Information for Patients: Chemotherapy Recommendations

Toothbrush

Use a soft small-headed toothbrush like Oral-B 30 or 35, Colgate Diamond Head or Sensodyne Search.  The Biotene Supersoft toothbrush has a large head; however, the configuration of the bristles has created an extremely soft toothbrush, ideal for sensitive mouths.  Should you wish to purchase an electric toothbrush the Braun Oral-B Plaque Remover is efficient and easy to use.

Brushing

Brush teeth twice a day following meals, using small circular strokes.  Avoid vigorous and horizontal brushing at the gum line of teeth as this may damage the gum and cause root surfaces to be exposed which can then decay rapidly.

Toothpaste

Most toothpastes contain the foaming agent sodium lauryl sulphate, or SLS, which has been found to cause irritation in sensitive mouths.  Toothpastes containing SLS should be avoided if you have sore mouth (mucositis), oral ulcers or dry mouth.  Biotene ‘Dry Mouth Toothpaste’ is SLS free, contains fluoride and important salivary enzymes.  Rembrandt ‘Natural’ is also SLS free, as is MI paste. These can be bought at cost at our office for our existing patients.

Mouthwash

A warm salt water or sodium bicarbonate mouth rinse may improve oral comfort for mild irritation with sore mouth.  It is important to only use an anti-bacterial mouthwash which does not contain alcohol or phenol if there are symptoms of dry mouth or sore mouth as alcohol has a drying effect on oral tissues.  Peridex is an antiseptic and disinfectant mouthwash and is effective against a wide range of oral organisms.  Superficial staining of teeth however, has been reported in some people.  Be aware that most other chlorhexidine containing mouthwashes contain alcohol.  Biotene mouthwash is anti-bacterial, alcohol-free and like the ‘Dry Mouth Toothpaste’ contains salivary enzymes. Carifee maintenance rinse contains xylitol and fluoride, and is pH balanced to help reduce decay.  If during treatment your mouth still becomes very sore and you feel that the mouthwash is too strong try diluting it with warm water.

Flossing

Use dental floss or dental tape between teeth at least once daily.

Denture Care

The acrylic resin from which dentures are fabricated has microscopic holes or pores.  It is essential that dentures are cleaned thoroughly at least daily with a toothbrush or denture brush.  They should not be worn at night and always left to soak in warm water or a denture cleaner such as Steradent from Reckitt and Colman when not being worn.  They should also be left out as often as possible during the day, whenever a mouthwash is used and during radiation therapy sessions.

The gums and areas under a denture should also be brushed on a regular basis and the mouth rinsed after all meals.  Brushing stimulates the gums and helps keep them firm and less likely to harbour the microorganisms which may lead to irritation or infection.  Removing accumulated food debris limits irritation, staining and bad breath.  Oralbalance moisturising gel can be used on the tissue fitting surface of the denture to minimise irritation and may also improve retention.

At first sign of discomfort, the denture should be removed and checked by a dentist as adjustment or relining may be required.

Topical Fluoride

Colgate Gel-Kam (0.4% stannous fluoride) or MI paste should be applied nightly to teeth after regular brushing, immediately before going to bed.  Dry the toothbrush and cover the bristles with Gel-Kam or use cotton buds if gums are sore.  Brush on to all tooth surfaces for one minute, then vigorously swish for one minute forcing the gel into the spaces between the teeth.  Spit out, do not swallow or rinse and go to bed with the Gel-Kam residue on the teeth.  The same should be repeated in the morning immediately after regular brushing.

MI paste can be applied with a fingertip, and is safe to ingest. You should not have anything to eat or drink for at least 20 minutes afterwards.  Should your mouth be very dry it may be necessary to have mouthguards constructed and place the Gel-Kam in the guards.  These may have to be worn for at least 5-10 minutes each night immediately before going to bed.

Saliva Substitutes

Saliva substitutes may help keep the mouth moist and allow for easier eating, swallowing, talking and sleeping.  Many patients have reported significant relief from the effects of dryness by using ‘Oralbalance’ moisturising gel.  It is also suitable to place under dentures.

Maintenance

You should see a dentist at least three times a year for cleaning and early treatment of cavities.  If there is decreased saliva there is likely to be an increase in the amount of tooth decay.

Diet

Should you have significant oral discomfort, small regular meals and snacks may help you obtain adequate nutrients and prevent weight loss. Carry a toothbrush with you and if you have your own teeth you can reduce the impact of tooth decay by limiting sweet, sticky, sugary foods or anything with a high acid level such as grapefruit, tomato or orange.  Always brush immediately after eating.  If it is not possible to brush, swish and swallow with water as soon as possible.

Suggestions to relieve dryness and preserve soft tissue

Where to buy the mentioned products

The electric toothbrush may be purchased at leading department stores or through some dentists and pharmacists.  The other products are all available from pharmacies or from our office.

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