CARING FOR ORAL CANCER PATIENTS
(Forward Science), Allday Dry Mouth Spray (Elevate Oral Care), Oral7 Mois-
turizing Products (Oral7 International), and the StellaLife Vega Recovery
Kit (StellaLife, Inc.) have been endorsed by cancer patients and dental
Products with stabilized chlorine dioxide may be helpful for cancer
patients. They do not contain alcohol, do not cause staining or alter taste,
and can be used long term without a prescription. Chlorine dioxide is an
excellent bactericide, fungicide, and antimicrobial agent. Products containing chlorine dioxide already mixed in a bottle lose their effectiveness
after being open for two weeks and no longer have bactericidal benefits.
A two-part system such as OraCare, in which ingredients are mixed and
activated for 30 seconds prior to rinsing, solves that problem.
In the past, both hydrogen peroxide and chlorhexidine rinses have been
used. Neither is recommended now. Hydrogen peroxide is not recommended
as it may delay wound healing, promote emesis, cause demineralization,
promote fungal growth, and contribute to dry mouth, thirst, and discomfort.
Chlorhexidine is not recommended as it may interfere with healing, alter
oral flora, promote bacterial (pseudomonas) growth, has an unpleasant
taste and results in taste distortion, stains teeth and cosmetic restorations,
and contains alcohol. Chlorhexidine is not effective in the presence of blood
or toothpaste, and nystatin reduces its effectiveness.
Caries—Dry mouth leads to a dramatically increased risk of dental
caries. For those patients undergoing cancer treatment and dealing with
this long-term side effect of head and neck radiation treatment, recommend
any of the following:
• CariFree toothpaste and rinse (Oral Biotech) contains fluoride and
calcium phosphate to remineralize teeth, xylitol to inhibit bacteria
and plaque formation, an antimicrobial agent to control bacteria,
and pH neutralizing to prevent decay, inhibit periodontal inflamma-
tion, and enhance oral moisture.
• Fluoride 1,100 ppm with nanohydroxyapatite calcium and phosphate
remineralize teeth and is used daily in custom trays.
• BasicBites, a sugar-free oral care soft chew produced by Ortek
as a lubricant in addition to a variety of artificial sweeteners, preservatives,
and fluoride salts. Products containing mucin have better wetting and
lubricating properties than cellulose preparations but they have a limited
duration of action, making frequent applications necessary.
You can best support your patients who suffer from dry mouth by
sharing the recommendations from the American Cancer Society. It’s also
helpful to give instructions for making mouth rinses at home (see sidebar
titled, “Simple mouth rinse recipe to make at-home neutral rinse”) as well
as information about commercially available mouth rinses.
It’s worth noting here some of the recommendations regarding xero-
stomia from the American Cancer Society:
• Drink eight to 10 cups of liquid a day, and take a water bottle wherever
you go. (Drinking lots of fluids helps thin mucus.)
• Take small bites and chew food well.
• Eat soft, moist foods that are cool or at room temperature. Try blended
fruits and vegetables, soft-cooked chicken and fish, well-thinned
cereals, popsicles, and smoothies.
• Avoid foods that stick to the roof of the mouth like peanut butter or
• Moisten foods with broth, soup, sauces, gravy, yogurt, or creams.
• Suck on xylitol candy or chew xylitol gum to stimulate saliva. Citrus,
cinnamon, and mint flavors often work well (not recommended for
patients with mucositis). Xylitol is beneficial for preventing decay and
moisturizing the mouth.
• Keep your mouth clean. Rinse before and after meals with plain water
or a mild mouth rinse (made with one quart water, one teaspoon salt,
and one teaspoon baking soda; shake well before using). Use a
soft-bristle toothbrush and gently brush tongue as well. Ask dentist
or oncologist if it’s OK to floss or to use interdental soft toothpicks.
• Avoid commercial mouthwashes, alcoholic and acidic drinks, and
• Limit caffeine intake from coffee, tea, energy drinks, or caffeinated soft
drinks. Caffeine can be dehydrating.
• Use a cool mist humidifier to moisten room air, especially at night. (Be
sure to keep the humidifier clean to avoid spreading bacteria or mold
in the air.)
• Fresh pineapple or papaya may help to thin saliva, but only try this if
your mouth is not sore.
• Saliva substitutes such as SalivaMax are helpful if your salivary glands
have been removed by surgery or damaged by radiation therapy.
These products add moisture to your mouth.
• Nutritional supplements, such as liquid meal replacements, may be
helpful. If you can’t get enough calories and nutrition through solid
foods, you may need to use liquid supplements for some time.
Oral moisturizers can help when prepared with natural enzymes to
help reinforce the functions of healthy saliva. Commercially prepared oral
moisturizers should not contain alcohol or menthol that may burn and
sting the tissues. Moisturizers can neutralize mouth acids, help keep breath
fresh, promote healthy gums, and clean away the bacteria associated with
halitosis, sore gums, caries, and plaque.
I’ve found it’s important to have a list of several different products that
patients with dry mouth can try because not every product works for every
patient for a variety of reasons. Products such as CariFree CTx Spray
(CariFree Oral Biotech), Spry Rain Oral Mist Spray (Xlear), SalivaMax
Guidelines for pain control
during cancer treatment
Avoid the following to reduce oral pain:
• Commercial mouthwash that has alcohol and/
or other harsh chemicals (such as Scope and
• Salty foods and foods that contain strong spices
(such as pepper, chili powder, horseradish, curry
powder, and Tabasco sauce)
• Citrus fruits and juices (such as tomato, orange,
lemon, lime, grapefruit, and pineapple)
• Hard, dry, or coarse foods (such as toast, crackers, raw vegetables, potato chips, and pretzels)
• Very hot or cold foods and liquids