Xerostomia and Breast Cancer

Breast cancer has become one of the most common types of cancer among women all over the world. Breast cancer occurs due to uncontrolled growth of abnormal cells in one or both the breasts. In advanced stages, these cells multiply to invade the surrounding tissue and form a mass called the malignant breast tumor. Test and treatments for breast cancer vary and depend upon individual circumstances.

The primary treatments of breast cancer include chemotherapy and radiation. Chemotherapy and radiation are a means of modern-day miracles. However, these treatments can have potential effects on oral health. One of the common symptoms of breast cancer therapy is xerostomia. Xerostomia or dry mouth is a condition of the oral cavity wherein the salivary flow and production slow down.

Although xerostomia might sound like a mild side effect of breast cancer therapy, it can have disastrous effects on oral health. Today’s article will highlight the link between xerostomia and breast cancer therapy. Additionally, we will also find out about the different ways to prevent and manage xerostomia.

What do you mean by xerostomia?

Xerostomia is a clinical term used to describe dryness of the mouth. It is an oral condition characterized by reduced salivary flow and production in the mouth. (1) Typically, a person may experience dry mouth as a side effect of medication, cancer therapy, mouth breathing, or dehydration. Signs and symptoms of xerostomia include –

  • Presence of dried, flaky and whitish saliva in and around the mouth
  • The thick consistency of the saliva which makes it sticky and ropy
  • Difficulty in chewing and swallowing food
  • A habit of mouth breathing
  • Burning sensation in the tongue
  • Food may stick to the teeth, tongue an gums
  • Cracked or rigged appearance of the tongue

How can breast cancer treatment cause xerostomia?

The most common cancer therapy that causes xerostomia is radiation treatment. Often cancer treatments require several sittings of radiation therapy. Salivary glands are the most radiosensitive parts of our body. This is the reason why salivary glands are the prime tissues that instantly get affected by radiation therapy.

Damage to the salivary gland affects the ability of the gland to generate saliva and produce a wet free flow of thin saliva. (2) According to the onset of xerostomia symptoms after cancer therapy, dry mouth can be categorized as follows –

  • Acute Xerostomia – as the name suggests, in this case, dry mouth occurs during or directly following the cancer therapy.
  • Late Xerostomia – A study at the University of Pennsylvania reported that it could take up to a year for xerostomia to occur. Moreover, the symptoms may be persistent for a long time or may even tend to be permanent.

The American Society of Clinical Oncology states that a graft-versus-host disease can cause xerostomia. It is when the patient may receive stem cells or marrow transplant, but the body fails to respond well. Other breast cancer therapies that may affect the salivary flow include –

  • Chemotherapy – It is one of the last treatments of cancer that can cause xerostomia at a later stage. Chemotherapy usually makes the saliva thicker and lessens the cleansing action of saliva in the mouth. (3)
  • Cancer Medications – dry mouth can also be exacerbated by several medications that are administered as the initial treatment of breast cancer management.

When should you see a dentist?

It is always better to take preventive measures and book a dental appointment at least one week before the onset of any chemotherapy or radiation treatment. Informing the dentist will help you to stay updated about the possible oral changes that you may experience along with the treatment. Preventive dental procedures like teeth cleaning and extractions can be planned before avoiding any complications.

Dental treatments are usually limited for a significant time after the completion of cancer therapy. Advanced dental appointments will ensure proper care and management of any critical dental conditions. Some of the conventional dental therapies that you can follow to cope with dry mouth are as follows –

  • Oncology rehabilitation – this includes a team of speech therapists who work with cancer patients experiencing dry mouth. In this therapy, the patients are taught about different techniques to swallow food and increase salivary secretions.
  • Nutritional support – dry mouth often complicates chewing and swallowing. Nutritional support guides the patients and educates them on modifying the textures of food to make it easier for eating. Initially, the patient may be put on a soft diet with increased intake of liquids. (4)

How can you manage the symptoms of xerostomia?

While dental therapies may provide comfort and convenience, there are certain things you can do at home to manage xerostomia. These tips include –

  • Drink plenty of water – sip on water or sugarless drinks to make chewing easier besides hydrating your mouth.
  • East soft and moist food. Take small bites and chew the food well before swallowing.
  • Suck on hard candy to increase salivary secretion
  • Sugarless chewing gums are another source for increasing salivary secretion and flow in the mouth. (5)
  • Do not smoke
  • Avoid caffeinated or alcoholic beverages
  • Avoid salty and spicy food
  • Maintain good oral hygiene – brush and floss regularly followed by a non-alcohol antibacterial mouth rinse
  • Use a cool-mist humidifier while sleeping to maintain moisture in the oral tissues

Take away message

Breast cancer is a prevalent form of cancerous diseases in the world that primarily affect women. It occurs due to the abnormal growth of cancer cells in one or both the breast. Early diagnosis and prompt treatment of cancer always reduce the chance of forming advanced stages. However, cancer treatments may pose a threat to oral health.

One of the common side effects of cancer therapy is xerostomia or dry mouth. It is mainly caused due to the damage of salivary gland tissue during chemotherapy or radiation. Xerostomia is an oral condition that occurs as a result of decreased salivary secretion and flow in the mouth. In this situation, the saliva often thickens and loses its ability to clean the teeth and gums.

Moreover, the oral tissues become dry and deprived of moisture. Dental screening before the onset of cancer therapy can take you a long way to manage oral symptoms. Additionally, the dentist can help you with any dental conditions that require immediate care. While dental therapy may prove to be useful, it is essential to take care of your dry mouth at home as well. Educate yourself on the oral effects of cancer therapy and be prepared well before your treatment starts.