Download 17) Cancer Directions

To our patients who are going to have Radiation Therapy
Please read carefully
INTRODUCTION
Because you have been advised by your physician that you require radiation therapy to
treat your tumor, you have been referred to the dentist. We want you to understand that
radiation treatment has a profound, long range, affect on your mouth, teeth, and jaws. The
radiation affects the mucosa, salivary glands, blood supply, and normal bacterial flora of the
mouth. This in turn causes disturbances that manifest themselves in various ways.
We want you to be aware of what these changes may be and what can be done to help
you during your treatment.
HOW DOES RADIATION WORK?
Compared to normal cells, tumor cells now grow faster and are less mature and
imperfect in their formation. Because of this they are weaker and more susceptible to the effects
of radiation. The radiation has a special ionizing effect on the molecular elements of the cells
causing them to break down and die. It is like a spray of miniature bullets penetrating each cell
and shattering its inner parts.
Even though the primary effect of the radiation is directed against the tumor cells, the
surrounding normal cells contained in the various glands and tissues are also affected, and
these changes will produce certain problems for you.
WHAT ARE THE PROBLEMS?
Dry Mouth
The mouth contains three pairs of salivary glands and thousands of small mucous
glands that line your mouth and throat. The purposes of these glands are to keep your mouth
moist, wetting your food to make it easy to swallow, and to wash and protect your teeth. The
radiation will affect these glands by decreasing the amount of fluid they secrete. You will notice
you have less saliva in your mouth and your mouth will “feel dry.” This will be particularly
troublesome during mealtime as well as between meals, and affects the comfort and fit of
dentures.
Inflamed Mucosa
The mucosa (skin) lining your mouth is affected by the radiation, beginning two to three
weeks after the beginning of therapy. The mucosa becomes thinner and may become very red
and inflamed. If this happens your mouth will become sore and uncomfortable. It will be
necessary for you to avoid spicy, acid, salty, and crispy foods since they are more irritating to
the tender mucosa. Eating for a period of time may also become uncomfortable, and difficult,
and denture wearing may be impossible during this time.
Infection
Because your mouth becomes dry and the mucosa is inflamed, and the normal bacterial
flora of the mouth is disrupted, you may become susceptible to a fungus infection called thrush
(moniliasis). These are yeast-type organisms normally present in everyone’s mouth, but under
the conditions created by radiation, can cause infections. When this happens your mouth will
become very sore and bleed readily, and the mucosa will be covered with a white “curd-like”
material,
Loss of Appetite
The radiation sometimes temporarily affects the taste buds of the tongue as well as the
olfactory bulbs of the nose. As a result of this, both taste and smell may be diminished and food
and drink may seem to have little or no flavor. Because of this you may feel you have “lost your
appetite.” These effects are usually temporary and following completion of treatment, the sense
of taste and smell should return.
Redness of Skin and Loss of Facial Hair
The radiator may cause the skin to become red and inflamed. Early during the radiation
treatment, the skin may appear red and moist, and later in therapy become red, dry, and scaly.
The hair follicles are also affected and there may be some loss of hair on the face over the
affected site.
Jawbone, Teeth, and Decay
You have been referred to the dentist because radiation has a profound long range
affect on your teeth and haws. Because your salivary glands will secrete less saliva, your teeth
will lose their natural protection and will be extremely prone to decay. The decay begins as
“gum line” cavities, and in a short period of time your teeth will literally “self destruct” unless
they receive vigorous attention.
Your jawbones are affected by the radiation, and after receiving the therapy, the ability
of the bone to heal is lost or diminished. If it becomes necessary for you to have a tooth
extracted after radiation therapy, there is a probability your jaw would not heal and it would
become seriously infected. For this reason it is necessary to extract teeth that are in the direct
path of the radiation, as well as any other teeth that are infected, have pyorrhea, or have
extensive decay.
The rationale for deciding which teeth to keep and which ones to remove is determined
by the location of the tumor and the proximity of the teeth to the radiation beam.
Feeling of Depression
Because of the realization that you have cancer, you may feel depressed, and find it
difficult to want to become motivated into believing that taking care of your mouth and teeth is
essential to your over-all health. Since you don’t need more problems, it will be our goal,
working with you,, to avoid and treat the complications of radiation therapy, make sure you
understand what is happening, and to help keep you healthy and comfortable.
WHAT WE PLAN TO DO
If you have some or All of Your Natural Teeth
We will clean your teeth and repair any teeth that are decayed or have defective fillings.
We will place you on a program of oral care using fluoride tooth paste, fluoride gels, dental
floss, and instruct you in proper brushing techniques, and periodic follow-up care, with the goal
of preventing the deterioration of your dentition as a result of radiation therapy.
Any teeth you have that may be in the direct line of radiation, have larger restorations,
diseased roots, or have severe gum disease, will be recommended for extraction prior to the
beginning of your radiation therapy.
No dentures will be made to replace any missing teeth until the radiation therapy is
completed, and in instances where the tissues of the mouth remain inflamed, the dentures may
be deferred for many months. In some instances, it may not be advisable to ever wear a dental
appliance in your mouth, but it is emphasized that these cases are decided on an individual
basis.
If You Are Wearing Complete Dentures
Since your mouth becomes dry and the mucosa irritated from the radiation, you may
find it expedient to leave the dentures out of your mouth for extended periods of time, or in
some cases all the time. You may find it advantageous to wear your upper denture only for
“looks” and wear the lower denture only when you eat. In the event the dentures you now have
are unserviceable, we will plan to re-evaluate you at the completion of your therapy, to
determine if and when a new dental prosthesis may be indicated. The size and location of the
tumor as well as the manner in which the radiation is administered will be determining factors in
deciding what course of treatment is best for each patient.
For All Patients
We will treat you for problems as they arise. We have special medications to help you
alleviate the problems of dry and sore mouth, antibiotics to treat infections, and suggestions for
diet. Our goal in treating you will be one of “prevention,” to help avoid problems, as well as
treating the problems as they arise.