By Jill Meyer-Lippert, RDH

Prostate cancer will affect 1 in 7 men at some point throughout their lifetime. Treatments for prostate cancer can vary depending on the individual’s situation. The American Cancer Society lists treatment options as:

• Watchful waiting or active surveillance
• Surgery
• Radiation therapy
• Cryotherapy (cryosurgery)
• Hormone therapy
• Chemotherapy
• Vaccine treatment
• Bone-directed treatment

Not all of these treatment options have the potential for oral side effects, so we will focus on the treatments that do pose the greatest risk of impacting oral health.

Chemotherapy

Chemotherapy can induce several side effects, including 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 used, 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.

Although not listed as a common side effect, some patients may notice changes in their saliva consistency or they may feel that their mouth is dry (xerostomia). Patients may benefit from saliva testing to see if they are at an increased risk for dental decay and alter home care considerations as needed.

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.

Learn more at: 11 Ways to Reduce Dry Mouth Discomfort Cancer Treatment and Mouth Sores

Hormone therapy

Also known as androgen deprivation therapy (ADT) or androgen suppression therapy, hormone therapy reduces the amount of male hormones (androgens) in the body. Since prostate cancer “feeds” off androgens, lowering the levels of testosterone and dihydrotestosterone can help shrink or slow the growth of tumors.

A side effect of ADT is a loss of bone mineral density and osteoporosis. The bone in the jaw that supports 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 of this tissue and bone loss, teeth may become loose and/or lost. The diseased environment of low grade infection promotes chronic inflammation 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.

Bone-directed treatment

When prostate cancer spreads (metastasizes), it has a greater chance of spreading to bone than many other types of cancer. When this occurs, certain medications may be given to help maintain bone strength, reduce bone pain and risks of fractures. These medications can have a rare side effect called Medication-related Osteonecrosis of the Jaw (MRONJ). Osteonecrosis means “bone death”. When the jaw bone dies, it can cause a long-term oral health concerns. Learn more details about MRONJ at https://anticancerclub.com/news-and-info/oral-health-cancer/

Ideally, treatment for Prostate Cancer 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. 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.

Other resources:

Treating Prostate Cancer The Effect of Androgen Deprivation Therapy on Periodontal Disease in Men With Prostate Cancer