Dental and Oral Health

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Many drugs or types of radiation therapy for cancer affect a patient’s mouth, teeth, and salivary glands. These effects can make it difficult to eat, talk, chew, or swallow. Fortunately, with good personal and professional care, people with cancer and their doctors can reduce these side effects.

In addition to your usual dentist, several other dental health professionals can also help with your oral care before, during, and after cancer treatment. These include:

  • An oral oncologist, who specializes in the dental and oral health of people with cancer

  • An oral surgeon, who performs surgery of the mouth and jaw

  • A periodontist, who diagnoses and treats gum disease

  • A maxillofacial prosthodontist, who replaces teeth or other structures in the mouth and jaws

Types of dental and oral side effects

Side effects of the mouth caused by cancer treatment may include:

  • Dry mouth

  • Thickened saliva

  • Changes in taste

  • Mouth sores

  • Tooth decay

  • Difficulty swallowing

  • Difficulty chewing or opening the mouth

  • Infection

  • Bone disease

  • Inflammation or pain in the lining of the mouth and tongue

Many of these side effects disappear shortly after treatment ends. Some might be long-lasting or permanent. Learn more about these side effects.

Causes of dental or oral side effects

Not all cancer treatments affect the mouth, teeth, and jaw. But, the following treatments may cause specific dental and oral side effects. To learn more about your risk of experiencing these side effects, talk with a member of your health care team.

  • Radiation therapy to the head and neck.Side effects from radiation therapy to the head and neck may include:

    • Dry mouth

    • Decrease in saliva

    • Thickened saliva

    • Infection

    • Increased risk of tooth decay

    • Loss of taste

    • Mouth sores

    • Bone disease

    • Stiffness in the jaw

    These side effects may be temporary or continue for several years after treatment. Patients who have good dental health before treatment have a lower risk of these conditions. Therefore, it is important to see a dentist BEFORE beginning cancer treatment. During these visits, your dentist can treat decayed, broken, or infected teeth. If you wear dentures, your dentist will check that they fit well and aren’t irritating your mouth.

    Radiation therapy is likely to cause a change in the amount and consistency of your saliva. This means that it can increase your risk of dental decay. To prevent dental decay, your dentist will likely recommend special fluoride treatments during radiation therapy. This treatment, along with a low-sugar diet, can help protect your teeth. Learn more about the side effects of radiation therapy.

  • Chemotherapy.Common side effects of chemotherapy include:

    • Mouth sores

    • Pain in the mouth and gums

    • Peeling or burning of the tongue

    • Infection

    • Changes in taste

    Some types of chemotherapy may also cause a temporary decrease in your body’s ability to produce infection-fighting cells. This means is it important to get rid of any dental infection BEFORE cancer treatment. Also, braces can irritate your cheeks or tongue, so orthodontic appliances should be removed before chemotherapy begins. There is no problem in replacing them after treatment ends. Likewise, if you wear dentures, try to keep them out of your mouth as much as you can during treatment. Dental and oral side effects from chemotherapy usually go away soon after treatment ends. Learn more about the side effects of chemotherapy. 

  • Stem cell/bone marrow transplantation. The high-dose chemotherapy that is usually given before a stem cell transplant may cause dental and oral side effects. These are similar to those described under “chemotherapy” above. This means that it is important to visit your dentist before the transplant. During this visit, you dentist can treat any oral disease, which is really important to do before treatment. If you are planning to get a stem cell transplant from a donor, you might also develop a side effect called graft-versus-host disease. This disease may cause dry mouth, decreased saliva, sores in the mouth, sensitivity to spicy or acidic foods, difficulty swallowing. It may also increase the risk of tooth decay. Learn more about the side effects of stem cell transplantation.

    For people with leukemia, lymphoma, or multiple myeloma who have a stem cell transplant, the U.S. Food and Drug Administration approved the drug palifermin (Kepivance) to prevent treatment-related mouth sores. Patients receive palifermin through an intravenous (IV) tube placed into a vein before the transplant.

  • Bone-modifying drugs. Medications such as bisphosphonates and other newer drugs are sometimes used to prevent or treat osteoporosis and

    other types of bone loss caused by cancer. An uncommon but serious side effect of these medications is osteonecrosis of the jaw (ONJ). This condition can cause pain, swelling, and infection of the jaw; loose teeth; and exposed bone. To help prevent ONJ, visit a dentist before starting treatment to make sure there is no infection. There are effective treatments available for this type of side effect. Find more information about bone-modifying drugs for breast cancer and bisphosphonates for multiple myeloma.

  • New types of drug therapy. New, effective medicines to treat cancer are being developed all the time. Some of these, called targeted therapies, target specific steps in cancer development. Targeted therapies also have side effects, some of which can affect the mouth. For example, drugs called mTOR-inhibitors may cause canker sores.

  • Other medications. Other medications that help manage cancer symptoms and side effects may also cause dental and oral side effects. For example, pain medications can cause dry mouth. And some mouth rinses that are used to treat infections may discolor teeth.

Preventing dental or oral side effects

See your dentist at least 4 weeks before starting cancer treatment. Ask your dentist to share details about your oral health with your oncologist. This way, both of your doctors can work together to plan your care. Typically, you should allow at least 2 weeks for healing between dental surgery and starting cancer treatment. You should also talk with your dentist or another member of your health care team about which mouth problems you should tell your dentist about right away. If you’ve started your cancer treatment and haven’t seen a dentist, see one as soon as possible.

Regular communication with your health care team is important for preventing dental and oral side effects. During treatment, the following tips may help improve your oral health and prevent side effects:

  • Gently brush your teeth 2 times a day and floss regularly. Try soaking an extra-soft toothbrush in warm water to soften the bristles before brushing. Try using a child-size, soft toothbrush if your regular brush is too bulky or uncomfortable. Your doctor may also give you special instructions to reduce the risk of bleeding and infection. Also, ask your dentist if you should use a fluoride gel or rinse.

  • Avoid alcohol and extremes in your diet. Eat foods that are soft and mild. Extremely hot, cold, spicy, acidic, or crunchy foods may irritate your mouth. Watch your sugar intake. The bacteria in your mouth use sugar to live, and this process makes the acid that causes tooth decay.

  • Promote good bone health. Getting enough vitamin D and calcium each day helps your jaw and teeth stay strong and healthy. Dairy products are good sources of calcium and, if fortified, vitamin D. Other food choices may include fortified fruit juice and fortified breakfast cereals. Talk with your doctor before taking any supplements.

Managing and treating dental or oral side effects

If you experience any dental or oral side effects, let your doctor, nurse, dentist, or another member of your health care team know immediately. Relieving side effects is an important part of cancer care and treatment. This is symptom management or supportive and palliative care.

The specific treatment your doctor recommends will depend on your symptoms. But there are several common treatments for dental and oral side effects:

  • Mouth rinses that contain salt and baking soda may help treat mouth sores. However, if you are taking high blood pressure medication, you may need to avoid mouth rinses with salt. In addition, there are a variety of prescription rinses that may soothe sore spots.

  • Pain medications, including narcotics, may also be used to treat pain from mouth sores. Medications may be placed directly on the sores, taken by mouth, or given through an IV.

  • Antibiotics, antiviral drugs, and/or antifungal drugs are used to treat infections.

  • Drinking water and sugarless drinks may help manage dry mouth. Sucking on ice chips may also help. Avoid things that will dry out the mouth, such as soda, fruit juice, cigarettes, chewing tobacco, and alcohol.

  • Medications that produce saliva may help some people prevent or minimize dry mouth. For others, topical oral gels or other medications may help dry mouth caused by radiation therapy to the head and neck.

More Information

ASCO Answers Fact Sheet: Dental and Oral Health (PDF)

Fear of Treatment-Related Side Effects

Nutrition Recommendations During and After Treatment

Additional Resource

National Institute of Dental and Craniofacial Research: Cancer Treatment and Oral Health

Category: Cancer-2

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