CDA Essentials 2017 • Volume 4 • Issue 2

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35 Issue 2 | 2017 |
Supporting Your Practice
Dr. Joel Epstein
Are there risks to flossing
during cancer therapy?
JE: In many hospitals, cancer patients may
be instructed to stop flossing because of
concerns about bleeding and bacteremia,
but in most cases flossing should be part of
their daily oral care.
DS: We need to dispel the myth that
flossing is not safe for patients with a
compromised bone marrow function
and immune dysfunction and in those
with clotting issues related to their cancer
therapy. The truth is that flossing during
chemotherapy is safe and important for
maintaining tissue health and reducing the
potential burden of bacteremias from a
gingival source. As dentists we appreciate
the impact of gingivitis on the development
of periodontal disease, and the potential
impact this could have on a patient with
bone marrow dysfunction resulting in
neutropenia and/or thrombocytopenia.
Is there evidence to support
the safety and need for flossing
during cancer therapy?
JE: A limited number of studies have
looked at whether there is a higher risk of
bacteremia in cancer therapy with flossing
versus without. Flossing is preventive.
Studies show that there is no increase in
bacteremia probably due to a reduction in
gingivitis.
DS: Studies have looked histologically
at the periodontal pockets of patients
undergoing cancer treatments. These
studies describe oral mucositis, an
ulceration breakdown in tissues secondary
to chemotherapy agents, associated
with periodontal pockets. This provides
a potential portal for the pathogens
in periodontal pockets to enter the
bloodstream.
Should cancer patients avoid flossing?
Drs. Deborah Saunders (DS) and Joel Epstein (JE) are dentists who have dedicated their careers to treating
cancer patients and others who are medically compromised. They are both active members of the International
Society of Oral Oncology, a global group of researchers and clinicians striving for better outcomes in cancer
therapy through optimal management of oral complications. The two dentists spoke with CDA about whether
flossing presents a risk to patients during cancer treatment.
Dr. Deborah
Saunders
Flossing is preventive. Studies show that there is no increase in bacteremia
probably due to a reduction in gingivitis.
Dr. Joel Epstein
Myth ?Truth