Oral Management for the Cancer Patient

Bacterial Plaque Control

Emphasize daily plaque removal to reduce microorganisms. The patient’s immunity will be compromised and there is a potential for oral side effects associated with cancer therapy. Toothbrushing instructions include using a soft or extra-soft toothbrush; a flavored dentifrice may not be tolerated, but fluoride is essential. Mouthrinses include saline solution to moisten the mucosa, as well as over-the-counter products managing oral mucositis. Chlorhexidine gluconate rinsing may also be recommended for antibacterial properties, if tolerated by the patient. Commercial mouthrinses that contain alcohol should be avoided. There are several saliva substitute products available over-the-counter, e.g., Biotene sprays and gels moisten the mucosa for patient comfort. I recommend the more viscous gels at night and the sprays during the day. However, patients can use the gel throughout the day to moisten their mucosal tissues.

Homecare and Professional Fluoride Therapies

Daily fluoride therapy is indicated for patients about to undergo head and neck radiation therapy, if the salivary glands are in the field of radiation. Make impressions and fabricate a custom fluoride tray, advise the patient to apply custom trays lined with prescription 5,000-ppm sodium fluoride gel to the teeth for 5-10 minutes once daily. Advise patient to refrain from eating, drinking, or rinsing for 30 minutes following fluoride application. Frequent sodium fluoride varnish applications in your office is recommended.

Dietary Instructions

Instruct the patient in food preparation. Avoid highly cariogenic foods, e.g., carbohydrates and also spicy foods. A soft, bland diet is recommended. Water is recommended throughout the day to moisten the oral cavity. Saliva substitutes are also recommended to decrease the risk of caries. See the NIH website for current dental provider instructions for cancer patients.

Avoid Alcohol and Tobacco Products

If your patient uses tobacco products, a logical step for the cancer patient is to start tobacco cessation counseling. In the U.S., young adults are more likely than adults to use e-cigarettes. In 2021 it was reported over 2 million middle (2.8%) and high school (11.3%) students used e-cigarettes. In 2019, 4.5% of adults reported using e-cigarettes. Currently the highest percentage of e-cigarettes users who have never smoked cigarettes are those aged 18-24 years (56%). See Tobacco 101: A Guide to Working with Nicotine Addicted Patients and Tobacco and Nicotine Products: The Times They Are A’Changing on dentalcare.com for continuing education courses on tobacco cessation programs. Some of the more common patient educational websites dental and medical providers use: ADA Oral Health Topics Smoking and Tobacco Cessation, CDC Quit Smoking, CDC Electronic Cigarettes, U.S. Department of Health and Human Services/National Institutes of Health/National Cancer Institute Smokefree.gov, and American Cancer Society How to Quit Smoking or Smokeless Tobacco. For national websites on alcohol and cancer, NIH and CDC have educational materials on alcohol and cancer. There are multiple research studies on esophageal cancer and the combination of alcohol and tobacco use.