Published: May 2003
The following products are recommended for the prevention or palliation of many of the oral problems associated with cancer therapies.
NB Use of all products should be evaluated for individual patient benefit and should be closely monitored for efficacy. Products that prove to be ineffective or result in additional morbidity should be discontinued and alternative methods sought.
Compliance will be greatly impacted by the patient's perception of need and by the cost and availability of the product.
Bacterial Plaque Control
Ideally patients should use an extra-soft nylon bristle toothbrush and dental floss for mechanical removal of plaque. Sponge toothettes/ foam sticks and lemon-glycerine swabs available to hospitalized patients may not adequately remove bacterial plaque. If used, a sponge toothette soaked in chlorhexidine rinse may enhance plaque removal. Patients who suffer from severe oral pain or significant neutropenia may soften their toothbrush in hot water before use, or they may switch to a super-soft, multi-tufted toothbrush. These brushes should be disinfected in chlorhexidine and air dried before reuse.
Chiorhexidine rinses or gels may be used to assist with bacterial plaque control when mechanical methods are inadequate. Chiorhexidine rinses with alcohol that irritate or dry friable tissue should be discontinued, and they should be diluted with water for pediatric patients.
A 1.1% neutral pH sodium fluoride gel or a 0.4% stannous fluoride gel is used for the prevention of caries and/or demineralization of the tooth structure secondary to xerostomia. For patients with long-term or permanent xerostomia, daily application is accomplished using custom gel-applicator trays. Patients with a transient xerostomia may brush the fluoride gel on their teeth daily.
Acidulated fluorides should not be used. Fluoride rinses do
not provide adequate protection. Patients with porcelain crowns should use a neutral pH fluoride.
A gel with calcium, phosphate and fluoride can be used in gel-applicator trays in addition to fluoride gel to remineralize early enamel breakdown in severely xerostomic patients.
Saliva Substitutes/ Oral Lubricants
A variety of OTC sprays and gels are available for temporary relief from xerostomia and dry lips. Occlusive lip balms, such as petrolatum, may promote microbial growth. During radiation therapy the patient should follow the advice of the radiation oncologist.
A prescription for pilocarpine (or anetholetrithione, available in Canada and Europe) may benefit patients with residual salivary gland function.
Tobacco Cessation/ Nutritional Information
Materials are available free of charge from the National Cancer Institute (1.800.4.CANCER).
- "How to Help Your Patients Stop Using Tobacco. A Manual for the Oral Health Team"
- "Clearing the Air How to Quit Smoking and Quit for Keeps" (a patient publication)
Oral Care Products
The following solutions are prepared by a pharmacist for relief of generalized oral pain:
Sulcralfate Suspension (Ferraro; 1984)
- 8 sulcralfate tablets
- 40 ml sterrie water
- 3 Ensure Variflavor Pacs dissolved in 10 mi sterrie H2O
Stir together. Add H2O to 120 ml. Swish and hold 1 tsp in mouth for 30 seconds.
Palliation of Pain
All palliative pain preparations should be closely monitored for efficacy and re-evaluated if pain persists. Topical anesthetic and protective preparations may be used for isolated ulcerations. The patient should be cautioned that some preparations can anesthetize the gag reflex and lead to aspiration of food. Lack of sensation may result in damage to intact mucosa.
Temporary palliation of pain also may be accomplished with the use of a magnesium aluminum hydroxide antacid mixed with an OTC alcohol-free Benadryl in a 1:1 ratio. The patient is instructed to swish and hold one teaspoon in the mouth to coat and palliate the oral tissues. A small amount may be swallowed.
Diphenhydramine injectable 1.5 ml 50 mg/ml. Xylocaine viscous 2% 45 mls. Magnesium aluminum hydroxide soin 45 mls. Swish and hold 1 tsp in mouth for 30 seconds. Small amounts may be swallowed.