How does chemotherapy affect oral and dental health? In a variety of ways; however, it is important to note that the side effects typically resolve when patients end their treatment.
There are several oral side effects associated with chemotherapy. To oversimplify chemotherapy, chemotherapy interferes with the metabolism and reproduction of tumor cells, also known as neoplastic cells. In the process of altering the metabolism and reproduction of these cells, chemotherapy also affects other rapidly dividing cells in the body including the cells responsible for defending the body. In other words, chemotherapy affects the immune system. Typically, the side effects of chemotherapy discussed below are seen when the blood counts drop.
Oral mucositis
Oral mucositis, or more colloquially known as mouth sores, 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, oral mucositis erupts two weeks after receiving high dose chemotherapy. Mucositis is most commonly seen on the movable tissues of the mouth (the cheeks, tongue, floor of the mouth, and the soft palate). Often it resolves when the blood counts recover.
How to treat/manage it
Prophylactic measures such as practicing good oral hygiene and avoiding spicy, hot, and acidic foods may help prevent the degree of mucositis experienced. Nonetheless, it is difficult to predict whether or not someone will experience oral mucositis as even those with impeccable oral hygiene may develop oral mucositis. However, it is important to note that practicing good oral hygiene and visiting a dentist prior to undergoing high dose chemotherapy has been associated with decreasing the duration of mucositis. There are several treatments that may help to alleviate the pain associated with mucositis including bland rinses, mucosal coating agents, and magic mouthwash.
Oral infections
Patients undergoing chemotherapy who are not on prophylactic medications may develop bacterial, fungal, and viral infections. The bacterial infections experienced may occur secondary to mucositis related ulcers. The viral infections that may occur usually resolve as the white blood cell count increases.
How to treat/manage it
These infections can all be controlled with appropriate medications. It is important to note that patients with fungal infections who wear dentures should also treat their dentures with an anti-fungal medication.
Neuropathy
Certain chemotherapies (such as vinca alkaloids) may result in neuropathies and mimic a toothache. Wait what? Yes, that’s right. Certain chemotherapies can actually result in phantom tooth pain and throbbing lower jaw pain despite no evidence of dental decay or infection. These chemotherapeutic agents are also associated with peripheral neuropathy (tingling and loss of sensation of the fingers and toes). The neuropathy manifests differently in the jaw and results in the sensation of a toothache.
How to treat/manage it
It is important to visit a dentist for a thorough examination. Additionally, it is essential for patients to provide a thorough history of their cancer treatment to help determine the diagnosis of the tooth pain. The phantom toothache usually resolves within a week of completing the associated therapy.
Xerostomia/Hyposalivation
Xerostomia is the medical term for the sensation of dry mouth. Hyposalivation signifies a reduction in salivary flow and is an objective, measurable entity. In addition to reduced flow, the saliva produced is ropey, thick and predominantly mucus. As saliva acts as a natural buffer in the mouth, bathing and lubricating the teeth and oral tissues, reduced salivary flow leaves patients prone to an increased risk for dental decay. Additionally, xerostomia 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. Nonetheless, because dry mouth is associated with an increased risk for dental decay, it is important to visit the dentist regularly and to maintain excellent oral hygiene to help prevent cavities. Drinking water frequently, sleeping with a humidifier and rubbing olive oil on the oral tissues may also help alleviate the symptom of dry mouth. Other remedies include sucking on sugar-free lemon drops to promote salivary flow as well as several over-the-counter saliva substitutes.
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.
About Dr. Levi
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. 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 interest in 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://laurenlevidmd.com.