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Alert Number 231

Protecting the Borders

Date: May 7, 2007

The inside of your mouth is a complex environment composed of tissues with different origins, structures, and functions. The warm, moist and dark environment makes it a wonderful neighborhood for a bewildering variety of commensal bacteria, fungi, and viruses, which populate the mucosa, connective tissue, salivary glands, taste buds, bones, and teeth.

Normally, having a flourishing ‘zoo’ in your mouth is not all that important, besides perhaps chasing away good friends and interfering with your love life. And your dentist will get rich over the years, as he replaces one rotten tooth after the other. But all this friendly co-habitation takes a sharp turn south when the mucosal barrier integrity of your mouth is disrupted. Breaks in the mucosa gives entry to all the bugs living in your mouth. Have you noticed how the slightest scratch or injury to the inside of your mouth, perhaps because you inadvertently bit yourself, can cause a little (or not so little) sore to develop? As immune compromised patients, giving the nasty critters a chance to get at your vulnerable insides is not a good idea.

When you get chemotherapy or radiation, it invariably does a number on the mucosal lining of your mouth (as well as your gut and the rest of the GI tract). This is because chemo and radiation are particularly suited to target and kill rapidly growing cell lines, rightly so because that is what cancer cells do - divide and multiply frequently. Unfortunately, the mucosal lining of you mouth and GI tract also consists of cells that divide frequently, to replaces losses from normal daily wear and tear. It should come as no surprise that oral mucositis is a serious complication of high-dose chemo-radiotherapy that affects up to 75% of patients who undergo stem-cell transplants.

Six months ago, at the insistence of my ever-so-grown-up daughter, I invested in one of those newfangled sonic toothbrushes. As she put it, I have already sunk a gold mine into her mouth, what with pre- and post-orthodontics, and I should be glad she is taking care of that lovely smile. Well, she was right. Using my “Sonicare” toothbrush regularly, morning and night, has made a huge difference. My teeth are whiter, no plaque or tartar build up, and the daily (well, almost daily) flossing has become a lot easier. My gums are stronger and less prone to bruise and bleed. Now when I have to use an old fashioned regular toothbrush when I am on the road, it just does not feel as good. I know, I am sounding like a commercial for Sonicare toothbrush, but trust me I have no financial dealings with the company. None, nada.

Below are some links that give you a lot more information about oral mucositis. It may sound like over-kill but believe me it is not. Any patient who has been through chemo-induced mucositis can tell you it is misery and nagging hell. I will finish with this final comment. Did you know one of the most common sources of infections of all kinds is a “dirty” mouth? I don’t care one bit if you do not have a radiantly white smile, if your teeth are stained from drinking all that tea. Just so long as you do your bit to keep the inside of your mouth clean and healthy. A little thing to do as we stare down the hordes of ravening pathogens out there just waiting to get into the promised land – but a little thing that goes a long way towards avoiding infections that can kill.

Oral mucositis, what it is, how to manage it
Best Practices from 1998, a little dated but still good.

Brush your teeth!

Be well,



Med Oral Patol Oral Cir Bucal. 2006 Nov 1;11(6):E497-502

Buccodental health and oral mucositis. Clinical study in patients with hematological diseases

Sabater Recolons Mdel M, Lopez Lopez J, Rodriguez de Rivera Campillo ME, Chimenos Kustner E, Conde Vidal JM.

Facultad de Odontologia, Universidad de Barcelona

OBJECTIVES: The objective of the present study is to assess whether a good buccodental status (evaluated by means of dentogingival indices), is associated with a lower incidence and severity of oral mucositis in patients with hematological diseases who receive treatment with chemotherapy or bone marrow transplant.
STUDY DESIGN: The study was carried out on 97 patients admitted to the Hematology Service of the Hospital Duran y Reynals in Barcelona during 2002-2003. These patients received treatment with chemotherapy or conditioning prior to bone marrow transplant. A descriptive study was made, analyzing oral hygiene, one dental index, and two gingivales indices, and evaluating their relationship with the appearance of mucositis.
RESULTS: The patients with high plaque (PI) and gingival (GI) indices during chemotherapy presented a higher percentage of mucositis (77.4% and 65.7% respectively) against those who had little or no visible plaque. In the case of the PI, the differences were statistically significant (p=0.015). Likewise, patients who brushed their teeth 3 times/day presented mucositis in only 26.7% of cases, against those who did not brush, or brushed only once a day (65.9% and 68.4%), these differences also being statistically significant (p=0.013). The CAO showed similar results in patients with or without mucositis (7.59 and 7.03 respectively).
CONCLUSIONS: In our study, a good gingival status as well as good oral hygiene during chemoradiotherapy is associated with a lower incidence and severity of mucositis.

PMID: 17072254


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