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Cancer Treatment and the Mouth

Having recently had three people, a colleague, a friend and a patient each go through the woes of chemotherapy / radiotherapy, it is important to realise that not only can dental health can affect cancer treatment but cancer treatment affects oral health as well. 

An unhealthy mouth can increase the risks of side effects from cancer treatments and may interfere with the therapeutic regime.

With chemotherapy, many parts of the body are affected, most frequently resulting in hair loss, gastrointestinal problems and others. With radiotherapy, almost all head and neck radiation patients will have oral complications.

Ideally, we would like to schedule a pre-cancer treatment examination about a month before treatment begins with the following objectives:

• Establish a schedule for dental treatment.
• Complete invasive procedures at least 14 days before head/neck radiation therapy starts; 7 to 10 days before myelosuppressive chemotherapy.
• Postpone elective oral surgical procedures until cancer treatment is completed.
• Identify and treat sites of low-grade and acute oral infections such as caries, periodontal disease, endodontic infections and lesions of the muscosa.
• Identify and eliminate sources of oral trauma and irritation such as ill-fitting dentures, orthodontic bands, and other appliances.
• Identify and treat potential oral problems within the proposed radiation field before radiation treatment begins.
• Instruct patients about oral hygiene.
• Educate patients on preventing demineralisation and dental caries.

By improving the oral health of the mouth, the aim is to:

• Reduce the risk and severity of oral complications
• Improve the likelihood that the patient will successfully complete planned cancer treatment
• Prevent oral infections that could lead to systemic infections
• Prevent or minimise complications that can compromise nutrition
• Prevent, eliminate or control oral pain
• Prevent or reduce the incidence of bone necrosis in patients receiving radiation therapy to the head and neck
• Preserve or improve oral health
• Improve the quality of life
• Decrease the cost of care

General Oral Complications of Cancer Treatment include:

• Oral mucositis/stomatitis – inflammation and ulceration of the mucous membranes
• Xerostomia/salivary gland dysfunction – dryness of the mouth because of thickened, reduced, or absent salivary flow
• Infection
• Xerostomia-associated cavities
• Taste alterations
• Nutritional compromise
• Functional disabilities
• Abnormal dental development in children 

 Specific complications from - 

Chemotherapy:

• Neurotoxicity
• Bleeding

Radiation therapy:

• Radiation caries
• Trismus/tissue fibrosis – loss of elasticity of chewing muscles that restricts normal ability to open the mouth.
• Osteonecrosis -blood vessel compromise and necrosis of bone resulting in decreased ability to heal if traumatised and in extreme susceptibility to infection. 

Together these can mean that it is painful to brush and floss and food may not be able to be removed from around teeth resulting in a greater chance on decay. Products like Biotene Oral Balance, Dry-mouth gel and Tooth Mousse/Plus, fluoride rinses amongst other natural therapies can help to wet the mouth and improve clearance of food and help to protect the teeth.

 To maintain a health mouth:

• brush teeth twice daily with a fluoride toothpaste; 
• clean between your teeth every day with dental floss;
• stop the use of tobacco products;
• rinse after vomiting with a quarter teaspoon of baking soda in a cup of warm water;
• moisten a dry mouth by drinking water; sucking on ice; chewing sugar-free gum or sucking on sugar-free candies; avoiding mouthwashes that contain alcohol; use a product mentioned above

Always keep in mind that we are just a phone call away and can help advise on treatment or products that will help keep your mouth healthy. Good luck with your treatment. Keep your chin up and stay positive!

Aussie children’s teeth are getting worse

Researchers from Adelaide University say that Australian children have terrible teeth and their oral health is getting worse, despite billions of dollars being spent on fixing the problem.

Adelaide University have been awarded $1.3 million to study why the system is failing Australia’s children.

Professor John Spencer from the Australian Research Centre for Population Oral Health will lead the research over the next four years.

“Despite a substantial level of resources, approximately $1 billion dollars annually being directed to dental services for children in Australia in the last decade, their oral health is still a major public health problem,” Professor Spencer says.

“After several decades of improvement, child oral health has worsened and inequalities have widened.”

In 2006 nearly 27,000 children 8114 of whom were pre-schoolers – were admitted to hospital for dental work. Latest statistics show that dental restorations and extractions are the most common reason for hospital admissions among Australian children under 14 years old.

All State and Territory public dental authorities will partner in the research project and a further $1.7 million will be committed, making the total funding for the study $3 million.

“In this study we will be looking at how dental services for our children are organised and delivered, comparing the use of private dentists and school dental services and the outcomes for child oral health,” Prof Spencer said.

When a child requires a general anaesthetic, the most common reason is due of dental decay. Perhaps the increase in bottled water and the lack of supervision of a child’s diet due to the busy lives of parents has contributed to this problem. It certainly appears that low-fluoride toothpastes are not helping.

Dental decay is preventable but it requires moderation in the amount of sugars that a child intakes. In toddlers it can be because of bottle decay where the child is given milk in a bottle to get them to sleep. In young children, it is not just soft drinks that can be the problem as all juices will have natural sugars that can be used by bacteria to create acids. Intake of sugary between-meal products is the most likely cause of the decay as it reduces the pH in the mouth making the oral environment conducive for bacterial acid production and making teeth susceptible to acid attack.

In cases where we know that a child has a high risk of tooth decay, we must to be very proactive in preventing further decay. Adult toothpastes or even high fluoride pastes may be required. Tooth Mousse can help reduce a child’s susceptibility and there are special mouth rinses to increase the pH of the mouth. Please have a good look at your child’s teeth when you next brush them and if you notice any dark areas on the teeth or there is anything amiss, please give us a call.

What is it you really want?

So many times we hear patients say that they only go to the dentist when they are in pain. And when the patient has a really sore tooth, all we can do is relieve their pain. We call this Emergency Dentistry. But is this really what the patient wants?

Sometimes it is but I think for others the questions is really,” Can you make sure that this does not happen to any of my other teeth?” or “Can you fix this tooth so I never have to think about it again?”.
If we know this we can put together a maintenance program with periodic recare appointments to ensure teeth are attended to when the issues are minor. Or we could repair the tooth in a porcelain material so that it not only restores the tooth, but also protects it during chewing and it will last a long time as the material is so strong.

When a patient is in pain, they  just can’t verbalise what they really want. All their thinking is clouded by a red mask of pain. But extracting a painful tooth then means an empty space where the teeth was and a whole new set of questions about what to do with that space.

Likewise a patient does not come in thinking they really need to have a bridge, or a denture, a Snap-On Smile or an Implant. What they would really like is to be able to smile again and be able to chew their food without it hurting their gums.

I rarely have a patient come in saying they want veneers. What they ask for is whiter teeth, or a nicer smile or a different shape to their teeth. If I just made them veneers, I might make them something they like, but the end result may not be ideal.

It sometimes happens that the solution for their problem is completely different to what they might think. For example, if a patient has wants longer teeth, it might be as simple as a laser gum lift, it may be inclining the teeth forward with Invisalign, or even extruding the teeth with implants!

That is the wonderful thing about modern dentistry. There are now so many options to achieve the end result. More than ever it is important that we as dentists ask the right questions, and you as patients think about what it is you really want, and how much it is worth to you.

At Cosmic Smile Dental, we offer a complimentary smile consultation so you can tell us your concerns and we have an understanding of your dental values. We’ll show you some of the ways that we can get there and together we can decide how quickly we can make your goal a reality. Just make sure you think about what it is you really want =)

How long will your fillings last?

Dental restorations or fillings are living in a very harsh environment. As I mentioned a couple of weeks ago, “The mouth is on a slippery downhill slide, the best that we can hope for is to make sure that it is not always slippery and that the slope is not steep.”

What this means is that although we might call a filling ‘Permanent’ it does not mean ‘lifelong’. Fillings are going to need to be replaced so matter how well they are done. Patients will chew on hard nuts and ice, they clench when they are stressed or just don’t take sufficient care of them. This means it is just a question of when they will fail.

Nowadays, the modern materials and cements are so strong that if things fail very soon after they are placed that it is usually our fault. Maybe the material was mixed wrong or you licked the tooth when we weren’t looking or we were just having a bad day. It happens. And we’ll fix it. But that’s not what I’m talking about.

Nature takes about 9 years to build a tooth. Unfortunately, bacteria that have evolved for millions of years are also around our teeth, and together with foods and drink and the stresses of everyday life, teeth decay or erode or crack. Many different materials have been used to restore teeth but let’s just call them white fillings (composite resin), silver fillings (amalgam) and porcelain fillings.

Studies have shown that a large white filling in a premolar has an 84% chance of surviving 12 years compared with about 75% chance for an amalgam filling. This is even higher in people considered to have a low caries risk. Porcelain restorations survived best of all and can last 20 years or more.
However, if we looked at fractured or cracked teeth there are between 5x to 50x more chance of an amalgam restoration being the cause versus a composite resin. The main reason is that teeth had to be prepared significantly more in the past when undercuts were required to retain the silver fillings.

For silver fillings, this is known as the Molar Life Cycle or the Circle of Death whereby a small filling –> medium filling –> large filling –> cracked tooth –> rebuilt tooth –> root treated tooth with post and crown –> extraction.

What this means is that because of the materials and equipment like the Diagnodent and dental laser, we can pick up fillings sooner, treat them earlier and more conservatively with composite or porcelain, meaning not only a longer life cycle for the filling but also your tooth. And surprisingly that also helps your hip pocket in the long run too.

So don’t be afraid to come in a have a checkup, even if it’s been a while. We are a Guilt-free office and we won’t give you a lecture. Take a look our Galleries to see what can be done with modern materials. You’ll be glad you did and you’ll be able to keep those pearly whites for a long time to come.

ZOOM teeth whitening of tetracycline stained teeth

I’m always getting comments about how white my teeth are, and getting asked by my patients if their teeth can look like mine. For most patients, they can. And it’s very simple.

My teeth were not always white though. When I was younger I was given tetracycline by a doctor. Tetracycline is a broad-spectrum antibiotic that causes teeth to get dark grey or brown banding. When the staining is severe, it can take many months of home teeth whitening to whiten the teeth to an acceptable colour. If the staining is too dark, it is not possible to remove the banding completely. The best solution is then to use Lumineers to mask the dark teeth which does not require removal of any tooth structure.

Lumineers on severely tetracycline stained teeth

Luckily my father who was a dentist, realised what I had been given and I did not take the full course of antibiotics. Still, for many years I had grey teeth that I was ashamed of. Over the years, I’ve done two lots of in-chair whitening and two complete treatments with home teeth whitening kits. Luckily my teeth were able to be whitened using both whitening systems in combination. The teeth are now a light natural white colour (B1 – see shade guide) and maintaining them is pretty easy. Keep them white only takes two or three sessions with a home whitening kit every years or so to get them back to the shiny white that they were.

Since it is getting to the end of the financal year we are offering Professional in-chair teeth whitening with the ZOOM or Sapphire Lumibrite system for only $590. This is such as great offer but it does not include the trays for home teeth whitening. It is really designed for the patient that already has them but just wants to get a quicker result. This offer is only valid until June 30th 2011. Give us a call for this or one of our other special offers!