After being diagnosed with cancer, patients should see their dentist as soon as possible, explained Dr. Susan Calderbank.
Chemotherapy regimens can wreak havoc on patients’ oral health, making it extremely important that individuals see their dentist before starting treatment – and keep up with them throughout cancer care, too, explained Dr. Susan Calderbank.
Calderbank is an associate professor of oral medicine at the University of Pittsburgh School of Dental Medicine and operates her own private practice, where she raises awareness of the oral complications of cancer therapies. She said that approximately 30% of patients undergoing chemotherapy will have mouth ulcers, and in patients with head and neck radiation or cell transplants, that percentage goes up to about 80 to 90%.
In a recent interview with CURE®, Calderbank – who is also on the professional advisory board at Breastcancer.org – discussed why patients should see their dentists as a part of their cancer care team and offered insights on what individuals should know about oral care before starting chemotherapy.
CURE®: Can you give a brief overview of how chemotherapy affect a person’s mouth and dental health?
Calderbank: When people get chemotherapy, a lot of times they think they're getting a magic bullet that's only going to go and take care of the cancer cells, and they don't know that it also affects normal healthy tissue.
(The mouth has) the cells that divide the fastest in the body, and when a person has cancer, the treatment is targeted to have an effect on fast-dividing cells. So when the chemotherapy shuts down the fast-dividing cells, it has an effect in the mouth also. As these replacement cells in the tissue of the mouth are being sloughed off with talking, eating (and) yawning, the replacement cells aren't there to fill in the gap, and then the tissue itself gets thinner and thinner and thinner. And then what can happen is that the mouth becomes inflamed and irritated. And then alterations actually can occur.
What are the most common oral side effects that patients should look out for?
The first side effect that you'll see is that the tissue becomes red, and that's a sign that there's inflammation going on. If that's not stopped, then the inflammation – and as the tissue thins – it can ulcerate very, quickly. In putting the dental care of the patient ahead of the cancer treatment, then we can jump in and give the patient helpful tips, like the Natural Dentist rinse, which is usually successful in reducing inflammation. It has a very strong aloe vera base and several other botanicals, and that's a really strong anti-inflammatory. In using that prior to beginning the treatment, you've already begun to reduce any neural inflammation in the mouth and make the tissue healthier. When it's healthier, it will withstand chemotherapy much better.
In addition, in putting the dental care ahead of the cancer treatment, we have the ability to assess the treatment of the patient – what the needs are, for instance, (like) if there are abscessed teeth, if there are teeth that are going to be causing infection. Because don't forget, in chemotherapy, the body's resistance to infection will decline. And that's when an infection that's been left unattended can really flare up and cause huge problems for the patient that can actually lead to a fatal infection that is unable to be cured with antibiotics. So it's a pretty important step.
What we like to think of is that the cancer care would be more holistic – you would actually be making connections and synergy between the different providers, which is always to the benefit of the patient. In our practice, we get the (patient with) cancer right in, there's very rarely a delay of treatment. It works out for all the parties involved: the oncologists have an easier time, because the patient is not in pain, they're still able to eat. When you get a mouth ulcer, it can be very painful. You don't want to eat or drink or talk. And a lot of times these are written off as just quality-of-life issues, when actually they have a really important side effect in that it may be to the detriment of the patient receiving the cancer treatment.
What do you want the final takeaway for patients with cancer to be?
Sometimes dentistry is regarded as the divorced second cousin of the rest of the body, and the mouth. It's very important to go to the dentist…for these patients, it’s just immensely helpful, because if we can see them early, we can help them get through their treatment.
If they get ulcerated to the point where they can't swallow … the tissue is the same actually from the mouth all the way down through the digestive tract, so when they begin to alter it, those alterations can also be in the throat. That's one of the great things about the Natural Dentist (rinse) because it's all natural. If they get the ulcerations in the throat, the patients can gargle with it and actually swallow it and soothe the tissue in the alimentary tract which is getting ulcerated also.
It’s a win-win, always, for the patients to get these pre-cancer treatment dental checks. Actually, I wrote an article once and it was entitled, “You've got to be kidding me,” because when most patients are told they have to go to the dentist, (they think) “I have cancer I need to treat it. Why do I have to go to the dentist?” and you know, actually that's the very first place they should come.
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