Advice on Oral Cancer Prevention and Care During Treatment

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April is Oral Cancer Awareness Month. To raise awareness and provide education on oral cancer, we’re sharing tips on cancer prevention and caring for your mouth during treatment.  Angela Hummel is a specialist in oncology nutrition and a consulting dietitian for AICR. She works at a cancer center in Danville, Pennsylvania. Read her tips and practical advice below.

Mouth, Pharynx and Larynx Cancer Prevention

Oral cancer can be caused by several factors. Damage to the tissues from tobacco and alcohol use and HPV infection are often the most common causes. The first step toward preventing oral cancer occurrence is to avoid using tobacco products and, if you drink alcohol at all, limit intake to no more than one standard drink per day for women and no more than two standard drinks per day for men. The combination of using tobacco and drinking alcohol significantly increases risk.

Nutrition can play a role in preventing oral cancer. Choosing vegetables and fruits to fill your plate has been found to help decrease risk. Specifically choose vegetables and fruit that contain carotenoids – bright red, orange and green fruits and vegetables. Getting in the habit of eating one to two servings of a brightly colored fruit or vegetable at each meal will help you meet the recommendations for eating 5 servings per day. It’s never too late to start eating fruit and vegetables, even if you have already had oral cancer. These brightly colored choices have a role in any diet, even during and after cancer treatment.

Cancer that develops in the oral cavity can significantly impact an individual’s nutritional status. As a certified specialist in oncology nutrition working in a radiation oncology department, I work primarily with people who have head or neck cancer because of the significant impact on nutrition intake.

Tips for Caring for your mouth throughout treatment

Your mouth is the first contact with food and because of that very reason it is an important area to focus on before, during, and after cancer treatment. The tissue inside the mouth and on the tongue are highly susceptible to damage from chemotherapy, bone marrow transplant, and head and neck radiation because the cells have short lifespan of 3-7 days.

You can help prevent serious oral problems during or after treatment, see your dentist approximately one month before starting treatment.

During treatment, daily oral hygiene will be important. Many times, I see people begin to neglect oral cleaning due to pain and discomfort. I encourage individuals to brush with a soft bristle brush and floss gently at least twice per day to help prevent infections and long term dental problems. If necessary, soften the bristles of your tooth brush by soaking it in warm water before you brush or use a soft bristle children’s brush. Before, during and after treatment, it is important to consume adequate calcium and vitamin D to help maintain the structure of teeth and jaws. Food is the best source of calcium and vitamin D, but if you are dealing with weight loss from inadequate calorie intake discuss supplemental forms of calcium and vitamin D with your healthcare team.

Damage to the tissue inside the mouth can develop as soon as seven days after starting treatment. I see people dealing with changes in taste, dry mouth, pain and inflammation from their cancer treatment.

Simple steps that people tell me have helped them include:

  • Keep your mouth moist by drinking plenty of water, carrying water with you when you leave the house, suck on ice chips or sugar-free candies, and use a saliva substitute.
  • Brush teeth and gums after every meal and before bedtime with a soft bristle brush and fluoride toothpaste.
  • Choose mouthcare products that are alcohol-free.
  • Rinse your mouth with a homemade mouthwash several times per day. Mix one cup of warm water with 1/4 teaspoon of salt and 1 teaspoon of baking soda.

Mouth and chewing pain, taste changes and dryness can significantly impact the ability to eat nutritious foods that promote healing. Expect your healthcare team to inspect the inside of your mouth. In the clinic, this is a routine practice for me. I inspect the inside of the mouth and tongue looking for signs of nutritional deficiencies, infection, mucositis and ulcerations. Treatment of these symptoms can lead to better overall nutritional status and improved treatment tolerance.

Generally, oral symptoms will start to improve 4 to 6 weeks after treatment has completed but could take as long as six months or longer for your mouth to heal. During this period of time, I encourage people to continue daily dental care even though this may be a time of significant irritation and pain. During healing, it is important to strive for a nutrient dense diet to help with tissue healing and repair.

People often try:

  • Fruit and vegetable blended smoothies, served either cold or at room temperature.
  • Soups, served either warm or at room temperature. Served at regular texture or blended and pureed.
  • Yogurt, either frozen, cold or at room temperature.
  • Beans, lentils or legumes mixed in soups, casseroles or pureed into a dip.
  • Cooked cereals like oatmeal, steel cut oats, cream of wheat, served either warm or at room temperature.
  • Nut and seed butters like peanut butter, almond butter, cashew butter or sunflower seed butter.

It may be necessary to alter your food choices for a long period after treatment has completed. Many people who have completed cancer treatment for oral cancer experience long-term side effects like dry mouth, taste alterations, changes in their ability to chew and swallow like normal and bone loss. Foods may need to be soft, moist and/or chopped small for ease of eating. During and after completion of cancer treatment, many survivors of oral cancer rely on puddings, custards, milkshakes and supplemental nutrition drinks. Instead strive for nutrient-dense choices by incorporating plant-based food into your meals. Do not allow your diet to become limited with energy-dense choices that are lacking nutrients. For example, try Mango Carrot Ginger Smoothie or Sweet Potato Bean Soup instead of a vanilla milkshake.

Need more insight? Ask your healthcare team for a referral to a registered dietitian or search The Academy of Nutrition and Dietetics for a local dietitian.

See AICR’s information and resources for cancer survivorship and healthy living, including Recharge, our monthly newsletter for survivors.

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    Author: Angela Hummel

    Angela Hummel, MS, RD, CSO, LDN, is a consulting dietitian with AICR. She is passionate about helping people make positive diet and physical activity changes for reducing cancer risk and for healthier survivorship. She initiated and developed two oncology nutrition programs in cancer centers. Angela also uses her expertise with two AICR programs – the New American Plate Challenge, and the Nutrition hotline.

    2 thoughts on “Advice on Oral Cancer Prevention and Care During Treatment”

    1. 2 – 3 years ago my family dentist specifically asked me to stop using commercial mouthwash containing alcohol to avoid elevated risk of oral cancers. My wife was recently told by another dentist at the same practice to make sure she *is* using mouthwash containing alcohol, and that the research showing elevated cancer risk due to mouthwash containing alcohol had been disproven.

      Should I avoid mouthwash containing alcohol, or not?

      Thanks.

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