Who is at risk for developing oral complications from cancer treatment?
Oral complications are common in cancer patients, and can arise for many different reasons, including the following:
- Patients undergoing chemotherapy, and in particular high dose regimens, are at risk for developing painful oral mucositis (mouth sores).
- Patients with head and neck cancers, in particular those treated with radiation therapy are at risk for developing mucositis. Radiation therapy to the head and neck also may also cause long-term damage to the salivary glands, which can result in discomfort due to chronic dry mouth, and increased rate of dental caries (cavities). These patients are also at risk for developing jaw osteonecrosis (jaw bone death).
- Patients who undergo hematopoietic stem cell transplantation (HSCT) are at risk for developing infections and oral mucositis. Recipients of allogeneic HSCT are also at risk for developing graft-versus-host disease in the mouth.
- Patients with cancer that has spread to the bones treated with antiresorptive (bone-strengthening) therapies are at risk for developing jaw osteonecrosis.
- Patients being treated with targeted cancer therapies may be at risk for developing oral complications such as mouth pain, mouth sores, and taste changes.
Your cancer doctors, together with the oral medicine experts, can discuss your specific risk factors and what may be done to prevent and/or manage such complications.
Why is oral care important prior to treatment?
Cancer therapy can cause suppression of the immune system and increases the likelihood of developing a dental infection. With a pre-treatment evaluation, the oral medicine team can identify and guide management of problems such as infection, fractured teeth or fillings, or periodontal (gum) disease that could contribute to oral complications after cancer therapy begins. Following certain cancer therapies, dental infections, and in particular dental extractions, can result in jaw bone complications. It is therefore important that oral health is maintained prior to, as well as throughout and after, cancer treatment.
Ideally, a comprehensive oral evaluation should take place at least one month before cancer treatment starts to allow adequate time for recovery from any required dental surgical procedures such as tooth extraction. The pre-treatment evaluation includes a thorough examination of hard and soft tissues, as well as appropriate radiographs (x-rays) to detect possible sources of infection and pathology. We work with your general dentist to help coordinate your dental care.
Can my own dentist screen my mouth prior to treatment?
Yes, for patients who are scheduled to undergo head and neck radiation, or HSCT, we have a well-coordinated formalized screening program where you can complete the required screening with your own dentist. Our doctors will be in communication with your dentist and be available to help with any questions.
What kind of oral care is important during cancer treatment?
Careful monitoring of oral health is especially important during cancer therapy to prevent, detect, and treat complications as soon as possible. The oral medicine team will provide detailed instructions on specific oral care practices, such as how and when to brush and floss, how to recognize signs of complications, and other instructions appropriate for your care. Good oral care during cancer treatment contributes to its overall success.
What types of complications can occur from cancer treatment?
A wide range of cancer therapy-associated oral complications can arise, including:
- Oral mucositis: Painful inflammation and ulceration of the mucous membranes or lining of the mouth and throat may interfere with chewing and swallowing.
- Oral infections: Suppression of white cell counts from chemotherapy increases the risk of developing viral, bacterial, and fungal infections in the oral cavity.
- Xerostomia/salivary gland dysfunction: Some cancer therapies can result in dryness of the mouth due to thickened saliva, and reduced or absent salivary flow. This increases the risk of oral infection and compromises speaking, chewing, and swallowing. Persistent dry mouth increases the risk for dental caries (cavities).
- Trismus: Treatment for head and neck cancer can result in scarring and reduced mouth opening, making many normal daily oral functions more difficult.
- Jaw osteonecrosis: Radiation therapy to the head and neck, as well as antiresorptive (bone strengthening) therapies are associated with an increased risk of developing jaw osteonecrosis, a condition in which the jaw bone becomes exposed and infected.
- Taste and other sense alterations: Many cancer therapies can result in changes in taste perception of foods, ranging from reduced taste, to unpleasant or unusual taste to no taste at all. In addition, some targeted cancer therapies can cause sensitivity and discomfort of the oral mucosa without visible mouth sores.
- Oral graft-versus-host disease (GVHD): Patients who undergo allogeneic hematopoietic stem cell transplantation (HSCT) are at risk for developing GVHD in the mouth. This condition is characterized by painful mouth sores and dry mouth.
- Nutritional compromise: Mucositis, dry mouth, difficulty swallowing and loss of taste can all contribute to reduced food intake, adversely affecting your nutritional health.
Our oral medicine experts will work with you and other members of your care team to help prevent and treat oral complications that may occur during or after your cancer treatment.
What if I develop a dental problem during treatment and I live far away from Dana-Farber?
If you develop a dental problem during your cancer treatment, please call your care team. If you are already visiting Dana-Farber, then you may be evaluated at the dental clinic at Brigham and Women's Hospital. You can otherwise be seen by your community dentist. It is important to provide them with information about your cancer and cancer therapy (including whether or not your white blood cells and platelets are low). Doctors from our service can be available for consultation by telephone.