Oral Health

How Does Cancer Therapy Affect Oral Health?

by Lauren Levi DMD on August 26, 2015

Cancer therapy may result in several side effects, your mouth included. Luckily, many of the oral side effects associated with chemotherapy typically resolve when treatment ends. However, chemotherapy alters the metabolism and reproduction not only of tumor cells but of other rapidly dividing cells in the body including the cells responsible for defending the body. In other words, chemotherapy affects the immune system, so it’s important to take care of your whole body, including your mouth. 

Here are some probelms that can occur during cancer treatment: 

Mouth Sores

Mouth sores officially called oral mucositis is a condition characterized by sloughing of the oral mucosa and the presence of red and white intraoral ulcers. It affects approximately 40% of patients undergoing chemotherapy. Traditionally, mouth sores happen two weeks after receiving high dose chemotherapy. Sores are most commonly seen on the movable tissues of the mouth. In other words, oral mucositis frequently has a predilection for the cheeks, tongue, floor of the mouth, and the soft palate. Often sores will resolve when blood counts recover.

How to treat/manage it

Practicing good oral hygiene and avoiding spicy, hot, and acidic foods may help prevent the intensity of mouth sores. Nonetheless, it is difficult to predict whether or not someone will experience mouth sores as even those with impeccable oral hygiene may develop them. It is important to note, however, that practicing good oral hygiene and visiting a dentist prior to undergoing high dose chemotherapy has been associated with decreasing the duration of sores. There are several treatments that may help to alleviate the pain associated with mucositis including bland rinses, mucosal coating agents, and magic mouthwash. It is also recommended that patients who wear dentures abstain from wearing their dentures until after the mucositis has resolved.

Oral infections

Patients undergoing chemotherapy who are not on prophylactic medications may develop bacterial, fungal, and viral infections. The bacterial infections experienced may erupt secondary to mucositis. The viral infections that may occur are often herpetic in nature such as cold sores and shingles and usually resolve as white blood cell count increases.

How to treat/manage it

These infections can all be controlled with appropriate medications. Patients with fungal infections who wear dentures should also treat their dentures with an anti-fungal medication.

Neuropathy

Surprisingly, certain chemotherapies (vinca alkaloids) may result in neuropathies and mimic a toothache in teeth with no evidence of cavities or infection. These chemotherapeutic agents are also associated with tingling and loss of sensation of the fingers and toes which manifests differently in the jaw resulting in the sensation of a toothache.

How to treat/manage it

Visiting the dentist for a thorough evaluation is essential to adequately diagnose the cause of the toothache. Patients should provide a detailed history of their cancer treatment. The phantom toothache usually resolves within a week of completing the associated therapy.

Senstive or Dry Mouth

Saliva acts as a natural buffer in the mouth, bathing and lubricating the teeth and oral tissues. Chemotherapy can cause reduced saliva leaving patients prone to an increased risk for dental decay. In addition to reduced flow, the saliva produced is usually thick. Mouth sensitivity is associated with taste alterations, difficulty swallowing and difficulty speaking.

How to treat/manage it

Chemotherapy-associated dry mouth usually subsides when the therapy ends. Even so, because dry mouth is associated with an increased risk for dental decay, it is important to visit the dentist regularly and maintain good oral hygiene to help prevent cavities. Drinking water frequently, sleeping with a humidifier and rubbing olive oil on the oral tissues may help to alleviate the symptom of dry mouth. There are several other over the counter salivary substitutes.

About Lauren Levi, D.M.D.

As a general dentist with advanced training in dental oncology, Dr. Lauren Levi delivers comprehensive oral care to cancer patients in a warm, supportive, and gentle environment in New York, New York. After receiving her D.M.D. at the University of Florida College of Dentistry, Dr. Levi completed a general practice residency at New York Presbyterian-Weill Cornell Medical Center. During her residency, Dr. Levi rotated through Memorial Sloan Kettering Cancer Center, where she discovered her passion for dental oncology. She then pursued a fellowship in dental oncology at Memorial Sloan Kettering Cancer Center. This training equipped her with extensive experience performing dental treatment on patients who are receiving chemotherapy, radiation therapy, and stem cell transplants and those who may face individual dental needs because of these treatment programs.

For more information on dental oncology, visit http://www.laurenlevidmd.com.

Further Reading

Little, James W. Dental Management of the Medically Compromised Patient. St. Louis: Mosby, 2002. Print.

Oral Complications of Cancer Treatment: What the Dental Team Can Do. NIH, n.d. Web. 4 Dec. 2014.

“Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®.” National Cancer Institute. N.p., n.d. Web. 19 Nov. 2014.

Neville, Brad W. Oral and Maxillofacial Pathology. St. Louis, MO: Saunders/Elsevier, 2009. Print.

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