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Dental and Oral Complications

Many cancer patients are at high risk for dental and oral complications due to their cancer treatment or the side effects of their cancer treatment. The severity of side effects depends on the individual and on the cancer treatment itself. Before treatment begins, it is important for patients to understand the causes of oral complications and how to treat them in order to reduce symptoms and improve quality of life. 


Treatments that May Cause Dental and Oral Complications

Chemotherapy. Most of the oral complications caused by chemotherapy are short term and typically resolve after treatment ends. Oral complications caused by chemotherapy include

  • Mouth sores (oral mucositis)
  • Bleeding in the mouth
  • Dry mouth (xerostomia)/salivary gland dysfunction.
  • Tooth decay and gum disease
  • Infection
  • Pain
  • Difficulty swallowing (dysphagia)
  • Changes in taste
  • Neurotoxicity
  • Changes in dental growth and development occur in children.
  • Malnutrition or dehydration

Radiation to the head and neck. Oral complications caused by radiation therapy include: 

  • Breakdown of tissue, bone or muscle in the area receiving radiation
  • Tooth decay and gum disease
  • Mouth sores (oral mucositis)
  • Infection
  • Pain
  • Dry mouth (xerostomia)/salivary gland dysfunction
  • Difficulty swallowing (dysphagia)
  • Changes in taste
  • Changes in dental growth and development occur in children.
  • Malnutrition or dehydration

Stem cell transplant. Patients who receive an allogeneic stem cell transplant have an increased risk of graft-versus-host disease (GVHD). GVHD occurs when transplanted donor cells attack the patient’s body. Symptoms of oral GVHD include:

  • Mouth sores that are red and ulcerated
  • Dry mouth due to a decrease in saliva flow
  • Pain from spices, alcohol, or other flavorings
  • Problems swallowing
  • Change in taste
  • Tightness in the skin or in the lining of the mouth

Bone-modifying drugs. Bisphosphonates are a class of drugs that prevent bone loss.  Patients should understand that although bisphosphonates are effective, these drugs also carry risk to their dental health. Bisphosphonate treatment can cause a rare but serious side effect called “osteonecrosis of the jaw (ONJ).” ONJ causes part of the jaw bone to die, which can lead to pain, open sores and higher risk of tooth loss and infection. Patients should have a dental check-up before starting treatment with this class of drugs and address any dental problems before treatment begins. Doctors will stop the bisphosphonate treatment if ONJ occurs.


Before Cancer Treatment 

Good dental hygiene, before and during cancer treatment, may help to either prevent or decrease the associated oral complications. Patients should learn about proper dental care so that they can lessen side effects and manage symptoms. The goal is to treat existing oral problems before treatment begins and to become educated about the potential risks, side effects and complications of therapy. 

When treatment is not urgent, patients should visit a dentist at least four weeks before treatment starts. A pretreatment oral evaluation will identify problems such as cavities, fractured teeth, loose crowns or fillings, or gum disease. These problems should all be addressed in order to reduce the risk of complications. 


During Cancer Treatment

To decrease the risk of complications such as cavities, mouth sores and infections during treatment, it is important to keep the mouth, teeth and gums clean.

Patients can take the following steps to help improve their oral health:

  • Brush teeth and gums two to three times a day.
  • Use a fluoride toothpaste with a mild taste—flavorings can irritate the mouth.
  • Gently floss once a day.
  • Every 2 hours, rinse the mouth with a solution of water, salt and baking soda to prevent soreness.
  • Use an antibacterial rinse two to four times a day to prevent gum disease.
  • Use a lip-care product to prevent your lips from drying and cracking.
  • Brush dentures every day, clean with a denture cleaner recommended by the dentist, and keep dentures moist when not being worn.
  • Pay attention to diet. Try to
    • Choose healthy foods that are mild, soft, and easy to chew and swallow.
    • Avoid hot, spicy, highly acidic and crunchy foods that may irritate your mouth.
    • Avoid sugary foods, like candy or soda, that can cause cavities.
    • Avoid alcohol and tobacco products.
  • Keep your mouth moist during cancer treatments so that you are more likely to avoid mouth sores. You can
    • Drink a lot of water.
    • Suck on ice chips to prevent dryness.
    • Use sugarless gum or hard candy.
    • Use a saliva substitute.
  • Ask about fluoride treatments that may be recommended to prevent cavities or tooth sensitivity.
  • Talk with your doctor about ways to improve bone health with vitamin D and/or calcium supplements.
  • Look in your mouth every day and note sores or other changes. Take steps to help prevent and treat a sore mouth.


Management of Complications

Call your doctor, nurse, or dentist if you notice oral complications. The patient and doctor or dentist should work together to manage symptoms and treat complications, either with medication or supportive care.

Financial Implications

Paying for dental care is a concern for many cancer patients. Not everyone can afford dental insurance, and dental benefits are not always an option. It is important that patients educate themselves about their medical and dental insurance coverage and its limitations before they begin cancer treatments. 

Patients should share their financial concerns with their medical and dental teams and find out if there are any financial resources available to them. See the fact sheet, Dental and Oral Complications of Cancer Treatment Facts, for a list of organizations that may be able to help. 

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