Caring for your mouth is about far more than having a pretty smile. Poor oral health has proven to raise risks for a variety of medical conditions, such as heart attacks, strokes (1), respiratory infections (2), pregnancy complications (3), and even Alzheimer’s disease (4).
After a breast cancer diagnosis, paying special attention to caring for your teeth and gums can help to reduce uncomfortable and potentially dangerous oral side effects. Minimizing oral side effects during treatments can also reduce risks for damage to long-term oral health and provide a better quality of life throughout survivorship and thrivorship.
Oral Health Risks from Treatment for Breast Cancer
The risks for experiencing oral health problems during treatments for breast cancer can depend on many factors including:
- How healthy your mouth is prior to starting treatments. A healthy mouth is less likely to experience negative oral side effects.
- Oral hygiene and lifestyle choices, such as diet or tobacco use.
- Additional medical conditions and medications may contribute to oral health problems.
- The types of cancer therapies administered.
- Chemotherapy, depending on which chemo medications create the cocktail, dosage, and duration
- Hormone therapies may contribute to dry mouth and loss of bone mineral density. Periodontal disease involves the loss of alveolar bone (the bone that supports your teeth).
- Medications that carry a risk of a condition known as Osteonecrosis of the Jaw (described below)
Dry mouth is a very common condition caused by many over-the-counter and prescription medications. While dry mouth is often viewed as a comfort issue, it can dramatically increase risks for oral diseases. Saliva is full of beneficial elements that protect against cavities, gum disease, and bacterial, viral, and fungal infections. Saliva lubricates the tissue to prevent trauma, allows us to taste properly, and is our first step with digestion. The tongue’s surface has taste buds that are dependent on saliva to function properly; a dry mouth is more likely to experience problems with taste.
Oral mucositis can occur with certain types of chemotherapy medications and may range from mild tenderness in the tissue to large, painful mouth sores. Mouth sores can make eating difficult and put one at risk for serious infections that can spread beyond the mouth. When possible, see your dentist prior to breast cancer treatments to resolve any existing dental issues and remove potential sources of irritation in your mouth. Good oral hygiene and treating dry mouth can also help to protect against mouth sores.
Osteonecrosis of the Jaw
Some medications typically used with advanced stages can carry a risk of developing osteonecrosis of the jaw, which is when areas of the jaw bone die.
- Bone-building medications may be used to prevent loss of bone mineral density or slow the progression of advanced-stages that have spread to the bone.
- Targeted therapies, such as trastuzumab and pertuzumab, when used in conjunction with bone-building medicines
- Pain, swelling, redness, or other signs of infection in the gum tissue
- Oral tissue that doesn’t heal after dental work
- Loose teeth
- Numbness or a heavy feeling in the jaw
- Exposed bone
While osteonecrosis (caused by medications) is very rare, it is wise to know if your treatment course puts you at risk and take simple steps to help prevent it from happening! The majority of cases are initiated by some type of trauma to the bone, like a tooth extraction. Prevention includes meticulous oral hygiene and preventive dental care to avoid the need for extractions and exploring less invasive treatment options as needed.
How to Prevent Oral Health Issues Related to Breast Cancer?
The main goal is to prevent oral health problems rather than fixing them. Keeping your mouth clean to reduce the number of harmful bacteria found in dental plaque while being as gentle as possible to avoid tissue trauma is key.
- Use an extra-soft toothbrush with a small, compact head with small circular strokes; avoid aggressive horizontal brushing
- Brush teeth and tongue at least 3 times daily
- Soften bristles under hot water if necessary
- Replace brush at the first sign of bending or fraying or bristles, every 3 months at a minimum
- Protect your toothbrush from germs; do not store your brush near a flushing toilet or touching other brushes. Use your own tube of toothpaste to avoid transmitting germs from one housemate to the next.
- If brushing after a meal is not possible, swish with water to remove food debris
If you have been flossing regularly prior to treatments, you may continue with the approval of your oncology team with respect to your platelets and white blood cell counts. Ask your dental hygienist to demonstrate the proper technique to thoroughly clean the inside edges of your teeth while avoiding trauma to the tissue.
Oral Hygiene Products
Not all oral care products are created equally and certain ingredients may accentuate problems, like dry mouth and mouth sores. During the treatment process, avoid irritating ingredients, such as Sodium Lauryl Sulfate (SLS), whitening ingredients, peroxide, and tartar control. Strong flavors, especially peppermint and cinnamon, may sting tissue and aggravate nausea.
Use products that have a near-neutral pH, or slightly alkaline to balance acidity levels in the mouth. Ask a trusted dental professional for recommendations as pH levels are not commonly listed on product packaging. Other product ingredients that are beneficial to oral health include fluoride, calcium & phosphate, arginine, chitosan, xylitol, and erythritol.
Rinse with a saltwater and baking soda mixture to soothe tissue, wash away debris, and neutralize oral pH. While recipes vary, the International Society of Oral Oncology recommends:
- 1 level tsp baking soda
- 1 level tsp salt
- 4 cups water
Mix together and store in a container with a lid at room temperature. Shake well before use. Use throughout the day and discard at end of the day.
Your oncology team may provide you with additional prescription rinses as needed for mouth sores or infections, like thrush. Prescription rinses known as Supersaturated Calcium Phosphate rinses can help reduce dry mouth and mouth sores while protecting long-term oral health.
More Ways to Combat Dry Mouth
- Stay hydrated with frequent sips of water
- Avoid caffeine, alcohol, and tobacco
- Use a humidifier at night
- Breathe through your nose, not your mouth.
- Use sugar-free hard candies and gum sweetened with xylitol
Xylitol is a natural sugar substitute used in a variety of oral health products that can protect against cavities. Look for products 100% sweetened with xylitol as lower levels will not provide the same benefit. Its sweet taste helps to stimulate saliva to reduce dry mouth. Introducing xylitol into your routine slowly allows your body to get used to its use and will reduce chances for stomach issues, as it is digested as a fiber. Keep xylitol products away from pets. Dogs cannot digest xylitol and can become very ill if they consume it, similarly to chocolate, raisins, and grapes.
Ask your oncology team when you can safely return to routine professional dental care. During the treatment process, low blood counts may limit you to emergency dental visits only.
When you return to your dentist and hygienist:
- Report any health changes to your dental team
- Bring a current medication list to each appointment
- Inform your dentist of any bone-building medications or targeted therapies used even if you are not currently receiving these meds. Some meds can potentially stay in your system for years after they are administered and may alter treatment recommendations
- Antibiotics prior to dental care may be recommended with a surgically implanted port or low blood counts
Seeing your dentist regularly can not only catch problems early so they can be treated conservatively but prevent them from occurring.
Protect Your Smile
“My hair will grow back, my teeth won’t.” This is a concern that a patient once expressed to me as she was going through chemotherapy that I will never forget. As a Registered Dental Hygienist, I have witnessed the dramatic impact that oral health problems can have on one’s quality of life. Preventing oral side effects and dental disease can avoid unnecessary pain along with added financial and emotional stress both during and after the treatment process.
It’s also easier to smile when you have a healthy mouth. Neuroscience has proven that smiling releases neurotransmitters that act as a natural pain reliever and antidepressant; reducing stress levels, relaxing your body, and lowering blood pressure and heart rate (5).
Your smile is important in so many ways! Taking simple steps to proactively protect your oral health can provide many benefits for years to come.
Jill Meyer-Lippert has worked in dentistry for nearly 30 years with over 25 years as a clinical Dental Hygienist. She is the founder of Side Effect Support, which is an online resource for cancer patients and healthcare professionals to reduce harmful oral side effects of treatments. Side Effect Support provides free informational articles and resources, affordable over-the-counter oral care products, access to prescription products for dry mouth and mouth sores (SalivaMAX and Orapeutic), and teledentistry services 24/7, 365 days a year provided by The TeleDentists. Watch for exciting additional products and services coming soon!
She is a member of the ADHA, the RDH Advisory Board for the Oral Cancer Foundation, and the Triage Cancer Speakers Bureau. Jill also provides Communications and Educational engagement services as the Custom Dental Solutions Community Relations Manager (https://customdentalsolutions.com/).