Dental Problems Associated with Breast Cancer
This month, I am tasked with being aware of two things that hold special significance in my life. The most recognizable is obviously breast cancer awareness month. From flight attendants to football players, folks across the country show their support by donning pink in their everyday attire. Thanks to my profession, I am also a fan of dental hygiene (and by proxy, the awareness thereof). In this article I am going to link the two, and explain why dental hygiene is even more important for some breast cancer survivors.
Breast cancer is notorious for bone metastasis. Thankfully, campaigns such as Breast Cancer Awareness Month, have strongly encouraged folks to participate in early screening efforts to minimize the chance of a late stage disease. When the unfortunate late diagnosis occurs, sometimes anti-resorptive agents are used as an adjunctive treatment. Examples of these fall into the bisphosphonate class (Zometa, Aredia). These drugs are used to treat a variety of bone diseases, including osteoporosis, which affects a similar demographic as breast cancer. When I think of these drugs, I think of Sally Field. Unforunately, not this Sally Field:
But, this Sally Field:
So, what does this have to do with teeth? I'm glad you asked! These drugs turn off the cells that allow the bone to heal properly. This can sometimes result in a condition known as anti-resorptive related osteonecrosis of the jaws (ARONJ) or Bisphosphonate related osteonecrosis of the jaws (BRONJ). This occurs most often with the use of IV drugs of these classes after invasive dental surgery (tooth extraction, jaw surgery, periodontal surgery, apicoectomies, implants). It is extremely painful, and extremely difficult to treat. Therefore, prevention is key. The sad thing is that I seldom (never in my private practice career), get a request from a physician for a dental consult prior to patients taking these drugs. Dentists usually find out our patients are taking these drugs after they have already started. A screening prior to beginning treatment allows the dentist to determine if surgery is necessary before the drug is taken, which can save our patients the agony of going through ARONJ/BRONJ. I mean, what can be worse than breast cancer, chemotherapy, and radiation? Probably having breast cancer, chemotherapy, and radiation while also dealing with painful areas of exposed, non-healing/dead bone in your mouth.
If you are already taking one of these medications, here are my recommendations to help minimize the risks of needing dental surgery.
1) Maintain regular dental checkups (3-6 month recalls/cleanings/maintenance).
2) Comply with recommended x-ray frequency, as suggested by your dentist.
3) Consider fluoride varnish to prevent dental cavities,
4) Use an electric toothbrush to help improve your brushing technique.
5) Use caution when eating sharp foods (tortilla chips, etc), especially if you have several bony areas in your mouth. Believe it or not, non-healing ulcers have developed from seemingly harmless trauma in at-risk patients, not just from surgery!
6) Treat small areas of decay before surgery is necessary (in other words, be less prone to "watch" some cavities).
If you are undergoing chemotherapy/radiation, please consult your dentist and/or oncologist for recommendations on the management of dry mouth or burning/sore mouth ("mucositis") related to your treatment.
So, why is breast cancer month important to me? From a professional perspective, my residency training helped me to better understand the special dental considerations that are necessary when caring for cancer patients. From a more personal perspective, My Momma had breast cancer, and our family is blessed enough to still have her around 6 years later to play with her two grandchildren. My Grandmother had breast cancer, and is still living well and enjoying with her grandchildren and great-grandchildren. My mother's close friend, Nancy Wilson, was not so fortunate. She and my mother went through diagnosis/treatment at the same time, but Nancy lost her fight. One of my teachers in dental school, Dr. Janet Lee lost her fight with breast cancer after I graduated from dental school. She was an educated woman who never missed a mammogram or women's health visit, and wound up with Stage IV Metastatic disease that eventually took her life.
So for me, October offers two reminders. The first is that folks who will be taking medications (as the ones mentioned above) for bone diseases need to have a dental consultation prior to starting treatment. And the second is to count your blessings and enjoy every sandwich.
The movie "Smokey and the Bandit", directed by Hal Needham. Seen here from left, Burt Reynolds as Bandit and Sally Field as Carrie. Initial theatrical wide release May 27, 1977. Screen capture. © 1977 Universal Pictures. Credit: © 1977 Universal Pictures / Courtesy Pyxurz.