Oral and Dental Management After Cancer Therapy
Guidelines for Management of Dentures and Orthodontic Appliances in Patients Receiving High-dose Cancer Therapy
- Minimize denture use during first 3 weeks posttransplant.
- Wear dentures only when eating.
- Discontinue use at all other times.
- Clean twice a day with a soft brush and rinse well.
- Soak in antimicrobial solutions when not being worn.
- Perform routine oral mucosal care procedures 3 to 4 times a day with the oral appliances out of the mouth.
- Leave appliances out of mouth when sleeping and during periods of significant mouth soreness.
- Dentures may be used to hold medications needed for oral care (e.g., antifungals).
- Discontinue use of removable appliances until oral mucositis has healed.
- Remove orthodontic appliances (e.g., brackets, wires, retainers) before conditioning.
Considerable variation exists across institutions relative to specific nonmedicated approaches to baseline oral care, given limited published evidence. Most nonmedicated oral care protocols use topical, frequent (every 4–6 hours) rinsing with 0.9% saline. Additional interventions include dental brushing with toothpaste, dental flossing, ice chips, and sodium bicarbonate rinses. Patient compliance with these agents can be maximized by comprehensive overseeing by the health care professional.
Patients using removable dental prostheses or orthodontic appliances have risk of mucosal injury or infection. This risk can be eliminated or substantially reduced prior to high-dose cancer therapy. (Refer to the list of Guidelines for Management of Dentures and Orthodontic Appliances in Patients Receiving High-dose Cancer Therapy.)
Dental brushing and flossing represent simple, cost-effective approaches to bacterial dental plaque control. This strategy is designed to reduce risk of oral soft tissue infection during myeloablation. Oncology teams at some centers promote their use, while teams at other centers have patients discontinue brushing and flossing when peripheral blood components decrease below defined thresholds (e.g., platelets <30,000/mm3). There is no comprehensive evidence base regarding the optimal approach. Many centers adopt the strategy that the benefits of properly performed dental brushing and flossing in reducing risk of gingival infection outweigh the risks.
Periodontal infection (gingivitis and periodontitis) increases risk for oral bleeding; healthy tissues should not bleed. Discontinuing dental brushing and flossing can increase risk for gingival bleeding, oral infection, and bacteremia. Risk for gingival bleeding and infection, therefore, is reduced by eliminating gingival infection before therapy and promoting oral health daily by removing bacterial plaque with gentle debridement with a soft or ultra-soft toothbrush during therapy. Mechanical plaque control not only promotes gingival health, but it also may decrease risk of exacerbation of oral mucositis secondary to microbial colonization of damaged mucosal surfaces.