Breast Cancer and Oral Health

Sol Silverman is a professor of oral medicine at the University of California, San Francisco, School of Dentistry and a spokesman for the American Dental Association. He completed his dental training at UC San Francisco and, in 2005, was honored by its dental school for his contributions to research in oral medicine. His research focuses on oral cancer. He received the Margaret Hay Edwards medal from the American Association for Cancer Education in 2002.

I have just been diagnosed with breast cancer. Should I check in with my dentist? If so, when is a good time to do that — before, during or after treatment?

If chemotherapy is part of a woman's treatment plan for breast cancer, she should schedule a regular cleaning with her dentist before starting treatment. Most chemotherapy agents will suppress white cells, which protect against infection. And that increases the risk that doing an invasive procedure, such as a tooth extraction or deep cleaning, will cause infection. This is true usually for about a week after each treatment is given. During this period, the woman's oncologist can advise her and her dentist about when it would be safe to do a dental procedure. Breast cancer patients should maintain good hygiene — brushing, rinsing and flossing — throughout their treatment.
If a woman has breast cancer and is treated by surgery or by radiation but not chemotherapy, the mouth is not affected in any way.

What oral health issues can arise as a result of breast cancer treatment?

Depending upon the agent or combination of agents that is used, treatment can affect the mouth and cause a mucositis, an inflammation of the mouth. That can be very painful and affect swallowing, taste, appetite, speech and sleep. It feels like a third-degree sunburn after a day at the beach and can seriously affect quality of life.
There are additional concerns for women whose breast cancer has not responded to traditional therapy. They might be considered for stem cell transplants. The process that prepares them for those transplants basically wipes out their immune system. After they go through conditioning, they are given stem cells to reconstitute their immune system. They need to have good hygiene throughout this process and should work with a dentist or dental hygienist who has experience with cancer patients.

What should a woman do to take care of her teeth, gums and jaw during breast cancer treatments? Are special rinses or toothpastes needed?

1. Use good hygiene: brushing, rinsing, flossing. Alcohol-free mouthwashes and sponge brushes for cleaning are usually better tolerated.
2. Avoid dental procedures during periods when white blood cell counts are low.
3. If mucositis develops, see someone — a dentist or hygienist — who's been trained to deal with this and can provide medications that will be helpful. We treat mucositis empirically; there is no single regimen that has been shown to work the same way with each woman.

What signs or symptoms of oral health problems should a breast cancer patient or her caregivers be on the lookout for?

The main thing to watch for is pain with mucositis. Medical oncologists are aware of mucositis, but it is also important to see a dentist or hygienist who is trained in this field.
Another issue for patients who have been treated with bisphosphonates to protect the bones is the risk of developing areas of decay in the jaw that don't heal, usually after an invasive dental procedure such as a tooth extraction or aggressive cleaning. The risk is low, but patients should be warned of it.

Sipping, Snacking, and Tooth Decay

Many parents across the country will issue a common refrain at dinnertime tonight: ―You’d better eat that--it’s good for you!‖ There’s another old favorite in the parental arsenal of dietary admonitions: ―Don’t eat that—it’ll rot your teeth!‖ Now more than ever, kids are faced with a bewildering array of food choices -- from fresh produce to sugar-laden processed convenience meals and snack foods. What children eat and when they eat it may affect not only their general health but also their oral health.

Americans are consuming foods and drinks high in sugar and starches more often and in larger portions than ever before. It’s clear that ―junk foods and drinks gradually have replaced nutritious beverages and foods for many people. For example, the average teenage boy in the U.S. consumes 81 gallons of soft drinks each year! Alarmingly, a steady diet of sugary foods and drinks can ruin teeth, especially among those who snack throughout the day. Common activities may contribute to the tendency toward tooth decay. These include ―grazing‖ habitually on foods with minimal nutritional value, and frequently sipping on sugary drinks.

When sugar is consumed over and over again in large, often hidden amounts, the harmful effect on teeth can be dramatic. Sugar on teeth provides food for bacteria, which produce acid. The acid in turn can eat away the enamel on teeth.

Reduce your children’s risk of tooth decay:

- Sugary foods and drinks should be consumed with meals. Saliva production increases during meals and helps neutralize acid production and rinse food particles from the mouth.
- Limit between-meal snacks. If kids crave a snack, offer them nutritious foods.
- If your kids chew gum, make it sugarless – Chewing sugarless gum after eating can increase saliva flow and help wash out food and decay-producing acid.
- Monitor beverage consumption – Instead of soft drinks all day, children should also choose water and low-fat milk.
- Help your children develop good brushing and flossing habits.
- Schedule regular dental visits.