Dr. Nammy Patel of Green Dentistry discusses how she approaches oral care for patients preparing for chemotherapy, radiation, or immunotherapy. She covers dental infections, dry mouth, oral hygiene, and coordination with an oncology team before, during, and after treatment.
John Maher: Hi, I’m John Maher, and I’m here today with Dr. Nammy Patel, founder of Green Dentistry in San Francisco, California, helping patients recognize the vital connection between dental health and whole body health and author of the bestselling books, Age With Style: Guide to a Youthful Smile and Healthy Living and Total Wellness: Understanding the Link Between Your Teeth and Your Health. Today we’re talking about cancer treatment and oral health – what patients should know before chemo, radiation, or immunotherapy. Welcome, Dr. Nammy.
Dr. Nammy Patel: Thanks for having me, John.
Preparing Your Mouth for Cancer Treatment
John: Sure. Dr. Nammy, why should patients who are preparing for chemotherapy, radiation, immunotherapy, or even a transplant think about their mouth before treatment begins?
Dr. Nammy: The most important thing for somebody who’s going through chemo, radiation, or any sort of treatment is to make sure that you put “mouth” as part of the protocol. Most patients are thinking either I need to undergo surgery, I need to do chemo, and this is my priority, but you have to look at the mouth first before you go into chemo, before you go into surgery. The reason being is that there are hidden infections.
So all of disease is inflammation. Now, cancer is uncontrolled cellular growth for one reason or another. So it’s really important that our immune system is very active to get rid of that cancer cell. And again, normally our bodies have cells that are uncontrolled on a regular basis, but our body is able to get rid of them on a regular basis. It’s just when cancer occurs, when there’s too many, cancer cells are overgrowing, and our body isn’t working fast enough to get rid of them.
So there’s two components. Of course, we need to do chemo, radiation, whatever the prescribed treatment is, absolutely. What we want to do is also beef up our immune system to work really well so that when we’re getting rid of these cancerous cells, our body is repairing itself as well. And the mouth is really important to be on top of that list because if there is a mouth infection going on, it is going to do two things.
One, it’s going to not let your chemo work really well or any of your cancer treatment. It’s going to be slower, it’s going to take longer and it’s going to be more problematic for you.
The second thing is you are immunocompromised when you’re undergoing cancer treatment. So what that means is there’s a higher chance of candida overgrowing, which is a fungus inside the mouth. There is a higher chance of dental infections. There’s a higher chance of cavities. There’s a higher chance of root canals that may need to be needed. And we definitely don’t want root canals.
We don’t want any sort of infection inside your mouth because when you’re undergoing through chemo, it does two things. One is it kills off the actively dividing cells, including your salivary glands, your salivary glands or your saliva. And that’s a protective layer for you. That protective layer of the saliva is diminished during therapy. And when that happens, you are going to be more exposed to bacteria and that bacteria eat away the teeth, they cause cavities, they eat away the gums, cause gum disease. And a lot of times patients will get blisters, will get fungus, painful ulcers on their teeth and gums. Those can be all avoided or decreased if we take care of the mouth first before we’re going into starting treatment.
So in my practice, I work specifically with cancer patients. I work specifically with oncologists to coordinate care. At minimum, what we want to do is make sure that the oral microbiome is healthy. That means that we want to get the mouth clean. We want to get rid of the bacteria that cause or correlated with heart attack, diabetes, cancer, Alzheimer, arthritis, all of those bacteria. They’re very pathogenic. We want to get rid of all of them in the mouth.
We also want to get a home care going for you. We also want to make sure you’re breathing really well so your body is supported throughout the chemo journey or the cancer journey. And we want to get our body’s defense system up because as you’re going to go to war with cancer, we want to make sure our defense systems are up so we can regenerate and really heal our bodies internally.
Oral Hygiene, Probiotics, and Saliva Support
So there’s two components to this. Get rid of the bacteria, get rid of the viruses, get rid of any of the bacteria, viruses or funguses, parasites causing disease. Secondly, let’s focus on making sure you’re breathing and sleeping really well because that’s going to be very important for you in that journey because when you’re able to sleep well, your body is able to repair well. The chemo is going to work really well. So let’s make sure you’re sleeping really well.
Now, after we do that, there’s going to be things you’re going to need to do during the therapy. And that starts with really good oral hygiene, making sure you’re flossing, you’re brushing your teeth, making sure you’re taking probiotics in the mouth so that as chemo affects the parotid glands and you’re not getting as much saliva, bacteria’s overgrowing. Instead of that bacteria overgrowing, you’re going to take a probiotic. It’s like a breath mint. You have that several times a day. You’re going to repopulate with the healthy bacteria and that’s going to help you avoid cavities and gum disease.
Also, it’s going to help you with eating food. The taste is going to taste better. You’re going to be better supported throughout the journey. We also recommend substitute saliva. So making sure that the mouth stays hydrated at all times so we can avoid any fungal infections. Those are some easy things that you can incorporate into your journey so that you can get better results during the cancer journey. And that is what I recommend to all my patients. We got to do some things in the dental office. Let’s get the gums cleaned up, make sure there’s no active infections. And let’s test the microbiome, let’s test your genetics. Let’s make a personalized customized plan for you so that you can be supported as you’re going through chemo or radiation so that you can have really great outcomes.
And one of the things, John, I’ll have to say is all of my oncologists that we’ve worked with, when we are coordinating with them, when we’re taking care of the gums and mouth in advance, what we’re finding is that the results are so much better for the patients and the patients are going through, they’re recovering faster, which is amazing to hear. They’re recovering faster and they’re staying healthier longer because we continue to stay part of their team.
Coordinating Dental Care With Your Oncology Team
John: Tell me a little bit more about that and how a biological dentist like yourself coordinates with that oncology team to make sure that the patient is getting supportive oral care without interfering with the medical treatment.
Dr. Nammy: One of the things that we do is we like to work with oncologists. We like to figure out exactly what is happening to the patient and what’s the timeline of the chemo? When’s the timeline of the radiation? Because we’re looking at things foundationally and also we’re working with the oncologist to make sure we have nutrition dialed in. We have sleep dialed in. We have oral habits dialed in. We’re also getting rid of infections that are in the mouth, really getting that dialed in and we’re coordinating care together so that we can make sure that the infection is out and then we start treatment so that everything is working better, faster, more efficiently.
And the easiest way I can describe this is sometimes we slow down to speed up. We slow down to speed up and the things that we’re describing about getting a gum detox cleaning, we can do that in one day over a course of hour or two. We can get the bacteria out. We can use ozone to be able to disinfect the mouth. We can use lasers to disinfect the mouth. We can also use lasers to help breathe better by activating the tongue muscles to shrink. We can make appliances that can help with sleeping right away. So there’s a lot of things that we can do as a biological dentist in order to make sure that our patients go through a great journey.
We’re also looking for hidden infections. Sometimes there is something called CSRs or areas of the jawbone that did not heal really well when wisdom teeth were taken out or any sort of teeth were taken out. And so what we like to do with our oncologist is to coordinate care. Our first step we’re always going to start with is going to be the gums getting you to breathe well, getting you to sleep well, making sure there’s no active cavity or active root canal that needs to be addressed right away.
Planning Dental Care After Cancer Treatment
What we like to do after that’s done is you do the chemo. If there’s major surgery that’s needed or anything like that, we coordinate with the oncologist, make sure you go through your chemo, making sure the cancer’s in remission, making sure your nutrition is back into balance and your body is able to tolerate surgery of cavitations or hidden infections that may be necessary. So it’s kind of like a pre-care and a post-care. So what we like to do is first make sure you’re ready for the chemo. Once the chemo is done, we want to make sure your body is healthy and it’s recovered so that we can take hidden infections out and then be part of ongoing care to be supportive to make sure that the cancer does not return.
John: All right. Well, that’s really great information, Dr. Nammy. Thanks again for speaking with me today.
Dr. Nammy: Absolutely.
John: And for more information about Green Dentistry, you can visit the website at sfgreendentist.com or call 415-433-0119.
