Dental health is a topic that may be overlooked in preparation for and during cancer treatment. Dental and oral health refers to the well-being of the entire mouth, including the teeth, gums, mucosa (lining of the mouth), and salivary glands (the glands that produce saliva). About one-third of Americans diagnosed with cancer each year may develop side effects affecting the mouth due to cancer treatment, although the incidence varies depending on the type of treatment. The side effects may make it difficult to eat, talk, chew, and/or swallow.
Fortunately, most dental and oral side effects can be prevented or managed with the help of your health care team, which includes your oncologist, nurses, and dentist. Sometimes, a dental specialist, such as an oral surgeon (a dentist who specializes in surgery of the mouth and jaw), periodontist (a dentist who specializes in diagnosing and treating gum disease), or prosthodontist (a dentist who specializes in replacing teeth or other structures of the mouth) will be needed to treat specific side effects.
Regular communication among all members of your cancer care team before and during treatment is important in preventing and managing dental side effects. Before starting any treatment, ask your doctor about the possible side effects and whether these will affect any parts of your mouth. If a treatment, such as radiation therapy to the head and neck areas or high-dose chemotherapy, is likely to cause oral side effects, be sure to have a dental examination before starting cancer treatment. If you have already started treatment that is affecting or is likely to affect your oral health, see a dentist as soon as possible.
Types of dental and oral side effects
Side effects of the mouth caused by cancer treatment may include xerostomia (dry mouth), mucositis (mouth sores), caries (tooth decay),dysphagia (difficulty swallowing), infection, inflammation or pain in the lining of the mouth and tongue, and difficulty talking. Some side effects may disappear shortly after treatment is finished, while others may be permanent.
Treatments that may cause dental and oral side effects
Not all types of cancer treatment cause dental and oral side effects. To learn about your risk of experiencing specific side effects, talk with your doctor.
The following treatments may cause dental and oral side effects:
Radiation therapy to the head and neck. Dental and oral side effects from radiation therapy to the head and neck may include dry mouth, an increase in tooth decay, loss of taste, mouth and gum sores, and stiffness in the jaw. These side effects may be temporary or continue for several years after treatment. Before beginning radiation therapy for any head and neck cancer, receive an examination from an oncologic dentist (a dentist experienced in treating people with head and neck cancer). This dentist may recommend removing teeth before beginning treatment to help prevent radioosteonecrosis (jaw disease) and may prescribe a special fluoride treatment to help prevent dental decay.
Chemotherapy. More than two-thirds of patients receiving high-dose chemotherapy and more than one-third of patients receiving standard doses of chemotherapy experience dental and oral side effects. Mouth sores are a common side effect of some types of chemotherapy. Other side effects include pain in the mouth and gums, peeling or burning of the tongue, infection, and changes in taste. People receiving high-dose chemotherapy (such as chemotherapy given before a bone marrow transplantation [also called stem cell transplantation] to destroy as many cancer cells as possible) are at increased risk for side effects. Side effects from chemotherapy usually occur only during treatment or for a short time after treatment ends.
Although chemotherapy may not directly cause dry mouth, some secondary medications, such as pain medications, may cause it.
Many people ask whether chemotherapy causes a yellowing or a discoloration of the teeth. Most doctors believe there is no evidence that chemotherapy causes teeth to change color. However, some mouth rinses with the chemical chlorhexidine that are used to treat infections may discolor teeth.
Bone marrow transplantation. As mentioned above, high-dose chemotherapy given before a bone marrow transplantation may cause dental and oral side effects. In addition, graft versus host disease (GVHD, a complication of bone marrow transplantation in which the immune cells in the transplanted bone marrow recognize the recipient's body as foreign and attack it) may cause dry mouth, sores in the mouth, dental cavities, sensitivity to spicy or acidic foods, and difficulty swallowing due to a decrease in saliva. For patients with leukemia, lymphoma, or multiple myeloma receiving a bone marrow transplantation, the drug palifermin (Kepivance) is approved by the U.S. Food and Drug Administration to prevent treatment-related mouth sores. Palifermin is given intravenously (through a vein) before the transplantation.
Preventing dental and oral side effects
Keeping your mouth and gums healthy is important in preventing dental side effects. Gently brush your teeth two times a day and floss regularly. If you are receiving chemotherapy, your doctor may give you special instructions to reduce the risk of bleeding and infection.
Schedule a dental examination and cleaning at least two weeks before starting any cancer treatment that is likely to cause dental or oral side effects. If you have already started these treatments, see your dentist as soon as possible. Your dentist will look for any problems that need to be addressed before starting cancer treatment. If you need any dental procedures, such as the removal of a tooth, ask your dentist how soon after the procedure you can start cancer treatment.
Treating and managing dental and oral side effects
Let your health care team know if you experience any dental or oral side effects, including any pain, bleeding, a decrease in the ability to open your mouth, or swelling in the mouth. Here are some ways to treat such side effects with the help of your doctor:
- Mouth rinses that contain salt and soda may help treat mouth sores. However, if you are taking high blood pressure medication, you may need to avoid mouth rinses with salt.
- Pain medications, including narcotics, may also be used to treat pain from mouth sores. Medications may be placed directly on the sores or taken by mouth or intravenously.
- Your doctor may prescribe antibiotics, antiviral drugs, and/or antifungal drugs to treat infections.
- Drinking water and sugarless drinks may help manage dry mouth. Sucking on ice chips may also help. Avoid drinking soda and fruit juice, and don't smoke, chew tobacco, or drink alcohol because these substances dry out the mouth.
- For dry mouth caused by radiation therapy to the head and neck, your doctor may prescribe medications.
Bone health and dental health
Practicing habits that support the strength and overall health of your bones is also important for your dental health. Strong and healthy bones support a strong and healthy jaw, which supports strong and healthy teeth.
To promote good bone health, many doctors recommend 1000 international units (IU) of vitamin D and 1000 milligrams (mg) of calcium each day. 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 first before taking any supplements.
Diseases of the bone, such as osteoporosis (thinning of the bones) may cause teeth problems. Bisphosphonates (medications that slow the rate of bone thinning) may be used to treat osteoporosis and bone loss caused by cancer. Although it is a rare problem, osteonecrosis (bone loss/weakening) of the jaw is a possible side effect in patients who receive bisphosphonates intravenously. Before starting bisphosphonate treatment, visit your dentist to make sure there are no areas of infection in your mouth.
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