I have a patient of many years who is also a close personal friend. She is also being treated for cancer with chemotherapy. So what are the dental guidelines?



The first thing is to have a cleaning and get everything checked out 1 month before treatments start. By doing this the dentist can assess any problems and address them before treatment begins.

Once treatment begins, the body will change rapidly. The goal of chemotherapy is to destroy cancer cells. Unfortunately there are healthy tissues that don’t do well in the new chemical environment.

Oral Side Effects

In the mouth alone there are side effects even when other parts of the body are the main focus. According to the National Institute of Dental Craniofacial Research changes to the oral cavity include xerostomia (dry mouth); burning of the gums, mouth and tongue; difficulty eating, talking and swallowing; taste changes, and an increased susceptibility to infections. This last point is a big deal, so the patient should not be getting regularly dental cleanings during chemotherapy. Dental treatments are recommended on an emergency basis only. Before any dental treatment I would consult with the patients oncologist, explain the treatment that is needed, and get in writing what I can do, what materials I can and can’t use (like using a local anesthetic with epinephrine), and what antibiotic coverage he(the oncologist) wants to prescribe before, during and after dental treatment. We don’t want a successful dental treatment that kills the patient!

What can the patient do?

As a routine the patient needs to keep the mouth moist. Drinking water or sucking on ice can help this. Sugarless gum and candy can induce salivary flow. If that still isn’t good enough saliva substitutes can be taken.

There are foods that should be avoided. Hard crunchy foods like chips can cut the oral tissues and should not be eaten. Spicy and acidic foods should be avoided, as well as alcohol.

Some habits should be avoided. Smoking is one of them. Using a toothpick can poke the gums and needs to be avoided.

Chemotherapy is not forever. However during this period of body changes the patient must make concessions to the cancer and the treatment. With successful treatment these concessions will be merely a thing of the past.