SHARE Cancer Community 40-45 min.pptx

Mouth Matters

Oral Health Before, During &After Cancer Treatment

Jill Meyer-Lippert, RDH

What I thought would happen

What really happened

Oral Health Fast Facts from the CDC

• Oral health is essential to general health and well-being.

• Oral disease can cause pain and infections that may lead to problems with eating, speaking, and learning. It can also affect social interaction and employment potential.

• The three oral conditions that most affect overall health and quality of life are cavities, severe gum disease, and severe tooth loss

https://www.cdc.gov/oralhealth/fast-facts/index.html

What determines oral health or oral disease?

The Oral Microbiome

We’renotallbad!

Tooth anatomy & cavities

Bacteria produce acidic byproducts

Acid removes minerals from teeth

Gum disease (gingivitis & periodontal disease)

What influences your oral microbiome?

Genetics

Sharing germs

Professional Dental Care

Oral Hygiene

Diet, Lifstyle Choices

Medications & Other Medical Conditions

The oral-systemic link

Heart disease Strokes

Erectile dysfunction

Astma and respiratory infections

Alzheimer’s Disease

Diabetes

Pre-term & low

birthweight babies

Certain cancers

What therapies can affect oral health?

• Chemotherapy

• Radiation therapy

• Surgery

⚬ Oral hygiene limitations

• Hormone suppresion

• Targeted therapies/Immunotherapy

⚬ Antiangiogenics

• Corticosteroids

• Antiresorptive Medications

• Antianxiety/antidepressants

• Diet (Ensure, Gatorade, etc.)

• Pain medications

Early Intervention and Patient Education are Key

Anticipate potential problems and start treating them before they have a chance to start!

Oral Health Risks

**Depending on type of cancer & type of treatments**

• Hyposalivation/Xerostomia (dry mouth)

• Oral Mucositis/Stomatitis (mouth sores)

• Caries (cavities)

• Periodontal Disease (gum disease)

• Enamel Erosion

• Infections (bacterial, fungal and viral)

• Dysgeusia (taste changes)

• Dysphasia (trouble swallowing)

• Trismus (limits jaw opening)

• Osteonecrosis of the Jaw from Radiation to the head & neck or from certain medications

• Graft vs. Host Disease after bone marrow

Dry Mouth (quantity and quality of saliva)

More than a comfort issue

• Tissue lubrication

• Wound Healing

• Infection prevention

• Buffers oral pH

• Remineralized teeth

• First step in food digestion

• Plays a role in taste

Dry Mouth - Simple Tips

• Stay hydrated

• Diet changes

⚬ Avoid caffeine & alcohol

⚬ Avoid dry, crusty foods

⚬ Use sauces & gravies

• Breathe through nose

• Use humidifier

Rx and OTC Dry Mouth products

• No “one size fits all”

Think long-term effects vs. just masking symptoms

Oral pH and oral diseases

Demineralization/Remineralization

Florida study evaluates acidity levels in oral lozenges

https://www.dentistryiq.com/dental-hygiene/article/16367852/florida-study-evaluates-acidity-levels-in-oral-lozenges

•DenTek OraMoist, pH 2.9

•Cotton Mouth Lozenges, pH 3.1

•MedActive Oral Relief Lozenges, pH 3.2

•Hager Pharma Dry Mouth Drops, pH 4.44

•Rite Aid Dry Mouth Discs, pH 5.1

•CVS Dry Mouth Discs, pH 5.3

•ACT Dry Mouth Lozenges, pH 5.7

•TheraBreath Dry Mouth Lozenges, pH 5.82

Oral Mucositis

Treatment and prevention are primarily aimed at reducing modifiable RISK FACTORS:

Dry Mouth

Existing Dental Issues

Poor Oral Hygiene

Medication-Related Osteonecrosis of the Jaw

• What is it?

• What medications put us at risk?

• Signs and symptoms

• What initiates most cases?

FOCUS

ON PREVENTION

⚬ Good communication is vital

• Treatment options

Toothbrush Basics

Size/shape of brush

Softness of bristles

When to replace

Protecting from germs

How is brush stored

Sharing is not caring

Detergent s

Sodium Lauryl Sulfate (SLS)

• Known to penetrate skin and cause cutaneous irritation

Cocamidopropyl betaine

• Allergy to CAPB is most commonly seen in a head and neck distribution, although other patterns have been identified.”

American Journal of Contact Dermatitis

2001

• American Contact Dermatitis Society Allergen of the Year 2004

Drying & Irritating Ingredients

The Scoop On Sugars

Xylitol & Erythritol

• Improve oral microbiome

• Buffers oral pH

• Exposure/dosage

• Introduce slowly into diet

• Safe for diabetics

• Keep away from pets

Systemic vs. topical

OTC vs. Prescription

Recommended vs. reality • Check for potentially irritating detergents

image courtesy of bmjopen.bmj.com/content/10/9/e038606

Prebiotics vs. probiotics

“My hair will grow back, my teeth won’t”

Over-the-counter products