Cancer treatment particularly chemotherapy and radiation therapy to the head and neck creates some of the most severe and challenging oral health complications seen in any patient population. These complications are frequently undertreated because patients and oncologists are focused on the cancer itself and because dental care is still sometimes treated as separate from real medical care. This is a costly separation.
Chemotherapy-related oral complications
Chemotherapy affects rapidly dividing cells throughout the body. The oral mucosa which has one of the fastest cell turnover rates in the body is frequently caught in the crossfire. Oral mucositis with painful ulceration of the lining of the mouth and throat occurs in 20 to 40 percent of patients receiving standard chemotherapy and in up to 80 percent of those receiving high-dose conditioning regimens for bone marrow transplant. It typically develops 5 to 7 days after chemotherapy, peaks at 10 to 14 days, and resolves in 2 to 4 weeks in most cases. Severe mucositis causes intense pain, makes eating and drinking very difficult, and increases infection risk. Management includes professional oral care before starting treatment, rigorous oral hygiene during treatment, ice chips in the mouth during infusion which reduces mucosal blood flow, and low-level laser therapy which has the best evidence for mucositis prevention.
Radiation therapy complications
For head and neck cancers radiation therapy to the salivary glands produces the most severe and long-lasting oral complications. Doses above approximately 50 to 60 Gy can cause permanent severe dry mouth. Radiation caries can be devastating causing rapid deterioration of all teeth if not managed aggressively with fluoride applications and dietary modification. Osteoradionecrosis which is bone death that can occur in the jaw following radiation is one of the most serious complications. This is why all necessary dental extractions must be completed before beginning radiation therapy.
What every cancer patient should do before starting treatment
Schedule a dental evaluation before starting chemotherapy or radiation therapy ideally 3 to 4 weeks before to allow time for any necessary extractions or procedures to heal. Inform both your dentist and your oncology team of the treatment plan. Complete any necessary dental work that involves potential infection risk or that would require extraction near the radiation field. This pre-treatment dental work prevents far more serious complications during and after treatment.
Educational content. Cancer treatment oral care requires collaboration between oncology and dental teams. Patients should proactively initiate this coordination.
