More than a million new cases of cancer are diagnosed each year and there is a shift to outpatient management.  Because cancer affects so many people, I thought it would be prudent to talk about potential oral complications.  Oral complications from chemotherapy for any malignancy, bone marrow transplant recipients or radiation to the head and neck can seriously compromise a patient’s health and quality of life, as well as affect their ability to complete planned cancer treatment.  The complications can be so debilitating that patients may tolerate only lower and less effective doses of therapy, may postpone scheduled treatments, or may have to discontinue treatment entirely.  Oral complications can also lead to potentially life threatening systemic infections.  Medically necessary oral care prior to, during and after cancer treatment can prevent or reduce the incidence and severity of oral complications, enhancing both patient survival and quality of life. 

Oral complications occur in almost all patients receiving radiation for head and neck malignancies, in more than 75 percent of bone marrow transplant recipients and in nearly 40 percent of patients receiving chemotherapy.  Depending on the type of therapy a patient receives, their risk for oral complications can be classified as low or high.  Some complications occur only during treatment, others such as xerostomia (dry mouth) may persist for years afterward.  Unfortunately, many cancer patients do not receive oral care until the complications develop.  As in most of health care, prevention plays a major role in a patient’s overall success.

Patients who are going to receive cancer treatment should see a dentist for a thorough oral evaluation at least two weeks prior to beginning treatment.  This evaluation is important to the success of the cancer treatment regimen.  With a pretreatment oral evaluation, the dental team can identify and treat problems such as infection, fractured teeth or restorations or gum disease that could contribute to oral complications when cancer therapy begins.  The evaluation also establishes baseline data for comparing the patient’s status in subsequent examinations.  The pretreatment evaluation includes a thorough examination of the hard and soft tissues of the mouth as well as appropriate radiographs to detect possible sources of concern.  I feel it is vital for all patients taking chemotherapy to have a daily fluoride treatment utilizing home trays – it can help prevent enormous problems in the mouth.

 How Does Chemotherapy Affect the Mouth?

Chemotherapy is the use of drugs to kill cancer cells, but they may also harm normal cells, including cells in the mouth.  There may be certain side effects in your mouth from chemotherapy.  One person may have different problems than another depending on the drugs that are utilized and how the patient’s body reacts to them.  Some of the complications that may occur are:

• A dry mouth – this is very common in chemotherapy patients
• Overall painful mouth or gums
• Burning, peeling or swelling of the tongue or gums
• Infection
• A change in taste sensation
• Demineralization of the teeth
• Bleeding of the gums

Side effects often happen because a person’s mouth is not healthy before chemotherapy begins.  Not all mouth problems can be avoided, but the fewer side effects one has, the more likely he/she will stay on their cancer treatment schedule.  

What Mouth Problems Can Head and Neck Radiation Cause?

Patients treated with radiation to the head and neck typically have a decrease in blood flow to the mouth and destruction of salivary glands in the areas that are treated.  Like chemotherapy, the mouth will potentially exhibit all of the potential complications listed above.  In addition, a stiffness of the jaws or changes in the jaw bone itself may occur.

Next week, I will give some tips on home care and how to minimize the oral complications that occur with cancer therapy.