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Understanding the Oral Complications From Cancer Treatment

Oral Complications

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 lives."

Before Treatment

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 as:

  • 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
  • Nausea
  • 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

What can the Patient Do?

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 Issues

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.