After hearing “you have cancer,” we know the moments, days and weeks after can feel like an absolute whirlwind. There are so many important topics to cover with your doctor about your health and treatment.
In our private Facebook group, we noticed a lot of questions about oral care and cancer. While navigating their diagnosis, treatment and life after, it seemed that people weren’t getting the information they needed on how to take care of their oral health.
YSC legacy advocate and 13-year breast cancer survivor, Ann Marie Potter, heard the buzz and was determined to get answers. She hosted a webinar with Dr. Ronald Koslowski, a dentist specializing in Prosthodontics in Encino, CA.
Dr. Koslowski was an American Cancer Society Fellow in Maxillofacial Prosthetics at Memorial Sloan-Kettering Cancer Center. He became board certified in the specialty of Prosthodontics and was named a Fellow of the American College of Prosthodontists (FACP) in 2000. Check out some of his answers to the questions left unanswered on oral care and cancer treatment.
How Can Breast Cancer and Treatment Affect My Oral Health?
Any sort of breast cancer treatment can affect your oral health. Most commonly chemotherapy is the culprit. Radiation can also cause some side effects, but that is more common with head and neck cancers.
Chemotherapy works by attacking cells as they divide. While this affects the rapidly dividing cancer cells, it also kills healthy cells. As a result, the effects of treatment on your oral health can include:
- Bleeding
- Sores
- General inflammation of the gums and soft tissues
- Infections which generally are asymptomatic but could lead to interruptions in treatment
How Can I Take Care of Myself in Light of This Information?
If you are newly diagnosed and have not begun treatment yet, schedule yourself for a dental cleaning before your treatment begins. In other words, take steps to improve your dental hygiene now. At your appointment, tell your dentist that you will be starting treatment and ask if s/he has any additional recommendations given your current oral health.
If you are currently in treatment, it is best to do in between cycles of chemo. Your dentist should consult with your oncologist to make sure that your blood counts are in a safe range for elective dental treatment. Because of treatment, it can take longer for your gums to heal. Try to be gentle with your oral care - get an extra soft toothbrush and avoid trying new techniques.
If you have breast cancer metastasis, you can continue with regularly scheduled cleanings, but it is best to find a dentist who specializes in dentistry for those who have been diagnosed with cancer.
If you have metastasis to the jaw, your radiologists should be working with a dentist. You may be experiencing dryness in the mouth and rapid tooth decay if you are receiving radiation to the head and neck. Also, you should avoid having teeth removed.
You Mentioned Dentists Who Specialize in Oral Care for People Who Have Been Diagnosed With Cancer. Where Do I Find One of Those?
Look for doctors who have done additional trainings - particularly those who have done them at cancer centers. The American College of Prosthodontics has a feature on their site to find a doctor: gotoapro.org Look for those who have training in maxillofacial prosthodontics. Finally, don’t be afraid to ask your current dentist if they are qualified or ask your doctors for referrals.
Can You Recommend Products for Oral Care with Cancer?
It’s best to be gentle with your oral care. You may find some of the following products helpful, particularly if you experience bleeding gums.
- Any toothbrush with soft bristles
- Water flossers
- Any over the counter mouthwashes
- Products with fluoride
- Prevident by Colgate (if you struggle with dry mouth, try the dry mouth version of this toothpaste)
What’s the Deal With Jaw Necrosis? Why Does It Happen and How Can I Prevent It?
Jaw necrosis, also known as osteonecrosis, can be a side effect of some medications called biphosphonates that are designed to protect bones. It can have the opposite effect on the jaw. When this happens, your jaw can have issues healing. Prevention is key because it’s easier than managing it once signs present.
- If you have teeth that are at risk of developing osteonecrosis, remove them ahead of time.
- Be on the lookout for teeth that need surgical treatment - even cavities
- Do thorough cleanings ahead of time.
Warning signs of Osteonecrosis include:
- Areas of roughness inside the mouth
- Pain
- Anything that feels different
If this occurs, see your dentist immediately. If you’re already experiencing it:
- Manage it closely
- Have a dentist or oral surgeon determine the severity
- Do not try to handle it yourself
What About Teeth Crumbling? What Can I Do to Prevent That?
Crumbling teeth are generally caused by tooth decay or wear from grinding. For cases of tooth decay, it is often associated with dry mouth. Daily fluoride applications can help. If you can, try to visit your dentist more frequently, perhaps every 2-3 months. Try to focus on restorative dentistry if you are out of treatment. If you are more concerned about grinding your teeth, this is likely from stress rather than a direct effect from treatment. Talk to your doctor about having a mouth guard made. Avoid over the counter mouth guards as they can have sharp edges and cause bleeding.
What About Insurance? Help!
Necessary dental care is rarely covered by health insurance. If you are newly diagnosed, try to be referred before treatment. Because if your dental care is preventative, it can be counted as part of your treatment.
Typically dental insurance is not the most helpful for your needs. Even if getting your own dental insurance is an option, Dr. Koslowski does not recommend because only the most expensive plans may comprehensively address oncology patients’ needs. If you need more frequent cleanings, check your plan to see if you are covered. You can also talk to your dentist’s office if you are having trouble navigating your plan.
Check out local dental schools to save some money. The appointments may be longer but they may certainly be more cost-efficient. Try to work with the graduate students if you can, as they will have more training and will be closely supervised by experienced dentists.
The best way of advocating for yourself is to talk to the insurance specialist at your dentist’s office. Insurance companies are not looking out for your best interest.
Taking care of your oral health can easily fall through the cracks during cancer treatment. But you are your own best advocate. So it’s always best to assume that there is information you don’t yet have and to ask all of your questions.
