Canterbury DHB

Oral Hygiene

See also:

• Keefe et al. Updated clinical practice guidelines for the prevention and treatment of Mucositis. Cancer March 1, 2007 / volume 109 / Number 5.
• Updated clinical practice guidelines for the prevention and treatment of mucositis - National Guideline Clearinghouse.

Patients Undergoing High Dose Chemotherapy

It is highly desirable that active dental and oral disease is not present when patients enter high dose chemotherapy programs. All patients should receive a dental assessment prior to receiving high dose chemotherapy treatments and an explanation of the reasons for this. The overall objectives of oral care are to:

• avoid development of oral infections during periods of immunosuppression
• protect the oral soft tissues from damage
• protect the hard dental tissues from damage
• provide curative or palliative care for inflamed or ulcerated soft tissue.

Dental Referrals

All patients receiving intensive chemotherapy or bone marrow transplantation require a routine dental assessment, even if they have false teeth. The completed special referral form should be sent to the Oral Health Centre, fax 80246, or emailed to oralheathcentre@cdhb.health.nz. If you need to speak to a senior dentist regarding a referral, please phone 80250.

Note: Newly diagnosed leukaemic patients need to be seen within 24-48 hours of admission/diagnosis if possible, and prior to commencing their first chemotherapy treatment.

Any oral problems occurring during high dose chemotherapy can be managed by the hospital dental service. Refer to the oral health centre - see above.

Mouthcare

Included are the following measures:

• Routine tooth cleaning

  The basis for any mouth care program is strict plaque control. Patients who begin chemotherapy with a clean healthy mouth develop significantly fewer oral complications than those with poor oral hygiene. A soft toothbrush and mild flavoured fluoridated toothpaste should be used 2-3 times a day. If wearing any type of denture, take the denture out before brushing natural teeth. An extremely soft toothbrush (Tepe special care) is available from B6.

• Denture cleaning
  • Plastic and metal: brush thoroughly with soap and water three times daily. Leave denture out of mouth at night and soak them in Polident® or Steradent. See CDHB Denture care guide – displayed on the wall in the sluice room.

  Note: All dentures should be removed from the mouth whenever topical oral medication is used (except when denture is used as a reservoir for medication, e.g. miconazole cream).

  Note: Occasionally with partial dentures, however, the natural teeth in the opposing jaw can traumatise the denture bearing soft tissue when the partial denture is out of the mouth. In these cases, the denture can be left in at night.

Topic Code: 4984