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Importance of Oral Health and Oral Care before, during, and after cancer treatment

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Oral Health Care before, during, and after childhood cancer treatmentChildhood cancer treatments can affect normal tooth development and cause long-term dental issues. The California Dental Hygienists’ Association is being proactive in highlighting this issue during Childhood Cancer Awareness Month and has asked us to share their Press Release. We encourage families to discuss their child’s treatment related dental issues with their oncologist and child’s dentist.

“CDHA joins the ACCO in recognizing Children’s Cancer Awareness Month

Importance of Oral Health and Oral Care before, during, and after cancer treatment is stressed.

Sacramento CA, September 1, 2015

All of us know someone who has been affected by cancer. Unfortunately, the sad truth is that our most vulnerable population, our children, can also be the victims of cancer. In the U.S., 15,780 children under the age of 21 are diagnosed each year with cancer, according to the American Childhood Cancer Organization (ACCO).

There are many types of childhood cancers that range from brain cancer to lymphomas and sarcomas. Treating a child with cancer involves a large team of specialists and oncologists. “Because there is a risk of developing side effects which are linked to dental disease, seeing a dentist and/or dental hygienist before cancer treatment begins is imperative”, states California Dental Hygienists’ Association (CDHA) President Lygia Jolley, RDH, BA. Both the disease and the treatment can cause many problems that affect the child’s mouth. Among these are dry mouth (xerostomia), mouth sores (mucositis), tooth decay, difficulty swallowing (dysphagia), difficulty chewing or opening the mouth (trismus), oral infections, bone disease, inflammation or pain in the lining of the mouth and tongue.

Treatments

According to the American Cancer Society , the types of cancer treatments which have proven to be the most beneficial and effective include chemotherapy, radiation therapy, and the new technique of plasma laser surgery.

Chemotherapy is a cocktail of drugs given intravenously to kill the rapidly growing cancer cells. Plasma Laser surgery uses focused lasers directed at the affected cells to destroy them. And radiation therapy is delivered directly to the tumor to kill the cancerous cells. Unfortunately, all three treatment options do damage or produce side effects that can affect the patient. The acute concerns of cancer treatment relate to the child’s immediate overall health, while the chronic effects can have implications regarding the growth of the child.

Oral Considerations

“Dental treatment is an extremely important need before beginning cancer treatment”, states Jolley. “It identifies existing risk factors, oral treatment needs, existing risk factors, and oral hygiene care recommendations”, continues Jolley. An appropriate amount of time needs to be considered for oral care before starting cancer treatment. To start, the child needs to visit a dentist and hygienist for evaluations, ideally one month before cancer treatment begins to allow enough time for the tissue to heal following any dental treatment needs. During this phase, the dentist should take a panoramic and full mouth x-rays to look for any abnormalities such as periodontal disease, ongoing infections, or cavities. Additionally, the dentist or hygienist will conduct an oral cancer screening to check for signs cancer may be present in the mouth. Orthodontic braces also need to be removed, and extraction of any loose and hopeless teeth should also be accomplished at this time.

Cancer treatment related dental education for the child and parents is key for good oral health during the child’s treatment. Overall, good brushing and flossing is imperative. The child’s immune system is compromised during treatment, so extra attention to daily cleanings to keep the mouth clean goes a long way. At the first sign of any oral complications related to cancer treatment, the child should be immediately seen by a dentist or hygienist. Be sure to alert your dental provider to the types cancer treatment the child is undergoing. Often times, blood work is needed 24 hours prior to care so that the clotting factors and immune system mediators are measured. Additionally, antibiotics may be needed to prevent infections following dental hygiene care. The CDHA suggests the following care tips:

Gently brush your teeth two times a day, and floss regularly. It is important to continue good oral hygiene practices. If the gums are sore, it may also help to soak an extra-soft toothbrush in warm water to soften the bristles before brushing. Prescription rinses are available to relieve oral pain associated with chemo and radiation therapy.

Avoid alcohol based mouth rinses and extremes in your diet. Do not rinse with an alcohol based mouthrinse – choose an alcohol free mouth rinse instead. Food choices should include foods that are soft and mild. Extremely hot, cold, spicy, acidic, or crunchy foods may irritate your mouth and cause damage.

Promote good bone health. Getting enough vitamin D and calcium each day helps promote a strong, healthy jaw and teeth. Dairy products are good sources of calcium and, if fortified, vitamin D. Other food choices may include fortified fruit juice and fortified breakfast cereals. Talk with your doctor before taking any supplements.

Drinking water and sugarless drinks may help manage dry mouth. Sucking on ice chips or using candy sweetened only with Xylitol is a good alternative. Try to avoid things that will dry out your mouth and cause cavities, such as sodas and fruit juice. Topical oral gels or rinses can be prescribed for dry mouth either caused by chemotherapy or radiation therapy to the head and neck.

The RDHAP

In some cases, the child cannot go to a dentist for checkups and dental hygiene care, in this case, and RDHAP (Registered Dental Hygienist in Alternative Practice) can be the best option. RDHAPs are licensed hygienists who can work in hospitals, home care facilities, and can travel to the sick patient’s home to provide dental hygiene care. RDHAPs don’t need DDS presence to provide dental hygiene care and they are able to do oral screening, place sealants, and clean patient’s teeth without having patient to leave the bed or his/her comfort place. To find an RDHAP, visit www.cdha.org/rdhap.

Follow up treatment is another part of dental care for those who suffer from cancer. Patient must explain all the medication that he/she was given during cancer treatment including bisphosphonate therapies and stem cell transplant; the patient needs to share the type of cancer, duration of treatment, methods of treatment, any complications before, after and during cancer treatment, and any surgeries that was done. If patient went under head and neck radiation therapy, a 4-8 weeks dental appointment is needed for the first 6 months since oral complications after radiation therapy can happen long after the termination of the treatment.7

Following successful cancer treatment

It is important to receive ongoing dental examinations as after effects of cancer treatment can be far reaching. Relay to your dental provider all medication that was given during cancer treatment including bisphosphonate therapies and stem cell transplant. Duration of treatment, methods of treatment, any complications before, after and during cancer treatment, and any surgeries need to be shared . If head and neck radiation therapy was administered, a 4-8 weeks dental appointment is needed for the first 6 months following treatment as oral complications can happen long after the termination of the treatment.

Children who have been under chemotherapy before their permanent teeth were fully formed, especially if they were younger than 5 years old at the time of treatment, are at greater risk of future dental problems. In addition, radiation therapy near or in the mouth, will affect the salivary glands and cause permanent loss of salivary function, leading to a life long increased risk for dental decay and periodontal disease. Radiation therapy can also cause unintended nerve damage creating taste alteration which can lead to disruptions in diet.

Chemotherapy affects bone density by decreasing the level of calcium in the body. As a result, the growing child can develop TMJ problems, locking of the jaw, asymmetrical growth of face and jaw bone, abnormally sized/shaped teeth, or severe orthodontic complications.
The CDHA recommends visiting its website for more information: www.cdha.org

The California Dental Hygienists’ Association (CDHA) is the authoritative voice of the state’s dental hygiene profession. The organization was established 30 years ago when two regional associations merged to form a unified professional group. CDHA represents thousands of dental hygienists.”

For more information about the American Childhood Cancer Organization and how we can help, call 855.858.2226 or visit:

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