From the Guidelines
Oral examinations for oncology patients after chemotherapy should prioritize meticulous oral hygiene, pain management, and prevention of infections to minimize complications and maintain oral health throughout cancer treatment. To manage side effects such as mucositis, xerostomia (dry mouth), taste alterations, and increased risk of infections, patients should maintain oral hygiene using a soft-bristled toothbrush and mild fluoride toothpaste, as recommended by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology Daily Oral Care Plan for Patients 1. Some key interventions include:
- Flossing at least once daily with waxed floss to minimize trauma to the gingivae
- Brushing with a small, ultra-soft-headed, rounded-end, bristle toothbrush and prescription strength fluoride toothpaste
- Rinsing the oral cavity vigorously with a bland rinse several times a day to maintain moisture and remove debris
- Moisturizing the oral cavity with water or artificial saliva products to prevent dryness
- Using only animal or plant-based oils such as bees wax, cocoa butter, and lanolin for lip care to keep lips lubricated and moisturized Regular dental check-ups, at least every 6 months, are essential to minimize complications and maintain oral health throughout cancer treatment 1. For pain relief, topical agents like 2% viscous lidocaine or "magic mouthwash" can be used every 4-6 hours as needed. Patients experiencing severe dry mouth should increase fluid intake, use alcohol-free mouth moisturizers, and consider saliva substitutes like Biotène. Fungal infections, particularly oral candidiasis, are common and may require antifungal treatments such as nystatin oral suspension or fluconazole. These side effects occur because chemotherapy targets rapidly dividing cells, including not only cancer cells but also the normal cells lining the oral cavity, leading to compromised tissue integrity and immune function. The management of oral and gastrointestinal mucositis is also guided by ESMO clinical practice guidelines, which suggest a multidisciplinary approach to oral care and the use of cryotherapy, low-level laser therapy, and other interventions to prevent and treat mucositis 1.
From the Research
Side Effects of Oral Examination for Oncology Patients after Chemotherapy
- Mucositis and xerostomia are common oral complications of non-surgical therapy of cancer, including chemotherapy 2
- These complications can have a significant impact on the quality of life and cost of care, and also affect survival due to the risk of infection 2
- Oral mucositis can be managed through proper basic oral care practices, appropriate pain management, and the use of medicated mouthwashes and oral rinses and gels 3
Management of Oral Mucositis
- The use of multi-agent combination oral care protocols is beneficial for the prevention of oral mucositis during chemotherapy, head and neck radiation therapy, and hematopoietic stem cell transplantation 4
- Topical 0.2% morphine can be used for the treatment of oral mucositis-associated pain in head and neck cancer patients treated with radiation therapy and chemotherapy 5
- Chlorhexidine should not be used to prevent oral mucositis in patients undergoing head and neck radiation therapy 4
Prevention and Treatment Options
- Cryotherapy, topical benzydamine, and amifostine may provide some benefit in specific situations for the prevention and treatment of oral mucositis 2
- Palifermin, a recombinant human keratinocyte growth factor, has been approved as a mucositis intervention in patients receiving conditioning regimens before hematopoietic stem cell transplantation for the treatment of hematological malignancies 2
- Systemic pilocarpine and pentoxifylline have been determined to be ineffective for the prevention of oral mucositis in certain patient populations 6