teeth, gums, and salivary glands. There are steps you can take to lower the risk of these side effects and manage them if they do happen.

Chemotherapy or radiation may cause mouth sores, dryness of the mouth (which can lead to discomfort and higher risk of cavities), and pre-existing infections may become worse.

Before Cancer Treatments Begin

You should visit with your dentist at least 4 weeks before cancer treatments begin to determine if there are any conditions with your teeth that should be treated before the cancer treatments begin.

  • Dental examination and x-rays
  • Dental cleaning
  • Impressions for fluoride trays. Fluoride trays are custom-fitted soft plastic trays that are used to apply fluoride. Fluoride is used to help prevent the formation of cavities.
  • Oral hygiene instructions:
    • brush three times a day with a soft toothbrush
    • use a prescription toothpaste such as Clinpro or Prevident which has a higher concentration of fluoride
    • floss daily
    • apply fluoride gel to teeth with custom tray at bedtime
    • eat a nutritionally balanced diet, low in sugar

During and After Cancer Treatment

It is important to adhere strictly to your mouth care plan. If your mouth is sore, some of the following tips may help:

  • Use a soft toothbrush to brush your teeth.
  • Wear dentures only for meals.
  • Rinse your mouth with warm salt water or baking soda and water (a teaspoon of either dissolved in eight ounces of warm water). The baking soda/water rinse is especially important if you experience vomiting in order to neutralize the acid and protect your teeth. Don’t brush your teeth in the presence of the acid or you will cause erosion of your teeth.
  • Avoid commercial mouthwashes because they contain alcohol that may burn your mouth.
  • If your doctor prescribes both an antibacterial rinse (Peridex) and an antifungal rinse or lozenge (nystatin), do not take them together because they will not work as well. Separate them by at least one hour.
  • To prevent discomfort when eating, you may apply Viscous Xylocaine or a special mouthwash prescribed by your dentist, especially before meals. Other topical anesthetics are available at your pharmacy. Ask your doctor or nurse about specific products.
  • Pain medicine may also be used. Tylenol will help reduce oral pain. If taken half an hour before meals it may be more comfortable to eat. It is important to avoid using aspirin or non-steroidal medication (Advil, Motrin) products while on chemotherapy since they may cause bleeding problems.
  • Do not smoke cigarettes, cigars, pipes, or chew tobacco and avoid drinking alcohol. These are all very irritating and drying to a sore mouth.
  • Avoid spicy food and food that is difficult to chew. Citrus and tomato juice may irritate your mouth when you have mouth sores.
  • Dry mouth (xerostomia) can be helped by drinking plenty of fluids (ideally water) throughout the day.
  • Avoid caffeinated beverages as the caffeine may increase mouth dryness.
  • Artificial saliva (sprays, gels, rinses) can be tried and is available in most pharmacies. You may find that chewing sugarless gum or sucking on sugarless candy is helpful. Coating your lips with a lip balm such as Vaseline or Chapstick will help prevent them from cracking. A cool mist humidifier will add moisture to your room.

Fluoride treatments are important during and after radiation treatments to the head and neck area. They should be done daily by using soft trays that are custom made for you by your dentist.

Fluoride treatment is performed as follows:

  • Brush your teeth with a fluoride toothpaste
  • Place fluoride gel into the tooth depressions in the plastic tray.
  • Place trays in your mouth and keep them in for at least five minutes. Try not to swallow the fluoride. Remove trays and spit out the excess fluoride. Do not rinse your mouth or take any food or drink for one hour.
  • Rinse out the tray