Cancer treatment—especially radiation therapy and chemotherapy—can result in dental problems or other serious oral complications. These complications can lead to discomfort, interrupt or delay cancer treatment, and affect daily oral function. Addressing oral health before, during, and after cancer treatment can help prevent or manage oral complications and contribute to improved health and quality of life.
Side effects of radiation and chemotherapy
Radiation therapy to the head or neck or some chemotherapy drugs sometimes damage the salivary glands, reducing the flow of saliva, a natural lubricant that makes it easier to chew, swallow, and speak. This common side effect is called dry mouth (xerostomia). Dry mouth increases the risks of gum disease, tooth decay, and plaque buildup.
Another common complication of chemotherapy or radiation therapy is mucositis. In mucositis, the mucous membranes that line the mouth become inflamed, causing pain and difficulty eating. The resulting loss of appetite and poor nutrition can affect the immune system’s ability to fight infection.
Oral infection by a virus, bacterium, or fungus can become a serious complication. Infections can result from existing tooth decay or compromised teeth, dry mouth, mucositis, or a weakened immune system due to reduced production of blood cells and platelets by the bone marrow.
Some oral complications are specific to radiation therapy to the head or neck. These include radiation-induced cavities and an increased lifelong risk of dental decay. Tissue damage from radiation can lead to an inability to open the mouth properly (trismus or “lockjaw”) or cell death in the bones of the jaw (osteonecrosis).
Most cancer patients do not experience all these complications, and preventive measures can reduce the risk of complications and help avoid interruptions to their cancer treatment.
Regular dental treatment is not recommended during cancer treatment because patients’ immune systems may be weakened. Ideally, cancer patients should have oral health issues taken care of before cancer treatment begins.
A visit to a dentist for a comprehensive oral evaluation should occur at least 1 month, or as long as possible, before cancer treatment begins. The dentist can identify existing infections or stabilize areas vulnerable to infection by filling cavities and performing tooth extractions or other dental surgery. One month gives the patient enough time to recover from any invasive dental procedures.
Throughout cancer treatment, patients should continue to brush their teeth with fluoride toothpaste. Using an extra-soft toothbrush helps protect the tissues in the mouth that have become sensitive from cancer therapy. Cancer patients should floss daily and avoid using mouthwashes that contain alcohol. Spicy or acidic foods, toothpicks, tobacco, and alcohol may cause irritation and should be avoided as well. Replacing sugary gum, candy, and soda with sugar-free versions helps prevent cavities. Using fluoride gel or treatment helps strengthen the teeth and reduces the risk of developing cavities.
Only emergency dental treatment is done during cancer treatment, and any emergency dental treatment must be coordinated with a patient’s cancer doctors. The doctors will look at the patient’s most recent blood tests to determine whether the patient can safely undergo the dental procedure. According to Theresa Hofstede, D.D.S., an associate professor in the Department of Head and Neck Surgery at The University of Texas MD Anderson Cancer Center, if a patient has a low level of white blood cells, which fight infection, or platelets, which are necessary for clotting, “then any kind of dental treatment can put the patient at risk for infection or bleeding.”
To relieve dry mouth and other side effects during cancer treatment, patients should drink water frequently throughout the day, suck on ice chips, or use sugar-free candy or gum. A dentist might also prescribe a saliva stimulant or a saliva substitute spray.
Dentures can cause mouth ulcers, and their use should be minimized during cancer treatment. However, if they must be worn, dentures should fit properly, be well cleaned, and not be worn while sleeping.
The oral care routine after treatment depends on the type of cancer treatment received and the immune status of the patient. Unresolved oral complications or a weakened immune system can affect a patient’s ability to return to a normal dental care routine. Usually, patients should wait 2 months after treatment to get a teeth cleaning. A patient who has had radiation therapy to the head and neck should be evaluated regularly (at an interval set by his or her dentist). And according to Dr. Hofstede, patients who have received stem cell transplants are usually asked to wait at least 100 days before having any dental treatment.
— U. Arizor
For more information, talk to your physician, talk to your dentist, call askMDAnderson at 877-632-6789, or visit www.nidcr.nih.gov/oralhealth/topics/cancertreatment.
OncoLog, June 2015, Volume 60, Issue 6