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Expert Q&A: Oral Health and Breast Cancer Treatment

Sol Silverman is a professor of oral medicine at the University of California, San Francisco, School of Dentistry and a spokesman for the American Dental Association. He completed his dental training at UC San Francisco and, in 2005, was honored by its dental school for his contributions to research in oral medicine. His research focuses on oral cancer. He received the Margaret Hay Edwards medal from the American Association for Cancer Education in 2002.

I have just been diagnosed with breast cancer. Should I check in with my dentist? If so, when is a good time to do that — before, during or after treatment?

If chemotherapy is part of a woman's treatment plan for breast cancer, she should schedule a regular cleaning with her dentist before starting treatment. Most chemotherapy agents will suppress white cells, which protect against infection. And that increases the risk that doing an invasive procedure, such as a tooth extraction or deep cleaning, will cause infection. This is true usually for about a week after each treatment is given. During this period, the woman's oncologist can advise her and her dentist about when it would be safe to do a dental procedure. Breast cancer patients should maintain good hygiene — brushing, rinsing and flossing — throughout their treatment.

If a woman has breast cancer and is treated by surgery or by radiation but not chemotherapy, the mouth is not affected in any way.

What oral health issues can arise as a result of breast cancer treatment?

Depending upon the agent or combination of agents that is used, treatment can affect the mouth and cause a mucositis, an inflammation of the mouth. That can be very painful and affect swallowing, taste, appetite, speech and sleep. It feels like a third-degree sunburn after a day at the beach and can seriously affect quality of life.

There are additional concerns for women whose breast cancer has not responded to traditional therapy. They might be considered for stem cell transplants. The process that prepares them for those transplants basically wipes out their immune system. After they go through conditioning, they are given stem cells to reconstitute their immune system. They need to have good hygiene throughout this process and should work with a dentist or dental hygienist who has experience with cancer patients.

What should a woman do to take care of her teeth, gums and jaw during breast cancer treatments? Are special rinses or toothpastes needed?

1. Use good hygiene: brushing, rinsing, flossing. Alcohol-free mouthwashes and sponge brushes for cleaning are usually better tolerated.

2. Avoid dental procedures during periods when white blood cell counts are low.

3. If mucositis develops, see someone — a dentist or hygienist — who's been trained to deal with this and can provide medications that will be helpful. We treat mucositis empirically; there is no single regimen that has been shown to work the same way with each woman.

What signs or symptoms of oral health problems should a breast cancer patient or her caregivers be on the lookout for?

The main thing to watch for is pain with mucositis. Medical oncologists are aware of mucositis, but it is also important to see a dentist or hygienist who is trained in this field.

Another issue for patients who have been treated with bisphosphonates to protect the bones is the risk of developing areas of decay in the jaw that don't heal, usually after an invasive dental procedure such as a tooth extraction or aggressive cleaning. The risk is low, but patients should be warned of it.