|The following article features coverage from ONS Bridge 2020. Click here to read more of Oncology Nurse Advisor‘s conference coverage.
A literature review of approaches for preventing dental erosion in patients with cancer revealed a gap related to patient education on this topic. These findings were presented in a poster on the Oncology Nursing Society (ONS) Bridge, a virtual conference.
“Dental erosion is manifested by the forfeiture of dental hard tissue related to exogenous, extrinsic or endogenous, intrinsic acids, explained lead author, Patricia Mulvaney-Roth, MSN, RN, lead clinical educator at Molloy College in Rockville Centre, New York.”
Extrinsic sources of acid include soft drinks and alcohol, whereas hydrochloric acid derived from gastric juices represents an intrinsic source of acid.
Specifically, reactions occurring between acid and hydroxyapatite, the main inorganic constituent of tooth enamel and bone, can result in demineralization following acid penetration through the plaque, enamel, and pellicle, a saliva-derived film deposited on the surface enamel, of teeth.
Since both cancer treatment-related vomiting, and medication-related xerostomia are common in the setting of cancer, a literature review was conducted by Ms Roth and her co-author, Debra R. Hanna, PhD, RN, ACNS-BC, for the purpose of revealing best practices for preventing acid-induced dental erosion in the setting of cancer.
Of the 31 articles screened, 14 were reviewed in detail. However, a gap was found in the oncology nursing literature regarding approaches to educating patients with cancer on best practices for facilitating good oral health.
Although not currently part of the standard for patient education on this topic, a key finding of this review was that “patients’ own oral dental self-care can mistakenly worsen dental erosion,” noted Ms Mulvaney-Roth.
“Remineralization takes several hours to occur after exposure to an acid so 50% of tooth mineral loss is attributable to brushing teeth after exposure to acid,” she further noted.
Instead, rinsing the mouth with either plain water, a saline solution, or a mouth wash containing fluoride after vomiting was recommended as the preferred initial approach, along with use of a tongue cleaner to remove acid from the tongue papillae.
In contrast, teeth brushing was not recommended in the first 60 minutes after acid exposure, since this is the period of time when dental enamel is considered to be softest.
Additional research is needed to further investigate the impact of these recommendations, as well as the role played by the salivary defense mechanism in protecting against the development of dental erosion, concluded Ms Mulvaney-Roth.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.
Mulvaney-Roth P, Hanna DR. Dental erosion: an adverse effect of good self care. Presented at: ONS Bridge; September 8-17, 2020. Accessed September 8, 2020. https://ons.confex.com/ons/2020/cp/eposter.cgi?eposterid=1041