Understanding the Oral Complications From Cancer Treatment
The Web site of the National Institute of Dental and Craniofacial Research cited
that most people are aware of common side effects of cancer treatment, such as nausea
and hair loss, but many may not realize that more than one-third of people treated
for cancer develop complications that affect the mouth. These problems may interfere
with cancer treatment and diminish the patient's quality of life.
Head and neck radiation, chemotherapy, and blood and marrow transplantation can
cause oral complications ranging from dry mouth to life-threatening infections,
says Jane C. Atkinson, DDS, director, Center for Clinical Research, National Institute
of Dental and Craniofacial Research in Bethesda, Maryland. "While some of these
adverse side effects only occur during cancer therapy, other complications are permanent,"
Dr. Atkinson says. "For example, radiation therapy to the head and neck can permanently
damage the salivary glands and dramatically reduce the amount of saliva a person
makes. Individuals with too little saliva are much more likely to develop dental
decay, and need to be followed closely by their dentist for the rest of their
It's a good idea to visit a dentist before starting treatment to assess any complicated
issues or create a baseline of dental care. Sol Silverman, Jr., MA, DDS, professor
of oral medicine, University of California School of Dentistry in San Francisco
says this proactive treatment can promote optimal oral health (caries, periodontal)
and prevent or minimize complications during or after treatment. Such complications may include infection, pain, discomfort, and and alterations in function such as mouth opening, chewing, and swallowing.
Dental Health Effects of Cancer Therapy
Dr. Silverman says that with regard to surgery, there are no great problems; many
issues are mainly related to hygiene. However, patients being treated with radiation
therapy may be at risk for complications related to dental health. "These may include
mucositis (inflammation, ulceration), dryness from hyposalivation, difficulty in
swallowing, poor hygiene, periodontal flare, pain, altered taste, dryness, dysphagia,
and depression," Dr. Silverman says.
Further, he adds that radiation and chemotherapy can also lead to complications, such
- Mucositis: inflammation and ulceration of mucous membranes
- Pain and bleeding that can prevent adequate or any oral hygiene
- Dysphagia: difficulty swallowing or almost inability to swallow
- Mouth dryness that interferes with hygiene, speech, swallowing, and oral comfort
- Immunosuppression: decreased ability to fight infections, which can cause bleeding problems and low white blood cell counts and increase the risk of infection and mucositis
One thing patients can do to maintain oral health, Dr. Silverman says, is maintain
a steady calorie intake. He cautions that alterations in taste, mouth dryness, oral
pain, and dysphagia must be controlled, because when out of control, oral hygiene
declines and dental and periodontal infections rise.
Long-term effects can vary, according to Dr. Silverman.
Surgical problems can include changes in physical appearance, speech, chewing, and swallowing, as well as difficulty opening the mouth. Radiation therapy problems may include dryness (xerostomia from decreased saliva production), chronic or recurring fungal infections (candidiasis), dental decalcification and caries from xerostomia, decreased appetite from dryness, pain, alterations in taste, trismus (difficulty in mouth opening), and difficulty maintaining hygiene because of mucosal and dental sensitivity. Radiation therapy also increases the risk of bone and soft tissue necrosis from alterations in blood flow. This can occur spontaneously, but the risk is higher after invasive procedures such as extraction. With regard to chemotherapy, concerns include maintaining hygiene, prolonged mucositis and pain, and improper caloric intake.
Use Your Dentist as a Partner in Care
Dr. Silverman recommends you have a frank discussion with a dentist about side effects
of treatment and concerns regarding your oral health. "Dental professionals are
an integral part of the treatment team from treatment planning, during treatment,
and in rehabilitation," says Dr. Silverman. "This is taught in dental schools, and
many continuing education courses are dedicated to this part of oral health care."
Further, he suggests that a dental hygienist is an integral part of the oral team
and often takes a leading role in orienting patients to radiation and chemotherapy
and helping prepare them for what to expect and how to cope. "All dental factors
affect quality of life, and the dental team can be very helpful in orienting the
patient to the main focus of tumor control and [reassuring them] that the dental/oral
issues that are problematic can be modified—at least to a degree—during the rehabilitation
phase, and some even during the treatment phase," Dr. Silverman says.