Oral and Dental Health in Cancer and Important Warnings

Cancer treatment, particularly radiotherapy and chemotherapy, may cause oral and dental health problems or other serious oral complications. These complications affect cancer treatment and daily life. Caring for oral health before, during and after cancer treatment will help prevent potential problems or make them easier to manage.

How Do Radiotherapy and Chemotherapy Affect the Mouth and Teeth?

Applied to the head or neck, radiation therapy or certain chemotherapy medicines may reduce the functioning of salivary glands, which play an important role in chewing and swallowing, and therefore reduce saliva production. This common side effect is called dry mouth (xerostomia) . Besides physical discomfort, dry mouth increases the risk of gum disease, tooth decay and plaque formation.

Another common complication of chemotherapy or radiation therapy is mouth sores (mucositis). Mucositis is inflammation of the mucous membrane lining the mouth, causing both pain and difficulty eating. The resulting inadequate nutrition may cause weight loss (cachexia) and adversely affect the immune system.

Reduced saliva production and immune cell counts, together with disruption of the mucosal structure, make it easier for viruses, bacteria or fungi to cause infections in the head and neck region.

Some cancers tend to metastasize to bone in advanced stages; examples include prostate, bladder, kidney, breast and lung cancer. Bone metastasis patients are given bisphosphonate medicines to slow cancer progression in bone. Although these medicines slow bone metastasis, they may sometimes cause unwanted damage to bone tissue. This rare condition, known as osteonecrosis , occurs in the jawbone where the teeth are located. Tooth loss and localized bone destruction (a type of decay), often accompanied by infection, occur in this area. Radiotherapy to the mouth also carries a risk of osteonecrosis.

Most patients with cancer can reduce the risk of oral and dental complications through preventive measures.

How Can I Protect My Oral and Dental Health During Cancer?

• Except in emergencies, dental treatment is not recommended during cancer treatment because patients’ immune systems may be weakened.
• Patients with cancer are advised to receive dental treatment for oral health issues before cancer treatment begins.

During Treatment;

• Throughout cancer treatment, patients should continue brushing their teeth with fluoride toothpaste.
• Using an extra-soft toothbrush helps protect against sensitivity caused by cancer treatment.
• Patients with cancer should floss daily and use alcohol-free mouthwashes (if they have not previously flossed, starting during cancer treatment is not recommended).
• Spicy or acidic foods, toothpicks, tobacco and alcohol may cause irritation.
• Only emergency dental treatment is performed during cancer treatment, and any emergency dental treatment should be coordinated with the oncologist.
• To relieve dry mouth and other side effects during cancer treatment, patients can drink plenty of water and chew sugar-free gum.
• Dentures may cause mouth ulcers, and their use should be minimized during cancer treatment. Dentures should be cleaned thoroughly and not worn while sleeping. Old dentures may begin to fit poorly during cancer; if this happens, visit your dentist.

After Treatment

The oral care routine after treatment depends on the type of cancer treatment and the patient’s immune status. Unresolved oral complications or a weakened immune system may adversely affect dental health. Generally, dental cleaning should be performed at least 2 months after treatment. Patients who have received head and neck radiation therapy should be examined regularly at intervals determined by their dentist.