Jill Meyer-Lippert and Jennifer Brown are co-authors of a series of in-depth articles on the oral side effects of cancer treatment and the importance of getting prompt medical/dental treatment. Treatment delays can compromise outcomes. Being a knowledgeable patient is a must!
This article focuses on the impact of hormone receptive positive breast cancers on oral health.
Knowledge is power. Understanding potential complications of cancer therapies is the best defense to reduce your risks.
– Jill Meyer-Lippert and Jennifer Brown
Breast cancer is the most common cancer among women of all races and ethnicities. When diagnosed, breast cancer cells are tested for the presence of receptors for hormones called estrogen or progesterone. To test positive for either estrogen receptors (called ER+) or progesterone receptors (PR+) or both, means that the hormones are encouraging tumor growth.
About 70-80% of breast cancer tumors test positive for hormone receptors. This percentage increases along with the age of the patient when diagnosed.
Hormone receptor positive breast cancers are treated differently than those that are hormone receptor negative. The main difference in treatment is the use of hormone therapies. We will take a closer look at the unique risks to oral health from hormone therapies as well as oral side effects of chemotherapy.
Chemotherapy can induce several side effects, including dry mouth, mouth sores (oral mucositis), loss of taste/taste changes and an increased risk for tooth decay and infections. While most of these complications may be limited to the time while in active treatment, they can cause pain and discomfort, compromise nutrition and can cause alterations or delays in treatment. Long-term damage to teeth and gum health can also occur, potentially requiring time consuming and costly dental care long after cancer treatments are complete.
Chemotherapy can affect blood counts including white blood cells and platelets. White blood cells help our bodies fight infections while platelets control our blood’s ability to clot. When these counts are low, special care needs to be taken to prevent any dental problems from becoming more widespread infections. Low platelets may cause gum tissues to bleed easily and may require oral hygiene techniques to be adapted to prevent trauma to the tissues within the mouth.
Many factors determine which side effects occur, including the specific chemotherapeutic agent, the dosage, the duration of treatments, and the status of overall and oral health of the patient when treatment begins. Effective oral care and plaque removal can also have a tremendous impact. Some of the short-term and long-term oral side effects of chemotherapy may be minimized or possibly avoided with a combination of preventive professional dental care, diligent homecare and product selection.
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Medications may be prescribed to either reduce the levels of hormones that encourage tumor growth or prevent the hormone from attaching to the receptors on the cancer cells. Hormone therapies include Aromatase Inhibitors (AI), Selective estrogen-receptor response modulators (SERMs), and Ovarian Suppression. The type of medication used, or combination thereof, can depend on several factors, including if the survivor is premenopausal or post-menopausal, the stage of the cancer and medical history.
Oral side effects of hormone therapies include a decrease in saliva leading to issues associated with dry mouth discussed above and taste changes. Blocking hormones may also lead to a loss of bone mineral density and osteoporosis. The bone in the jaw that supports the teeth, called alveolar bone, can be affected and contribute to a condition known as periodontal disease. Periodontal disease (also known as periodontitis) causes destruction of the tissues that support the teeth; as a result, teeth may become loose and/or lost. This low grade infectious process promotes a chronic inflammatory response ensuing undo stress on the body. There is no cure for periodontitis and treatment requires frequent, long-term dental care to prevent periodontal disease from advancing.
Ideally, treatment for Breast Cancers would be approached by a team of professionals, including oral healthcare professionals, to address dental needs and provide education with individualized prevention and management protocols. When possible, this should be done prior to the start of treatment to minimize risk and the severity of side effects. If this is not offered through the facility and physicians who are providing cancer therapy, it is wise for the newly diagnosed to seek guidance from dental professionals who are knowledgeable in the field known as Dental Oncology.
Knowledge is Power
Knowledge is power. Understanding potential complications of cancer therapies is the best defense to reduce your risks. A proactive and preventive approach to oral health is vital to reduce the impact of these life changing side effects.