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Oral HealthSide-Effects Management

Simple Strategies for Relieving Oral Pain Caused by Cancer Treatment

Dental hygienist Kris Potts breaks down the side effects, such as dry mouth and oral ulcers associated with cancer treatments and lists treatments available to combat these problems.
August 2022 Vol 8 No 4
Kris Potts, BS, FAADH, RDH
Founding Member of the National Network of Healthcare Hygienists
Fort Worth, Texas

Among the many side effects associated with cancer treatments, 2 of the most common that often affect the mouth are dry mouth (called xerostomia) and oral mucositis (or painful oral lesions). These are common with cancer therapy, but there are many things that patients can do to relieve these complicators during cancer therapy.

Dry Mouth

Dry mouth is caused by reduced saliva, leading to a parched feeling in the mouth. This can be mild, moderate, or severe. Compared with battling the cancer, medical professionals often consider dry mouth trivial and unimportant. However, severe dry mouth can diminish the patient’s quality of life, impairing the ability to eat, carry on a conversation, get a good night’s sleep, and engage in normal social interactions.

For some patients with cancer, dry mouth is far from trivial. In addition to compromising psychological well-being, it is a symptom often underreported to doctors. By the time people complain of dry mouth, they may have already lost more than half of their salivary function, which makes it more difficult to treat.

Saliva

Although we take it for granted, our saliva is critical to health and comfort. It provides lubrication needed for our lips, cheeks, and tongue to slide over our teeth when speaking, chewing, and swallowing, and protecting the oral lining (mucosa) from injury.

Saliva plays a role in defending against bad bacteria in the mouth. Saliva also contains a digestive enzyme that is responsible for the onset of digestion and the perception of the taste and texture of food.

Electrolytes within saliva provide a buffer that keeps the oral cavity within a neutral pH range and carries essential elements, such as calcium and phosphates, to keep tooth enamel strong.1 If the oral cavity becomes too acidic, minerals are leeched from the teeth to buffer the acid, weakening the enamel and causing decay.2

The pH is often thought of in terms of pool water and shampoo, but it is a vital component of oral health. Besides regulating the pH level, saliva also helps to increase the body’s immune response to infections in the mouth.

Common remedies for dry mouth include using a humidifier, drinking water, and avoiding sharp, crunchy, acidic, and spicy foods and alcohol.

Several common medications—including allergy medications, antidepressants such as the SSRIs (selective serotonin reuptake inhibitors), and anticonvulsants used for neuropathy—cause dry mouth. A potential remedy may be to change the medication, change the time when the medication is taken, or using a liquid or transdermal form of delivery of the medication.

Simple strategies and lifestyle modifications are worth trying.

Few treatment options are available for severe dry mouth. Prescription drugs, including pilocarpine and cevimeline, increase salivary output in severe cases of dry mouth, but these drugs can have unpleasant side effects.

Electrostimulation is becoming accepted and can be administered externally or through a prosthetic device containing electrodes placed inside the mouth.

You must always weigh the risks versus the benefits of any treatment.

Painful Oral Ulcers

Chemotherapy and radiation work by targeting rapidly dividing cells, but they are unable to distinguish cancer cells from noncancerous rapidly dividing cells in the lining of the mouth.3 Therefore, the mucosa is adversely affected by the cancer treatment.

Painful, ulcerative lesions in the mouth form in about 40% of patients receiving chemotherapy.1

Patients with head and neck cancers who receive radiotherapy are more likely to have oral mucositis when the radiation affects the mouth and salivary glands.

Oral mucositis necessitates aggressive treatment and pain management. Oral lesions can be so painful that they lead to dehydration, malnutrition, and severe weight loss, because the patient cannot eat and drink properly. If the lesions become severe enough, cancer treatment may need to be interrupted.4 These ulcers are also a source for bacteria, viruses, and fungi that cause secondary infections, such as candidiasis, a yeast infection in the mouth known as thrush.4

Many medical and dental professionals believe that oral mucositis is an unavoidable side effect of cancer treatment and are unaware of the various solutions available that can offer relief. Many doctors and nurses still recommend drinking more water and sucking on sour candies.4

Water, however, does nothing to improve poor taste sensations, and many bottled waters have a low or slightly acidic pH level, which should not be used by people with oral lesions.

Common Therapies for Oral Side Effects of Cancer Treatment

Several treatments are available for the oral side effects of cancer treatment, including over-the-counter and prescription remedies that provide varying degrees of relief.

Cryotherapy. A popular treatment for oral mucositis is cryotherapy, in which the patient holds ice water in the mouth or sucks on ice chips during chemotherapy infusion. This causes vasoconstriction of blood vessels in the mouth, which prevents some of the toxic chemicals from reaching the oral mucosa. This is similar to wearing a “cold cap” on the scalp to prevent hair loss caused by chemotherapy.

Artificial saliva rinses include Lubricity, SalivaMax, and Neutra­Sal. These replace lost salivary function by providing missing salivary elements. They are helpful for patients with head or neck cancer whose salivary glands were damaged during treatment.

Chewing gums, lozenges, rinses, and mucoadhesive discs, including Xylimelts, All Day Spray, Xyligel, and Spry, can stimulate the salivary glands to produce more saliva in people who retain some salivary function.

Topical rinses and gels are often recommended for oral mucositis, such as Magic Mouthwash and Biotene. These are soothing, but they do not promote healing of ulcerations.

Many rinses and gels contain sugar, artificial sweeteners, and/or citric acid to make the product more palatable. But these ingredients lower the pH level in the mouth and increase the risk of tooth decay. It is crucial to be attentive to the pH of all oral care products, because several are inherently acidic and can cause decay when used regularly.

Two products that enhance healing of oral mucositis without decreasing pH levels are Stella­Life and PerioSciences.

Stabilized chlorine dioxide is another option for dry mouth and oral mucositis caused by cancer therapy. Stabilized chlorine dioxide in oral rinses, toothpastes, and sprays has a long history of being safe and effective. It is available over the counter, maintains a neutral pH range between 6.8 and 7.5, and contains no irritating sodium laurel sulfate or alcohol.

Treatments containing alcohol are common but are not recommended for the mouth of a patient with cancer. Stabilized chlorine dioxide also inhibits the harmful bacteria found in the oral cavity that cause periodontal infections.5 Because it is stabilized and activated by the saliva, it does not have to be mixed before its use. It is available with or without fluoride and has a mild, pleasant flavor. Most important, it can hydrate the oral tissues and alleviate oral mucositis, making it suitable for frequent use.

Don’t Give Up

Although there are no guarantees for preventing or healing oral mucositis, currently available options provide moisture, promote the healing of ulcerations, and prevent decay.

What works well for one person may not be as effective for another and depends on a variety of factors. Using some of these options can relieve pain and reduce the need for opioids and steroids to offset the oral side effects of cancer treatment.

Try products recommended by cancer survivors, doctors, dentists, and dental hygienists who have had success with dry mouth and oral mucositis caused by cancer treatment. Never give up hope.

Don’t be daunted by the oncology team. Although they are experts in treating cancer, they cannot always focus on or keep up with all the new products and innovations that can relieve treatment side effects, such as dry mouth and oral mucositis.

Become an advocate for yourself, and learn about current options. When you find a solution that works, share it with others.

Also discuss it with your oncologist, and help educate the rest of the team on how it has benefited you. You need not suffer through oral side effects.

Mitigating dry mouth and healing oral mucositis will help you navigate your cancer treatment with less pain, weight loss, and stress.

References

  1. Natarajan K, Gayathri R, Priya VV. Analysis of electrolytes in saliva of periodontitis and healthy individuals. International Journal of Pharmaceutical Sciences Review and Research. 2016;41(1):12-14.
  2. Hurlbutt M, Young DA. A best practices approach to caries management. Journal of Evidence-Based Dental Practice. 2014;14(suppl 1):77-86.
  3. Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, Farré M. Salivary secretory disorders, inducing drugs, and clinical management. International Journal of Medical Sciences. 2015;12(10):811-824.
  4. Eggert J, ed. Cancer Basics. Pittsburgh, PA: Oncology Nursing Society; 2010.
  5. Wirthlin MR, Ahn BJ, Enriquez B, Hussain MZ. Effects of stabilized chlorine dioxide and chlorhexidine mouthrinses in vitro on cells involved in periodontal healing. Journal of the Western Society of Periodontology Periodontal Abstracts. 2006;54(3):67-71.

Key Points

  • Two of the most common side effects of cancer treatment are dry mouth and oral mucositis (painful oral lesions)
  • Severe dry mouth can diminish a patient’s quality of life, impairing the ability to eat, talk, get restful sleep, and engage in regular social interactions
  • Saliva is important because it provides lubrication needed for our lips, cheeks, and tongue, and defends against bad bacteria in the mouth
  • Painful, ulcerative lesions in the mouth form in about 40% of patients receiving chemotherapy
  • A popular treatment for oral mucositis is cryotherapy, in which the patient holds ice water in the mouth or sucks on ice chips during chemotherapy infusion
  • Oncologists cannot keep up with all the new products and innovations that can relieve cancer treatment side effects, such as dry mouth and oral mucositis

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Last modified: August 25, 2022

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