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Disease, Treatment, and Oral Health

by Shirley Gutkowski, RDH, BSDH

Effects of radiation therapy
One medical procedure that can have serious oral side effects is radiation therapy of the head and neck. Side effects can include dry mouth, altered sense of taste, mucositis (inflammation of the insides of the cheeks and lips), gum swelling (which can interfere with the fit of dentures), jaw stiffness, and radiation caries (a type of severe tooth decay that is difficult to control). In fact, the risk of oral complications from radiation therapy is so high that a number of health organizations, including the Centers for Disease Control and Prevention, the National Institute of Dental and Craniofacial Research, and the National Cancer Institute, have drawn up guidelines for the prevention and management of oral complications during radiation therapy. Among their recommendations is that people scheduled to undergo radiation of the head or neck have a thorough dental checkup and cleaning and have any dental problems corrected before beginning therapy.

During radiation therapy, a person should be advised to brush the teeth, gums, and tongue with an extra-soft toothbrush and fluoride toothpaste after every meal and at bedtime and to floss daily. Toothbrush bristles can be made even softer by holding the toothbrush under warm water before brushing. A person may also be advised to apply fluoride gel to the teeth using a customized applicator tray for several minutes each day. Using fluoride toothpaste and gel helps prevent tooth decay.

If mouth soreness is a problem, rinsing the mouth with a baking soda and salt solution periodically and eating soft, moist foods can help. Many people are referred to a dietitian during radiation therapy to help with eating issues, and many also see their dentist frequently to have their oral health monitored.

Some of the oral side effects of radiation therapy, such as mucositis, gradually clear up after therapy is concluded, but others linger, suggesting that radiation therapy can have permanent effects on the mouth tissues. People who wear dentures or other mouth appliances may need to have them refitted after radiation. If mouth dryness lingers, daily application of fluoride gel may be needed for life to prevent cavities; self-help measures such as sipping water and possibly using a saliva substitute will also be necessary.

Depression and dental disease
Most people know about the importance of regular brushing and flossing, but what if you just don’t have the energy or motivation to do it? Depression isn’t commonly thought of as a cause or contributor to periodontal disease, but it can be if it affects your ability to care for your teeth and gums. Depression can cause a number of emotional and physical symptoms, including insomnia, lethargy, irritability, forgetfulness, feelings of sadness and hopelessness, decreased or increased appetite, dry mouth, constipation or diarrhea, and loss of motivation to maintain normal routines, such as exercising and practicing oral hygiene.

Simply neglecting oral health care raises the risk of periodontal disease, and the risk rises further if depression is accompanied by an increase in smoking or consumption of alcohol. (Even in the absence of depression, smoking and heavy drinking are detrimental to gum health.)

Depression is a common problem in the United States, and it is even more common among people with diabetes than among the general population. Its onset is often (though not always) associated with life events, such as the death of a loved one or being diagnosed with diabetes, but it can also be a side effect of some prescription drugs, including some used for treating high blood pressure. Since depression frequently goes unnoticed by health-care professionals, it’s often up to the person experiencing depression to ask for help.

Help for depression can come in the form of antidepressant drugs, psychotherapy, or both. If depressive symptoms appear to be drug side effects, switching to another drug may be an option. Self-help measures, such as getting regular exercise, following a healthful diet, and taking steps to control blood glucose level, are important, but they are not enough to treat depression.

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