Dental Infections and Bleeding

One of the most important reasons to maintain good oral hygiene is the prevention and minimization of infection. Damage to the lining of the mouth and a weakened immune system make it easier for infection to occur. Your mouth contains many microorganisms that, under normal circumstances, pose no risk to you or may actually be beneficial. Once tissue is damaged, however, it provides a way for harmful microorganisms to enter your blood or lymph system and cause a systemic infection, which can be very serious. In addition, cancer therapies reduce your body’s normal ability to fight off infection (immune suppression), which increases the risks posed by even mild infections.

Contact your doctor immediately if you have any of the these symptoms:

  • fever of 100.5° or higher
  • chills or shivering
  • diarrhea
  • red, swollen, painful, orpus-filled sores

Prevention is best, but should you get an infection then early, aggressive treatment can reduce the risks that the infection will worsen or spread and also lessen your discomfort/ pain.

Types of Infection

Viral Infections

  • People receiving chemotherapy, especially those with weakened immune systems, are at risk of getting mild to serious viral infections. Finding and treating the infections early is important. Drugs may be used to prevent or treat viral infections.
  • Herpes virus infections may recur in radiation therapy patients who have these infections.

Bacterial Infections

Treatment of bacterial infections in those who have gum disease and who are receiving high-dose chemotherapy may include the following:

  • medicated and peroxide mouth rinses
  • brushing and flossing
  • wearing dentures as little as possible

Bacterial infections in patients undergoing radiation therapy are usually treated with antibiotics.

Fungal Infections

  • The mouth normally contains fungi that can exist on or in the body without causing any problems. An overgrowth of fungi, however, can be serious and requires treatment.
  • Antibiotics and steroid drugs are often used when a patient receiving chemotherapy has a low white blood cell count. These drugs change the balance of bacteria in the mouth, making it easier for a fungal overgrowth to occur. Fungal infections are also common in patients treated with radiation therapy.
  • Drugs may be given to prevent fungal infections from occurring. Treatment of surface fungal infections in the mouth only may include mouthwashes and lozenges that contain antifungal drugs. These are used after removing dentures, brushing the teeth, and cleaning the mouth. An antibacterial rinse should be used on dentures and dental appliances and to rinse the mouth.
  • Deeper fungal infections, such as those in the esophagus or intestines, are treated with drugs taken by mouth or injection.

Bleeding

Bleeding may occur during chemotherapy when anticancer drugs affect the ability of blood to clot.

Areas of gum disease may bleed on their own or when irritated by eating, brushing, or flossing. Bleeding may be mild (small red spots on the lips, soft palate, or bottom of the mouth) or severe, especially at the gum line and from ulcers in the mouth. When blood counts drop below certain levels, blood may ooze from the gums.

With close monitoring, most people can safely brush and floss throughout the entire time of decreased blood counts.

Continuing regular oral care will help prevent infections that may further complicate bleeding problems. Your dentist or doctor can provide guidance on how to treat bleeding and safely keep your mouth clean when blood counts are low.

Treatments for Bleeding During Chemotherapy

  • Medications to reduce blood flow and help clots form.
  • Topical products that cover and seal bleeding areas.
  • Rinsing with a mixture of one part 3% hydrogen peroxide to 2 or 3 parts saltwater solution (1 teaspoon of salt in 4 cups of water) to help clean oral wounds. Rinsing must be done carefully so clots are not disturbed.