Amanda Wilde (Host): Doctor of Dentistry, Dana Bodenner explains what to keep in mind when considering dental care for cancer patients. This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. I'm your host, Amanda Wilde. And Dr. Bodenner, welcome and thank you so much for being here.

Dr. Dana Bodenner: Thank you for having me, Amanda.

Host: For those getting cancer treatment, how do cancer treatments affect our mouths?

Dr. Dana Bodenner: So unfortunately, about 40% of patients that are going through cancer treatments will have some kind of oral side effect. I like to break it up into the different types of cancer treatment, because they all have different side effects. So chemotherapy, there's bisphosphonates, patients may be familiar with Zometa, that's for metastatic cancers and multiple myeloma; and also radiation.

When we're talking about chemo, the things that patients need to remember is this really causes dry mouth. If you have dry mouth, you no longer have a good saliva flow. And what that means is you're not washing off any of the debris, the harmful bacteria, which we see a lot of cavities start to develop from patients that have dry mouth. With the Zometa and the bisphosphonates, this drug actually inhibits bone remodeling. So if you have a tooth extraction or any kind of injury to your bone, you don't have the cells to break down that bone and rebuild healthy bone. So, what we see is a lot of necrotic bone or dead bone, which can cause pretty bad infections down the road.

And then, lastly for radiation, this one kind of has the same side effects as bisphosphonates, but it's a different mechanism. So when you have irradiated bone, it becomes avascular, so you don't have that blood supply. You know, if you have a tooth taken out, you get that nice healthy blood clot. Well, patients that have gone under radiation, they no longer have that blood supply. It's a very deoxygenated environment. So again, we see that necrotic bone that, again, can lead to some pretty nasty infections down the road.

Host: So, how do you deal with these side effects?

Dr. Dana Bodenner: I think the most important thing first is that you need to see a dentist before we start the cancer treatments. So, we like to have you see us at least a month before. That's the minimum, you know, usually, three months depending on how invasive your treatment's going to be. So, we're really looking for any teeth that can cause infections down the road. So, may it be a really large cavity that needs a filling or a crown or broken or abscessed teeth that need to be extracted prior to your cancer treatment. Maybe you already have some type of gum disease that needs to have a deep cleaning.

And then lastly, just to kind of prevent any kind of dry mouth issues and cavities down the road, we like to make molds for your fluoride trays that you'll wear during and after your cancer treatment.

Host: How do those help?

Dr. Dana Bodenner: These are wonderful. So, a lot of times, like we said, if you don't have really good saliva, then you're not having that good rich nutrient environment. So, we want to have some kind of fluoride supplement. So, they look like whitening trays, very comfortable to wear. And all you have to do is use just a little bit of a special fluoride that we give you, it's a prescription, and you wear it for five minutes. You spit afterwards and you don't eat or drink anything. But you're getting an extra layer of fluoride on top of the fluoridated toothpaste that you're using.

Host: And that can be a good preventive measure. So, those are things we need to do before starting cancer treatments. What should we expect during cancer treatments?

Dr. Dana Bodenner: Unfortunately, some of the other side effects that we haven't touched on are some of the mouth ulcers that you may see. The term is called mucositis, where you just get really painful, red, irritated areas in your mouth. What's very important with that is to make sure that you're avoiding any kind of spicy food. You don't want to have an ulcer and then eat something really spicy. That can be very uncomfortable, as you can imagine.

For dry mouth, there's different supplements that you can use. One of my favorites is called XyliMelts. And I have no affiliation with that at all. But I prescribe that to patients a lot, it's a lozenge that will stimulate saliva flow. And another great just over-the-counter thing that you can do is sugar-free lemon drops or some kind of candy just to kind of stimulate that saliva flow. With a lot of my patients that do have mucositis or painful gums, either from chemo or the radiation, I tell them not to use a minty toothpaste. That's probably the best tip I could give you, is go to Target, look in the kids' aisle. They always have that fruity flavor and that's going to feel a lot better to your gums and your mouth than something that's minty and can be a little bit more potent.

Host: Yeah, this is really helpful information. So, you want things that are as gentle as possible and including in flavor. And then, after cancer treatment, how should we think about our dental care?

Dr. Dana Bodenner: So, just like we talked about doing treatment before cancer treatment, we also want to make sure that we're still doing these preventative measures. So, what that means is excellent, immaculate oral healthcare at home. So, brushing your teeth in the morning after meals at night, we just really want to make sure that your mouth is as clean and healthy as possible so that you're not developing cavities or infections.

Another thing is to be wearing those fluoride trays like we talked about every single night, just to get that extra exposure and seeing your dentist at least twice a year. We want to make sure that we're getting x-rays, you're getting your cleaning done. So if there's anything that is developing, we can notice it early before it becomes an issue down the road.

Host: Now, we should say that not all cancer treatments and not all chemo will cause these problems, but in what percentage? You said about 40 some percent of people do experience these side effects depending on the kind of treatment they're getting. Is there anything else we should consider when approaching dental treatment before, during, and after chemotherapy?

Dr. Dana Bodenner: I think it really depends on what type of cancer treatment you're having. That's a good point, Amanda. I did want to touch on that. For your radiation clearance, before you go under your radiotherapy, your dentist might be a little bit more aggressive depending on how many treatments and how high the percentage of the radiation that you're going to be receiving.

So, that may mean that, if you have a broken tooth, they may want to extract that rather than just crown that. So, I do want patients to be aware that we're trying to do preventative measures, because once you have that radiation, it's almost near impossible to do extractions afterwards.

Host: Oh, that's something I didn't know. And I bet a lot of people don't know that. Dr. Bodenner, these are things we don't necessarily naturally consider. Thank you so much for helping us to think about dental care for cancer patients.

Dr. Dana Bodenner: It is my pleasure. Like you said, it's so difficult that you're having to do all these cancer treatments and we just want to make sure that you're not having to deal with the mouth issues on top of it. So, like we said, prevention is key. So if you can talk to your dentist before you start any kind of cancer treatments, that is going to help you the most.

Host: Yeah. With all the things to take care of before cancer treatments, this has got to be on the top of the list. Thank you, Doctor.

Dr. Dana Bodenner: Thank you so, Amanda.

Host: Dr. Dana Bodenner is a dentist at the UAMS Delta Dental of Arkansas Foundation Oral Health Clinic. To make an appointment at the UAMS Delta Dental of Arkansas Foundation Oral Health Clinic, please call 501-526-7619. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. Thanks for listening. This is UAMS Health Talk.