Radiation and chemotherapy can have unfortunate effects on the teeth and gums. Join John Mason, DDS, Mason, Faith & Hoscheit dental practice in St. Charles, Ill., to gain knowledge and learn about resources to help support this aspect of your health during cancer treatment.

Hello and welcome to the facebook Discussion tonight um on the effects of Chemotherapy and radiation To the teeth and oral cavity my name is John mason i’m a dentist here in saint Charles I’ve had the Pleasure through the last several years To come to living well and Talk with a live audience regarding The the dental Ramifications of chemo and radiation Treatment so it’s a pleasure to be here Tonight On facebook and we’ll manipulate this And do the best we can Um With me also is sue and sue is uh here At living well and she’s going to be Monitoring monitoring Any questions you may have that you can Post on comments and at the end of the Talk Uh she will relay those to me and we’ll Have a discussion on those We also might have some comments From karen webster she’s a dental Hygienist Who is active with tri-city health Partnership and i’ve asked her to Be involved she may have some more ideas On products that are available And she may chime in as the questions Come in if you have

Specific Questions or concerns on different types Of world products during chemo and Radiation Living in wells a great place a great Resource for cancer treatment And help i shouldn’t say treatment but It is part of the treatment with the Different resources they have and I know in our practice As dentists we are quick to refer the Many patients we see whether it’s head And neck cancer or Other Issues they may have and they always Come back with glowing reviews of the Type of care they’ve had here And the help so It’s always a pleasure for us to be part Of this Um I’m going to talk a little bit about A couple things Head and neck cancer is one of those Things that Oral cancer specifically makes up Anywhere from Five to eight percent of all cancers Depending on who you Uh Talk Or read about Um And there’s with head and neck cancer

Typically Anymore depending on the type it is you Can have Radiation treatment to the head and neck Area or chemotherapy One of the It used to be in the day that your Common risk factors would be Heavy smoking heavy drinking But certainly over time We’ve had Oral cancers That Are in non-smokers non-drinkers And certainly most recently the Hpv Has had a real impact on head and neck Cancer In the day it was uncommon to see a Young head and neck cancer patient Today it’s more common where you can see Anyone from 30 to 60 That has a Head and neck cancer related to hpv The The If there is anything fortunate which About with an hpv type of cancer is that It has a very very High cure rate And the treatment can be anything from Surgery To radiation oftentimes surgery can take

Care of it sometimes it’s a combination Surgery and radiation It really depends on the Where you happen to be having it Done and what surgeon and or Larger medical facility what their Comfort level is and the kind of results They’ve had with their treatments Um With A head and neck cancer treatment And i’m going to move right into the Radiation effects because those are Really the most significant as it Relates to head and neck cancer There’s a few things that in particular Really uh stick out And the first is mouth sores um it’s Called mucositis which is just an Inflammation of the inside of the mouth It typically starts to you start seeing It anywhere from two to four weeks The radiation treatment depending on the Program could be a six to eight week Course Sometimes depending at that two to four Week how patients are doing they may Have to take a little vacation time Because of the soreness that can arise When the soreness does come in if you Can imagine this is it’s like having a And and i may be talking to the choir Oftentimes when i come to these programs In the audience there are people who

Have been through the treatment and they They’re a much better Uh Person to really Say what it’s like in terms of what it Really feels like My experience is just in talking to them And the The kind of symptoms they’re having but If you can imagine just the inside of Your mouth going down your throat where You have like The worst sunburn you can have a Blistering type sunburn And In the oral cavity When that happens and typically the Radiation oncologist or dentist who Might be helping out Will give you Different rinses a lot of times they Just refer to it as a magic mouth wash Rinse And the primary component in that is Usually a Local anesthetic which really just numbs The inside of your mouth and some also Uh Benadryl kaopectay things that help coat The inside of the mouth that actually Like act like a band-aid to help hold That local anesthetic around It’s strictly palliative care um it’s Not going to make it go away

And it’s really the the The hardest part that people That i have talked to As part of their treatment Leaving out if there’s been a surgery Involving removal of the jaw That the The patient has And oftentimes the burning gets uh Significant enough That They make you might go through periods Where you actually you can eat And you might need to uh have a feeding Tube placed Some of the things that can be helpful During that time that we talk to people About of course are Protein shakes scandi’s a shake S-k-a-n-d-i Is one that people Have mentioned that they can be helpful The saliva along with the pain becomes Very thick and ropey And with that it becomes very difficult To swallow And Even in taking some of the medications They have a hard time swallowing Some of the things that people have Mentioned that can be helpful is if you Take ginger ale Or 7up And you leave it out for a little bit

Just to get rid of a little bit of the Hard core carbonation That when you drink Where you need to take a pill you can Take it with that and that helps break Up some of the The thicker rope your saliva so you feel Like you can swallow a little bit better With that So mucositis or burning on the inside of The mouth Along with The Difficult and swallowing it are probably The biggest things initially and again Usually somewhere in that two to four Week time frame It can be a real uh issue The One other item that can be helpful Besides the magic mouthwash is you they Do make a lollipop that’s a A numbing type lollipop And you can put that in your mouth and Suck on that And that too can be helpful Prior to eating to help create some Numbness so that you can Eat by mouth Taste typically during radiation will go Away will you’ll lose your sense of Taste That typically happens anywhere from you Know could be four to eight weeks

It typically always comes back it may Take as long as six months Sometimes people will say that it comes Back almost all the way But not quite there of course when we When we live in a time of coven more People have had experience without taste And some people with covet as we know Have lingering Effects of no taste Certainly with the radiation you’ll have No taste but generally speaking it’ll Come back to some degree With time Dryness Uh is a Particularly long term issue And the dryness in the mouth If you can imagine The Saliva acts as a protectant to our teeth For the formation of decay carries or Cavities you know whatever Whatever you’re used to hearing cavities Unfortunately is it’s caused by Bacteria But when the bacteria gets in our mouth In a dry mouth it sticks more and it Typically sticks along the gum line and In between the teeth And with that dryness and with the Bacteria Literally hanging on in a much Uh greater tenacity than when we have

Our saliva our normal saliva you’re very Very very prone to having um Decay form So With that We we try as part of the follow-up Have people use fluoride and there’s Diff Most toothpastes have fluoride and That’s always a good toothpaste to use Unless you have an allergy to it But there are prescription fluorides That we’ll use During cancer treatment and With in radiation particularly Not only During the time of treatment but Certainly shortly thereafter when you go Through the treatment sometimes wearing What we will make what’s called a Fluoride carrier tray where you put Fluoride in the tray and you put it in The mouth Typically you wear it for five minutes During treatment oftentimes you can’t do It once the mouth starts to calm down When the mucositis goes away Then it’s a good idea to use the Fluoride five minutes a day or if you Can’t use a fluoride tray we’ll have People brush it on their teeth It’s strictly a preventive along with It’s not magic One of the things that you find when you

Try to Increase your saliva that you’ll start Using different types of mouth candies To try and encourage Salivary flow And the problem with that is that it Erodes the enamel and really feeds the Bacteria in the mouth and it can really Precipitate A much faster incidence of decay And usually what you’ll find in people That where it becomes more rampant Is that the decay forms at the neck of The teeth and then you start filling Around the neck of the tooth the teeth Start to wear because you don’t have the Saliva as it as a friction it’s almost Like an oil lubricant so your teeth Start to wear more they take stress They begin to lose their The structure at the gum line and then They have a tendency to snap off And that’s that’s the worst scenario Because then it becomes very difficult To build those back up over time So prevention is key And Certainly It’s a good idea and we’ve found through The years oncologists typically will Have you see the dentist Prior to starting radiation treatment They usually do that where we have to Sign off that we’ve

Taken a look Teeth that are not Able to be saved because of poor gum Reasons or Significant amount of decay really need To Come out At least two to four weeks prior to the Start of radiation And the reason for that is the effect Radiation has on healing it compromises The the blood flow Um so you really want to try to remove Those teeth and get in a preventive mode Right off the bat Most dentists you don’t need to Necessarily see a specialist uh and There is no like oncology dental Specialist Most dentists should be very familiar With this And they should have this kind of Conversation with you Because and for most people we live in An area where they’re seeing their Dentist regularly They will give you some once they are Advised and you let them know They’ll go through and really check your Teeth for Teeth that have Looked to have poor prognosis from a gum Perspective and decay perspective and Those should come out

Now when you look to the future Because dryness is going to stay A factor That You’ll get some saliva back six months To a year but it’s typically the thick Ropey saliva And of course then again you’re going to Be wanting to use things to try to Encourage saliva and or Using more carbonated drinks which could Be again a not They they do present a risk for Increasing decay uh on the teeth So the uh The fluoride of course helps with that But If you have a tooth that becomes a Problem that needs to come out And this can be from A tooth that abscesses Has poor bone support Or unfortunately in back molars Depending on the amount of radiation They have and this The concentrated site of the radiation It can encourage Bone loss around the tooth where it Might need to come out Well those teeth As they come out the healing can be very Poor And you’ll hear a fancy word called Osteo osteoradionicrosis

Means bone Radio means Radiation necrosis means Death So If a tooth comes out and you’ve had Significant radiation The bone in the area of the tooth may Not heal and so you have little pieces Of bone that work their way out Sometimes they can be picked out and it Can heal over But the dentist taking that out really Needs to uh It can be a little Uh A very compromised situation and you Just don’t want to take a tooth out with Without some precaution Oftentimes we’ll have an oral surgeon Get involved with that Um it used to be in the day that there Was a treatment called hyperbaric oxygen That was very common to use It’s not quite used quite as much now as It used to be but the idea of what this Hyperbaric oxygen is is that you might Spend You know six to eight weeks in a chamber Where you’re in a highly concentrated Oxygen environment To help encourage healing in areas that Are compromised blood flow because of The

Radiation That’s a discussion that needs to be had With the dentist oral surgeon and Radiation oncologist if you got in a Situation where the tooth might need to Come out after you’ve had significant Treatment with Radiation because of a head and neck Cancer Um people sometimes will ask What’s it like to wear a denture after Treatment Uh your mouth is dry And Dentures typically what helps hold them Into place Is the the bone and the type of tissue That you have that the denture is Holding onto A moist environment typically is a Better Situation for a denture So There are things that you can uh use to Help hold them in the place but it’s It’s not quite the same as it is when You’re able to have A mouth that has a little bit more Normal type saliva But you can certainly wear a denture you Can wear partials that come in and out Root canals You’ll hear can i have a root canal After i’ve had radiation root canals are

Not a problem after radiation They can be done They can be Handled And usually they go along very Uneventfully What about implant placement Implant placement’s a little bit of a Different animal It depends on where the ratio radiation Has been how concentrated is it and that Is definitely something that would need To be discussed with The oral surgeon At that time because you You need to have a little bit more Tender loving care In that case and to make it the most Predictable Uh That the implant will take Products Um Most of the products are geared towards Dryness And Because that’s where most of the Complaint is And through the years there’s been a lot More products that are that are on the Market and everybody has Different ones that work best for them And in fact Some people say oh it’s it’s okay

But it it’s just not the same but it Becomes very difficult to keep moisture In the mouth There There’s a Company called spry S P r y s p r y Um you can google spry and you’ll see a Litany of different oil products that They have In the area you’ll usually find them at A Fruitful field Or at a health Kind of a Holistic Type store Whole foods may have them as well but in Today’s day and age Getting on the internet Googling Spry usually you’ll come up with a Litany of products they do not require Prescription It relates to dryness They make a couple different products One is called rain spray It comes in a little bottle and it gives You a couple spritz so you can keep it In your Pockets you can keep it in your purse You give yourself a couple spritz and it Just helps keep moisture in the mouth

A lot of people like that It doesn’t last a long time but it’s Easy and they can cut they come in Different container sizes that are small And easy to carry around It’s moisture it’s got what’s called Xylitol Xylitol is a sweetener that the bacteria In our mouth has not figured out how to Use to create to cause help promote uh Cavities it has a little aloe vera in There as well And You can keep it at your bedside when you Wake up or have some dryness and of Course through the day The other product and Along with spry making one is called Biotin B-i-o-t-e-n-e Biotin usually will be at an osco or a Cvs Walgreens You may have to ask the pharmacist it Too is not prescription But biotin along with spry makes an into All lubricant And what you do before you eat Or before you go to bed at night Is you put some on your tongue And then you work it all through the Inside of your mouth It has a little bit longer lasting Effect than the the spray

Because it is a vaseline type lubricant But there again Uh you you typically you need to use it A fair amount and most people like to Try the spray And the lubricant just to see what works Out best for them everyone has their own Little nuances what seems to work best You’ll also see what are called xylem Melts those you can find at most Drugstores X Y l i m e l t x Xyl amounts Those you can put in your mouth they Have like a little adhesive area It’s non-cariogenic meaning it doesn’t Promote decay But it just helps stimulate more saliva In the mouth Now between those three things again Most times i hear people like spry Rain spray And then the inchworld lubricant and Then you get into some of these Different mouth products but they’re all Worth trying i think karen’s Webster actually and she may chime in Karen as you listen Uh that there’s a couple other products That she’s used that she’s had uh Success with and sue’s nodding her head That she has and so i’ll mention those As well

In today’s world With all the marketing and products You’ll also see toothpaste For dry mouth and rinses for dry mouth They’re more People use them they really To be honest say they don’t help a lot But it’s one of those things if you like The taste and you like cabbing it around After you brush your teeth it doesn’t Hurt to use it act act Was probably one of the Earlier mouth rinses that You’ll see for dry mouth and that’s That’s in most pharmacies Even walmart and target you can find That but uh there again uh unfortunately I wouldn’t expect a miracle but it’s one More thing you can try there’s just so Many different products 3m makes a spray product That one you it does require a Prescription That’s something you can ask your Dentist about 3m It’s a spray that you just squirt in Your mouth I haven’t heard a lot of feedback on That We’ve given some out as uh For To be used as trials but nobody’s really Come back and said oh my goodness that Was just amazing how that helped

They do try with some of the diff like Sjogren’s is a disease that affects Saliva dryness There’s always these treatments where They stimulate the nerve That we don’t do that that’s something You can talk to a rheumatologist about Varying effects most times people just Wait it out six months to a year things To get to be a little bit More moist And go from there whereas some of the Sjogren’s diseases and those kinds of Things it’s always there and always dry To the point where That’s something you could talk to a Rheumatologist about to see if that if That might be helpful Um Chemotherapy so that’s kind of a Looking at radiation which really has Really significant effects on the oral Cavity a lot of different areas For those that have chemotherapy whether It’s for head and neck Breast Uh pancreatic all the different cancers They don’t have such a direct effect on The mouth Most of that is all in passing meaning That Depending on the chemotherapeutic agent You might get mouth sores That usually happens that can happen as

Soon as a week or two after the Chemo When you look to how what can be helpful There that goes back to the magic Mouthwash something that that you would Use as a rinse that’s very transient as You go through the chemotherapy it hurts But it won’t stay on for long lasting it Rarely gets to a point where you can’t Swallow like sometimes can happen with Radiation So that you can talk to your dentist or Radiation or excuse me you’re on college About oncologist and usually have some Thoughts for that as you go through the Chemo Dryness too Is usually Transient with chemo It’s just an effect of the medication And the changes that are going on and That typically comes back Much quicker than let’s say with Radiation treatment Um [Music] Taste is affected As well most people will say it’s a Metallic type taste Most people say that comes back as a General rule sometimes it’s a little bit More lingering There’s not anything specifically that You would

Use in the mouth to help increase Your Sensation of taste And again fortunately most times that Comes back with time so probably the Biggest thing with chemo is the Transient mucositis that you might have Some people as they Come out of chemo They’ll be concerned about their teeth Because of the effects that chemo has in General and those things if you again Stay in a pre-preventive program You go along and everything comes back And you’re not at high risk for having Dental problems the same way you would Be with radiation In and around the head and neck area As it relates to Teeth cleanings Most times during the time of your chemo They prefer for you not to visit the Dentist For usually two Big reasons one is that As you well know your counts can can go Down your blood counts so you just Become a little bit more at risk for Infection And depending on what your chemo is or Certainly if you’re in a Bone marrow transplant situation You just want to stay out of a Environment where you have lots of

People coming in and out where you’re More prone to infection and at the same Time not breaking that blood when we Clean teeth You know you do bleed Uh into in putting bacteria in your Bloodstream although the it’s a low risk It’s best if you’re not having a problem [Music] To not do that and deal with your Cleaning during that time when your Blood counts have Increased to a point where you’re less Risk for a problem Bone marrow transplants a little bit of A different animal because as you well Know they Before you go in for a bone marrow Transplant there again too They’ll usually want you to have a Dental clearance And the dental clearance is because as The As your Body Is being prepared for the bone marrow Transplant you’re really weakening your Immune system and as part of weakening Your immune system If you have teeth that are on the verge Of or they’re in a low-grade infection Once that immune system goes down all of A sudden your dental problem can really Go into high gear particularly if you

Have Gum related problems and when i say gum Related problems i mean as you many of You know when you go to the dentist and We poke around the teeth to see how your Gum health is and what your bone support Is Issue if you have a significant bone Loss problem where infection has a Tendency to be ready to Take off in a healthy person it’s not an Issue but when you’ve had bone marrow in Preparation for bone marrow transplant Your immune system can’t fight off that Infection the same way it can so it’s Usually a good idea And again i can’t emphasize you Typically oncologists will want a Clearance prior to that to make sure you Don’t have any teeth that might need to Come out or try to Get Things taken care of before your Immuno compromise to that level As always things do happen And if they happen in during those times That’s where the dentists and Oncologists really need to be in close Contact so that whatever’s being done as Part of the treatment the oncologist is Aware and everything is being done so That It’s in your uh It’s in your

Behalf to make sure that it goes along Smoothly Can you have implants after chemo yes Can you have crowns after chemo yes Can you have extractions after chemo yes It’s just all a matter of where Once the chemo is over getting back to a Kind of a normal Blood count level uh in From uh preventive dental care and all The things that go along with that Typically there’s no risk Whereas of course with the radiation you Have to be a little bit more aware Of what you might be doing and what Needs to be done in the mouth I’m going to bring up now Some of the what are called Bisphosphonates And they’re used primarily for Osteoporosis but in today’s world Whether it might be for chemo with Breast cancer depending on where you are Staged and if it looks like it might be Beginning to affect the bone Prostate cancer Multiple myeloma They might use These drugs that are called Bisphosphonates now The the Names on those are actinol Vasa max o’neiva Reclassed

Those types of drugs particularly if They’re given by Iv Or By injection They they’re a little bit Harder On your bone healing capabilities So If you’re having bone metastasis And they’re gonna they’re gonna be using Those kinds of drugs It’s always good to take another good Look at where you might be dentally with Gum disease or teeth that might need to Come out Because it’s typically Best if you really try not to to not Take teeth out when you’re on those Medications And the problem is there’s a balance Change with The cells that make bone and the cells That take away bone And those medications really affect the Cells that take away the bone and when a Tooth comes out it can really affect Healing And What you get Is that as the tooth comes out The the bone is exposed to the Environment And it dies it the you it doesn’t get

Taken away by the osteoclasts because They’re not working the same way that They were prior to using those Medications so the bone works itself out Uh if there’s rarely pain with it It’s just it’s an it’s a nuisance and [Music] It can get to the point where you keep Losing bone losing bone losing bone and It can be more of a problem it’s usually A a slower process But it can be multiple visits to the Dentist oral surgeon to remove those Hard spiculi areas of bone Sometimes the oral surgeon can take away Enough bone to where you get to live Bone and then you’re able to cover that Over With gum tissue and you may have some Success with gum coverage But the best Treatment is prevention and to just try To be as proactive as you can With going on those medications to talk To the dentist talk to an oral surgeon Talk to the oncologist so you try to Stay away from Extractions down the road As we all know things happen and if it Does happen everybody just needs to be On the same page with when you might be Going off those medicines It’s a little er there’s protocols out There they’re learning all the time

About what seems to be the best but a Lot of these medications are Not new new but new enough that Once they’re in your system they stay There a long time And there is a vacation time frame to be Off of them But in some situations They you know your oncologist doesn’t Like for you to be off of them for a Very long period of time Um So it’s something to be very aware of The other one i didn’t mention is prolia I don’t think i did but again vasa max Boniva re-class iridia Prolia are ones that You just If you’re on those it’s a red flag to to Dennis or oncologists if you had to have A tooth out There’s another uh Type of bisphosphonate that’s uh Actually builds bone it’s they’re They’re anabolic as opposed to making Your cells Slow down they help build up bone those Are forteo And timolis t-y-m-l-o-s Those are injections But they act differently So you can have a tooth out with those And your risk for bone breakdown is a Lot less

Typically those are medications it’s a Red flag All your physicians will say you can’t Have that for any more than two years as Part of your treatment protocol Because They have their own downsides and if They have a high risk of Causing osteosarcomas to form so Uh it’s something that they’ll use for About two years and then you’re off of It uh very similar to some of the Bisphosphonates so you’re able to take Them for so long and then you have to Change to something else because of the Effects that those have on your cells So These medications as as you well know They change there’s different ones that Come out But they are ones when you hear of What kind of effect of these This is a medication that’s going to Affect your bone You just want to be aware of okay How is it going to affect my bone as it Relates to if for some reason i had to Have a tooth out and again most times Your oncologist will Be on that but As we all know over time it’s good to be Your own advocate and be aware of that And certainly be aware of it As you talk to your dentist

Um I at this time is kind of i’d like to go To Questions if there aren’t any sue Um Yes okay i’ll start from the top okay Okay So first question that is um Uh Come in and karen has been answering Some too so um Uh This first question is i’m four weeks Into imrt for a glioblastoma No mouth source but i had some Pre-existing dental issues which haven’t Gotten worse at least not yet can i Expect to Can i expect it to start and when would It be a good time to get a dentist and To start to work in my teeth So I would say that you I wouldn’t worry that all of a sudden There’s going to be a time frame where Uh your dental work that needed to be Done Is going to start to become a problem I’m kind of assuming That it may have been more elective Treatment meaning that you don’t have a Toothache Certainly a broken tooth Decay

Any of those kinds of things can Happen after the treatment i think now The only thing that may drive it is what Your comfort level might be and i would Talk to your oncologist You might say excuse me ask Here’s where i am I had some pending dental work It was nothing that was of an immediate Emergency type situation when can i go Back in to have that looked at And um Usually the other thing as it relates to Radiation is that they use a lot of mass Now And in direction of where the beam’s Going to go So you may uh Not be experiencing mouth sores and in Fact Might be able to go in and have uh Dental treatment while the Treatment’s being done particularly if You’re feeling okay you know if your Blood counts are okay if you feel if You’re not too lethargic and or if You’re not too vulnerable to being in an Environment where there’s lots of people Where you could be more prone to Infection So Good conversation to have with your Physician Certainly if it’s a toothache

That you just want toothaches whether You’re pregnant or you’re In the midst of cancer treatment Those can get really Very very uncomfortable and there’s Things that can be done to get you out Of pain without having a tooth out or Doing a lot of dental work as a general Rule so that you don’t have to suffer During that time while you have All these other things going on in your Life Another question a good one too uh can Chemo cause or contribute to teeth Discoloration they can That varies a lot Um But you definitely can see that i’m not Going to say it happens to everybody Because i haven’t seen it happen with Everybody you definitely see it Sometimes Happen in some people And not to get too um Be too technical But teeth Are basically translucent And most of the color of teeth come from Inside so you have an outer enamel layer Which is the hard Protective part of the tooth And that’s just to throw out numbers is Like 98 percent mineralized Once that’s about a millimeter and a

Half thick and then you get into what’s Called the dentin The dentin is about 75 percent Mineralized but it has a lot of color Matter of fact For many of us That are 60 and over early on in life Would have had tetracycline even Tetracycline and That you may take as you age it’ll Discolor teeth because of the way it Binds to calcium and it’s binding into That dentin that causes the issue But as you have some of these different Chemotherapy agents and there is blood Flow into the center of the tooth It can have an effect on that dentin The other thing that can happen is that The inside of the tooth Just over time and with Lots of Medical Issues the the tooth can calcify more on The inside of the tooth where it becomes More dense and as it becomes more dense The translucency changes into the tooth And that can have an effect but I i can’t say that there’s a specific Chemotherapy that’s going to cause Tooth discoloration But certainly everybody is affected in Different ways And through the years you can see people That definitely notice an effect

It may be that when you finish the Chemotherapy there’s bleaching that can Be done Uh It’s it’s simple it doesn’t hurt the Teeth most of you probably are very Aware of it with Tray bleaching where you make a tray It goes on you put a bleach gel in even With significant tetracycline Doing that for four to six weeks Can have a a a positive effect The negative effect is sometimes that it Can make your teeth sensitive To cold Uh and brushing your teeth It goes away you know if you need to Take a day or two off take a day or two Off from the bleaching but There’s in a chemotherapy situation it Wouldn’t be one of those things to say Oh i can’t bleach my teeth i would just When you’re out of it you the chemo and You feel better Try tray bleaching or at least talk to Your dentist about it as a possibility For you as it might be helpful I i’m not going to sit here and say that All chemotherapy Causes discoloration but everybody’s Different everybody’s affected by those Things differently And and it’s not to say that it can’t Happen and not that it i haven’t seen it

Happen over time with different patients Uh another question uh what are your Feelings about the medications zomita Does that cause any issues with t I’m not sure how to pronounce but right So zometa is one of the bisphosphonates And that has a an effect on the bone So your biggest effect there Is that if you had to have a tooth out Everybody needs to be aware and to be Talking about what the benefits would be Depending on where the tooth is that Needs to come out Is Taking a vacation from that And there again oftentimes what will Happen is is that you’ll have your Zometa And then on your next cycle when you’re To have it is the time that you might Take the tooth out And then you wouldn’t take it again Until your next cycle Now the problem with that is that Pain You know you can’t be in pain or Infection for Six months sometimes it just has to Happen And that’s where you talk to the oral Surgeon and oncologist because you have To get your get out of pain you can’t be On you know high-dose pain medicines or Antibiotics for that time frame

While you’re waiting for your tooth to Come out i mean stuff does happen where You have to act a little bit more Aggressively but zometa is one of those That you definitely want to be aware of For the tooth coming out it doesn’t make You any more prone to decay doesn’t mean That You can’t have a crown doesn’t mean that You can’t have a filling but if you were To have An implant or you were to have a tooth Out it can definitely play it plays a Role that everyone should be very aware Of Uh another question uh anything uh to do For sore swollen gums with chemotherapy Also sore teeth with chewing This but yeah so with gums uh one of the Things is and you’re probably already Doing this i don’t want to take it to a Point where i’m not taking care of one Of that you’re not taking care of your Teeth but If it’s Possible mean you know chemo is coming Up And you typically maybe you do have some Gum issues it’s just to make sure you Get a good You know dental prophylaxis and cleaning Bacteria as it sits as it stays in and Around the gums causes your gums to Become

Red and bleedy And Sometimes some of the medications can Cause it to be more red and bleedy So your Hygiene care And i know this is old story you know Brushing your teeth Lightly at the gum line some people say When my gums hurt i don’t want to brush My gums it just means you need to brush Them a little bit more In today’s world with sonicares and Which are the automatic toothbrushes and The [Music] Bronze those are great brushes to put Toothpaste on and gently hold it into Your gums so that it stimulates them The other thing that can be helpful They’re called little soft picks and the Soft pick actually fits in between your Teeth you can put a little toothpaste on That a little sensodyne Which is a toothpaste for sensitive Teeth work that between your teeth Helping stimulate your gums is making Those gums where they become puffy and Red and they start to firm up and come Right around your teeth If you have a heavy build up and You know as you go around and have your Teeth clean and the scraping that goes On you might be familiar with

Calculus where it’s a hard deposit on Teeth Sometimes that’ll form just underneath The gums and it can make your teeth Really Really red and sore As it relates to Chemo Now if you’re finding that you’re having That and it uh it’s just not going away And depending on when your last dental Visit it may be worth a look just to see If that’s there because if it is and Assuming your blood counts are at a good Level it’s helpful to get that off your Teeth Uh sometimes some of the products i Might recommend will you’ll be like well It doesn’t really do anything well Sometimes the irritant that’s underneath There Just hasn’t had a chance to get off so You always want to check that If the gums are really red and swollen And Uh it’s and it doesn’t seem to be from Infective reasons whether it’s from the Plaque The hard calculus buildup and you’re not Having any improvement With the Brushing of the teeth and using the soft Picks And you’ve seen the dentist sometimes

You can use a steroid mouth rinse The steroid mouth rinse is something you Can rinse with you don’t swallow it but It’s called a decadron elixir it is a Prescription And what you do is you rinse with that And it helps with inflammation But if it’s related to infection you Want to make sure that the source of That is taken care of which would be the Plaque or the hard tartar buildup on the Teeth So i might say if it’s been a little While since you’ve seen the dentist it Might be worth a check You can always use to start with Brush your gums Give them some stimulation use a soft Pick using a normal Toothpaste and see what happens Because it’s worthwhile to give that gum Some stimulation to see if it if it Improves at all One last question and that is your Feelings on imperial science gel Well I would say with those perio science Gels it’s like it’s it’s not a panacea But i think that as you Um if you’re more prone to gum problems As an example there’s a toothpaste i Think it’s by Colgate Called periocare

This is when i need our hygienist karen Here It’s a it’s a toothpaste that’s focused On the gums not unlike what period gel Would be And taking those things and working Those in and around the gums Can be helpful i mean it may not take it All away but it can be helpful you’ll Hear sometimes or at the dentist there’s Some antibiotics that we can put in and Around the gum They don’t necessarily make it Completely go away But they can be helpful in times when You have A gum abscess or a gum irritation that’s Been precipitated and once everything is Cleaned out sometimes we’ll use some of Those Products to help encourage the gums to Heal So It oftentimes it’s using lots of Different things at the same time Whether it’s period gel It’s toothpaste directed toward the gum Again stimulating the gum with a soft Pick or putting the period gel on the Soft pick working it in between your Teeth along with your toothpaste To help stimulate that gum to start to Shrink up around the tooth and get Much firmer

It’s one of those things where you have A flappy gum flappy gum lots of stuff Gets in between tight gums it’s harder For things to get in between so you’re Trying to tighten those gums up with the Stimulation these different products to Help out And karen came through paradise paradigm Peridontics yes i don’t know karen if You have any comments related to period Gel She might I think that is a last weight i do have One more question um And you may have answered this but uh Can i or should i still choose Sugar-free gum while undergoing Thank you yes what is the story i’m sure So there’s so many different sugar-free Gums and i’m glad that was brought up Because i’ll always even for those that Don’t have cancer and they’re you’re Seeing a different decay pattern Bacteria is really smart of course when We grew up it was juicy fruit spearmint And all the good bubble yells that were Full of sugar and were fun to to chew on In today’s world almost You see more sugar-free gum than you do The regular sugar gum The problem with not the problem but not Unlike what you’re seeing with and i Don’t want to put bacteria in our mouth Related to coronavirus

But they figure out how to make things Work whether they mutate as a Coronavirus mutates or a bacteria that Figures out how to use different Carbohydrates to survive So a lot of the bacteria in our mouth Whereas before we just thought of it Using sugar so it takes in the sugar Metabolizes it gives off an acid and That’s what causes tooth decay They can use a lot of the different Sugar-free gums the same way they used To use the sugar that was in juicy fruit Or spearmint so when you see sugar-free Gum you think well i’m home free i Shouldn’t have a problem this is where Xylitol comes into play and xylitol is a A Sugar-free It’s a substitute for sugar that the Bacteria really hasn’t figured out how To use So if you look at your product See that it says xylitol it has some of The other sugar-free Additives Try to stay away from those and use the One that has xylitol now i’ve mentioned Spry before they make a gum And that gum is sugar-free and it’s a Good gum to use because it has xylitol It’s not the only one you just have to Be pretty specific When you look in whether it’s tri-dent

Or wriggly sugar-free well what are they Using as a sweetener and if the Sweetener is xylitol you know that that Would be a better choice to use and and It’s okay to do that but you wouldn’t Want to use Just any sugar-free gum Or certainly gum in general to try to Stimulate Saliva particularly when your mouth is Very dry Sue thank you always a pleasure to be With living well they’re always very Good here if you have questions that Might come in later be they can pass Them on to me or if you’re having a hard Time just let us know so thank you very Much