Cancer Treatment

Cancer treatment, especially on the head and neck involving radiation or chemotherapy can have a negative effect on normal oral health in both the short-term and long-term. Therefore, in consideration for routine dental care, the specialist should be aware of the potential complications that may be present. Further, in the dental treatment of cancer patients, ensuring that the oral health of the patient is in good standing in order to prevent oral disease spreading or osteonecrosis of the jaw is paramount in care.

Main oral complications of cancer treatment

  • Trismus: Trismus is believed to occur as a result of fibrosis around the muscles of mastication. Exercises can be used to prevent the onset of fibrosis, however will not act curatively after the onset.
  • Xerostomia: Radiation therapy interferes with the body’s natural production of saliva. This has two main side effects as 1. It limits the presence of antibodies and antimicrobial proteins present in the oral cavity normally carried in the saliva, and 2. Can result in dental demineralization.
  • Infection: Due to the decrease in saliva colonization by oral pathogens (most notably the opportunistic fungal pathogen Candida) can be very common in cancer patients. In order to prevent either local or systemic infection, frequent bacterial or fungal cultures should be performed if infection is suspected.
  • Osteoradionecrosis: Most commonly occurring in the mandible because of the lack of higher bone density when compared to the lower amount of vascularization, osteoradionecrosis is a side effect of radiation to the jaw in which necrotic bone and soft tissue is unable to heal. Alcohol and tobacco use are common in patients who develop osteoradionecrosis.

Prevention of complications

In order to prevent oral complications of cancer treatment, the Journal of the American Dental Association (JADA) has four main recommendations:

  1. Reducing the risk of cavities by practicing good oral care; brushing twice a day, flossing once a day, and avoiding sugary foods. As a consequence of radiation therapy the salivary gland function is decreased, resulting in a higher chance for cavities.
  2. Reducing the effects of dry mouth by sipping water or sugarless drinks or sucking on ice chips. Using sugar-free gum can also stimulate saliva production. The patient should also avoid alcohol, tobacco, and salty or spicy foods.
  3. Practice exercises to reduce jaw stiffness. Jaw stiffness can cause difficulty in chewing and swallowing
  4. Seeking treatment for oral sores as they can interfere with cancer treatment.

Pre-existing dental conditions like broken teeth, poor oral hygiene, or periodontal disease can increase the presence of oral side effects during cancer therapy, and similarly regular dental checkups prior to radiation treatment have shown to significantly decrease the severity of side effects.  

Child with mouth open showing thrush aka oral fungal infection on the tongue.

Thrush (oral fungal infection) in a child. (Picture by James Heilman, MD.)

A person's tongue showing oral cancer