Oral Health Care for Patients with Cancer

Patients undergoing a BONE MARROW TRANSPLANT (BMT) or OR HIGH-DOSE CHEMOTHERAPY: Oral health instructions

Before Bone Marrow Transplant:

Prioritize a dental cleaning before you get admitted. Studies have shown that a cleaning can minimize the severity of mouth sores that may arise.
- Avoid dental treatment during stem-cell harvesting for autologous stem cell transplant
Have your cavities filled and hopeless teeth (or teeth that have potential to cause an infection) extracted
- Ideally dental extractions should be performed at least 1 week before initiation of chemotherapy (white blood cell nadir (lowest point) typically occurs 7-14 days after chemotherapy)

During Bone Marrow Transplant:

Use an ultra-soft toothbrush throughout the course of your BMT
Avoid flossing your teeth for as long as your blood counts are low (ie. Platelets <50K) or when your coagulation profile is abnormal
Use a prescription fluoridated toothpaste at bedtime
Avoid alcohol containing oral products/rinses
If you are wearing a removable prosthesis (like a denture), leave it out for as long as possible each day and clean daily
If you have no teeth, wipe tongue and mouth with moist washcloth twice a day

After Bone Marrow Transplant:

Resume flossing when your platelet counts are adequate or your coagulation profile is back to normal
Resume routine dental care when your lab values are adequate (This roughly takes 6 months post-autologous SCT and 1-year post-allogeneic SCT)

Before Head and Neck Radiation Therapy:

Prioritize a dental cleaning before you get admitted. Studies have shown that a professional dental cleaning can minimize the severity of mouth sores that may arise during therapy.
Have your cavities filled and hopeless teeth (or teeth that have potential to cause an infection) extracted
- Ideally allow 2-3 weeks of healing after dental extractions and before starting HNRT
Have your cavities filled and hopeless teeth (or teeth that have potential to cause an infection) extracted
- If you have metal in your mouth (silver fillings and crowns), get a custom acrylic mouth guard made by your dentist.

During Head and Neck Radiation Therapy:

Wear your mouth guard during your simulation appointment and all radiation therapy treatment appointments
Removal all other dental appliances during HNRT
Clean removable dental appliances including mouth guard worn during treatment daily
Use an ultra-soft bristled toothbrush with a prescription fluoridated toothpaste after every meal
Reduce sugar consumption
Avoid alcohol containing oral products/rinses
Rinse with warm salt and water rinses several times a day if you get mouth sores
Keep mouth hydrated by using water and lubricating agents such as Biotene to temporarily relieve dryness.
Consult with a physical therapist
- Perform jaw muscle exercises 3x/day to minimize jaw muscle stiffness

After Head and Neck Radiation Therapy:

Reduce sugar consumption
Use a fluoride containing toothpaste
Follow-up with your dentist for regular check-ups and cleanings (3-4x during the first year or two, and every 6 months thereafter)
Keep mouth hydrated by using water and lubricating agents such as Biotene to temporarily relieve dryness.
Speak to your provider about salivary substitutes if swallowing difficulties arise.
Avoid elective oral surgery procedures on areas of the jaws that have been exposed to high radiation doses. TALK TO YOUR ONCOLOGY TEAM!
Perform jaw muscle exercises daily to help prevent jaw muscle stiffness

Before initiation of antiresorptive medication:

Allow at least 2-3 weeks for healing after extractions and before initiating anti-resorptive medications

During and after use of antiresorptive medication:

Maintain meticulous oral hygiene (brushing 3 times a day and flossing dailing) to avoid the need for dental extractions post treatment
Avoid elective oral surgery procedures
Coordinate care with your medical provider if dental or oral emergencies arise.