Vomiting-Related Dental Erosion: What Nurses Need to Know

Oncology nurses are equipped to handle vomiting that can occur from cancer treatments. However, they may be less confident in treating the dental erosion that can go along with it, and there are key messages they need to pass along to their patients about the health of their teeth.

Researcher from Molloy College recently evaluated 14 articles on dental erosion and best practices. Patricia Mulvaney-Roth, MSN, RN, PMHCNS-BC, ACNS, lead clinical educator at Molloy College, presented the findings at the 2020 ONS Bridge virtual conference.

“Dental erosion is a complex clinical condition that is not well-known by lay people or by non-dental health professionals,” she said, explaining that erosion occurs when dental hard tissue erodes. This can be a result of drinking excess soft drinks or alcohol, or by the mixing of hydrochloric acid from gastric juices formed by the stomach lining — what happens when a person vomits.

All of the articles used in the researchers’ literature review evaluated acids and the role of dental erosions. But there were some differences between the studies, too.

• Four articles said that rinsing with plain water or saltwater after vomiting potentially reduced dental erosion.
• Four articles recommended that individuals do not brush their teeth for 60 minutes after vomiting. In this time period, dental enamel is still soft.
• Five articles stated that the use of commercial mouth washes with active agents reduced dental erosion after vomiting.
• Five articles looked at the salivary defense mechanism and how it effects dental erosion.

“[There are] some important things to look at here. A patient’s own oral hygiene self-care can mistakenly worsen dental erosion, tooth sensitivity and tooth breakage, because they’re running to brush their teeth after a vomiting episode,” Mulvaney-Roth said. “If dental erosion is left unchecked, certain cancer patients who survived the cancer illness phase can eventually suffer long-term mandibular and maxillary problems. Once lost, enamel cannot be replaced.”

Ultimately, it was found that saline rinses may be the best defense against tooth decay after vomiting. However, Mulvaney-Roth emphasized that both patients and clinicians need to be better educated on dental health.

“Nurses need to be educated on risk factors … when patients are experiencing vomiting, such as recommending not brushing teeth for 60 minutes after vomiting, when dental enamel is at its softest,” Mulvaney-Roth said.

Oncology nurses can then pass that knowledge on to their patients.

“Patient education should include [discussing] rinsing your mouth with plain water, a salt mixture, or mouthwash with fluoride after vomiting to reduce dental erosion. Using a tongue cleaner is recommended after the vomiting to remove the acid from the tongue.”