The type of cancer therapy chosen by all of your cancer team depends on many issues such as tumor size, location, tumor aggressiveness, medical history, etc. The type of therapy chosen by your doctors is the regimen that has shown the best results for each particular case. Fortunately, cure rates are now quite good in many cases. Unfortunately, all of these weapons against cancer have undesirable side effects; some of them being very permanent. The good news is most of the side effects are treatable and with the proper planning and care your mouth can remain healthy.
Surgery performed to remove cancer often takes away vital parts of the head, neck and mouth. Oral cancer is often removed with teeth and parts of the jaw, palate, tongue and throat and neck. Patients can have difficulty talking, eating and swallowing not to mention appearance issues. Fortunately, advances in medical and dental technology have made reconstructions possible for many debilitated patients. Most patients can recover and still have a good quality of life post cancer surgery. Part of the specialty training of a maxillofacial prosthodontist, involves working closely with your surgeon and radiation oncologist to fabricate all the special temporary and permanent oral appliances needed for your proper care and rehabilitation during and after cancer treatment.
Chemotherapy is often used as another weapon in the battle against head and neck cancer. Chemotherapy is often used in conjunction with radiation or surgery to treat cancer. Fortunately, most of the chemotherapy side effects; mainly dry ulcerated mouth are short lived and will disappear soon after the treatment is completed. Usually the chemotherapy side effects are treatable with medication and mouth rinses, and usually no permanent damage is done.
Radiation therapy used to treat cancer in the head and neck region results in permanent changes to your saliva quality when the salivary glands are in the treatment area. This weakened saliva greatly increases the risk of tooth decay, periodontal disease and oral infections. The saliva is reduced in volume and there is a reduction in some important chemicals (such as bicarbonate), which neutralize acid. Xerostomia (dry mouth) causes an increase in the type of bacteria, which produce acid and cause cavities and gum disease. In spite of all these changes, which predispose your teeth to breakdown, effective preventive measures are available. You will be instructed on the daily use (10 minutes) of a special fluoride gel (available by prescription or directly from our office). Custom-made flexible fluoride carriers, which precisely fit your teeth, will be made for you to enable you to most effectively apply the fluoride to your teeth. These are to be used daily until such time that we determine it may be safe for you to decrease the use of fluoride. For most patients, the risks of tooth decay remain high permanently and the use of daily fluoride is recommended indefinitely. The portion of the teeth most susceptible to decay is the area at the gum line. It is imperative that you learn and apply daily oral hygiene procedures for the fluoride to be effective. We will instruct you in the procedures. If you have any gum recession with exposure of the roots of the teeth, it is even more imperative that compliance with oral hygiene measures and fluoride use are followed. The roots are not covered by hard enamel and they can decay easily if care is not taken to clean them properly.
Radiation therapy also has an effect on the portion of the bone, which receives the radiation. This affects the bone by permanently reducing its ability to heal and to resist infection. If teeth with periodontal deficiencies (bone loss, looseness, gum loss, pockets or infection) exist in the bone to be irradiated, pre-radiation extractions may be recommended (especially in the lower jaw). Extractions are sometimes recommended prior to radiation to prevent the serious bone infections, which can result if teeth have to be removed after the radiation treatment is completed. The need for extractions will be evaluated and discussed on an individual basis following examination, radiographs and discussion with you and your referring physicians.
During the radiation and/or chemotherapy treatments, your mouth may get quite sore and ulcerated (mucositis). Due to mouth soreness, it often becomes difficult and painful to clean your teeth effectively during treatments. Rinsing with dilute solution of salt and baking soda (1/4 teaspoon of each in a large glass of warm water) will help reduce soreness. A variety of medications are available and will be prescribed on an individual basis as needed. These include a topical numbing agent for the gums (viscous xylocaine), artificial saliva, antifungal rinses, antibiotic rinses, etc. Our office will follow your progress through treatments, and once healing is completed a cleaning and any necessary dentistry be performed. Healing times can vary widely from case to case so most recommendations must be made on an individual basis.
