* It is essential to carry out an evaluation of the oral cavity before oncology treatment, and to perform any dental work that is indicated to reduce complications during and after treatment./span>
* Oral care and hygiene are essential to prevent and minimize the effects of chemotherapy and radiotherapy on oral health.
As we told you in our previous article, the treatment of malignant lesions with chemotherapy and radiotherapy of the head and neck causes various complications at the oral level. Today we want to present a series of recommendations to take care of oral health during cancer treatment, and thus prevent and minimize these alterations. Remember that not all patients suffer the same complications.
Patients with good dental health before treatment have a lower risk of suffering from these conditions. Therefore, it is important to see a dentist at least 4 weeks before starting treatment.
During these visits, your dentist or oral health specialist can do the following:
• Treat teeth with decay, broken or infected, and any other dental infection.
• Make sure your dentures fit well and do not irritate your mouth.
• Modify or adjust removable prostheses to avoid ulcers.
Ask your dentist to share details about your oral health with your oncologist. In this way, both specialists can work together to plan their attention.
Normally, at least 2 weeks should be allowed between dental surgery and cancer treatment to allow the wound to heal.
Frequent communication with the health care team is important to prevent dental and oral side effects.
The following tips may help improve your oral health and prevent side effects:
• Invasive oral treatments such as tooth extractions should not be performed. If it is essential, it is recommended that it be done at the hospital level.
• In the case of pulpitis or abscess (phlegmon): root canal treatment (endodontics), pharmacological treatment and rinses with chlorhexidine.
• Careful hygiene and non-cariogenic diet also avoiding irritants (alcohol, tobacco, heat, spicy, acid).
• Minimize the use of removable prostheses to avoid ulcers due to friction and not to use orthodontics.
• In case of hypersensitivity, use pastes and rinses with potassium nitrate.
• Mouthwashes that contain salt and bicarbonate can help treat sores in the mouth. However, if you take medications for high blood pressure, you may need to avoid mouth rinses with salt. There is also a variety of mouthwash sales in pharmacies that can relieve sores.
• Drinking water and drinks without sugar can help manage dry mouth. Sucking on pieces of ice can also help. Avoid things that dry your mouth, such as soda, fruit juices, cigarettes, chewing tobacco and alcohol.
• Medicines that produce saliva may help some people prevent or minimize dry mouth. Topical oral gels or other medications may help with dry mouth caused by head and neck radiation therapy.
• Dental check-ups every 2 or 3 months, reinforcing oral hygiene and fluoride applications for at least 6 months or 1 year.
• Dental extractions should not be performed, conservative treatment is always preferable, for at least one year, bearing in mind that the risk of osteoradionecrosis is indefinite.
• For three months it is recommended to limit or avoid the use of full and removable prostheses mucosoportadas to avoid ulcers and possible bone necrosis, although there are authors who suggest at least one year.
• Trismus: may appear between 3-6 months after treatment, fibrosis or osteoradionecrosis. Muscle relaxants will be recommended.
• Osteonecrosis: to prevent its appearance, traumatic treatments should not be performed in the oral cavity as extractions or surgeries, the removable prosthesis should be avoided before three months. The extractions will not be done until 6-12 months after the treatment although the risk remains indefinitely.
Sources: 
Dr. Marco Antonio Herrera Ruiz
Odontólogo General y Prostodoncista.
AECC (Asociación Española Contra el Cáncer) / Cancer.net / FCOEM (Fundación del Colegio de Odontólogos y Estomatólogos de Madrid)
January 21, 2019
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