Oral Complications of Cancer Treatments and Preventive Dental Care
Maintaining oral health is critical during cancer treatment, as many therapies can adversely affect the mouth. Below is a comprehensive overview of how different cancer treatments impact oral health and what preventive and supportive care measures should be taken.
Cancer Treatments That May Affect Oral Health
The following cancer therapies can lead to oral side effects:
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Chemotherapy
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Radiotherapy (especially to the head and neck region)
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Supportive medications such as sedatives and painkillers
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Surgical removal of tissues in the head and neck region
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Bone marrow transplantation
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Immunosuppressive or immune-boosting drugs
Preventive Oral Care Before Cancer Therapy
Since only emergency dental treatments are recommended during cancer therapy, all potential oral problems should be addressed beforehand:
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Removal of dental calculus (tartar) and adjustment of faulty fillings or ill-fitting dentures
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Treatment of gum disease and dental caries
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Fabrication of custom fluoride trays based on impressions, used before and after treatment to protect the teeth with fluoride gel
Effects of Radiation Therapy on Oral Health
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Mucositis: Radiation causes damage to oral mucosa cells, typically leading to painful ulcers (mucositis) starting 5–10 days after treatment begins, which usually heal in 3–4 weeks.
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Dry mouth (xerostomia): Reduced quantity and quality of saliva leads to dry mouth, bleeding gums, difficulty swallowing, altered taste, and speech or chewing difficulties.
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Osteoradionecrosis: Reduced blood supply and oxygen to irradiated bone—particularly the lower jaw—can result in bone necrosis (death of bone tissue).
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Vascular and muscular damage: Radiation can cause narrowing of blood vessels and tissue changes in the jaw joint and chewing muscles, leading to long-term functional problems.
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Tooth mobility and loss: Radiation weakens the periodontal ligaments, making teeth more prone to loosening and loss.
Oral Side Effects of Chemotherapy
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Mouth sores and inflammation: Some chemotherapy drugs cause mucositis.
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Infections: Weakened immunity increases the risk of bacterial, viral, and fungal infections.
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Taste changes: Food may taste metallic, overly salty, or sour. These changes are usually temporary.
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Dry mouth: Long-term use of certain painkillers and sedatives may reduce saliva flow, increasing the risk of cavities.
Oral Care Guidelines During Cancer Treatment
Daily oral hygiene is essential to reduce the severity of oral side effects:
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Brush teeth 3–4 times a day, especially after meals and before bed, using a very soft toothbrush and a fluoride toothpaste without peroxide or tartar control agents.
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Use two alternating toothbrushes, disinfecting them in chlorhexidine or hypochlorite solution and letting them dry between uses.
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Avoid electric toothbrushes or oral irrigators.
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If flossing is already a habit, use waxed, ribbon-style floss; do not begin flossing during treatment.
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Use a baking soda mouth rinse at least four times daily: dissolve half a teaspoon of baking soda in one glass of boiled and cooled water.
Avoid brushing during the 7–10 days after chemotherapy when the risk of gum bleeding and infection is highest. Instead, use mouth rinses and baking soda rinses for cleaning.
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After vomiting, rinse frequently with baking soda water.
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If toothpaste causes irritation or nausea, switch to baking soda rinses.
Guidelines for Denture Use
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Avoid wearing removable dentures during cancer treatment if possible.
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After treatment, clean dentures thoroughly after meals and at night, and remove them before sleeping.
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Do not use ill-fitting dentures as they can cause trauma.
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Store dentures in cleaning solution, not dry.
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If a fungal infection occurs, both the oral tissues and dentures should be treated.
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Keep lips moisturized with petroleum jelly or lip balm to prevent cracking.
Managing Dry Mouth
To relieve dry mouth (xerostomia):
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Use baking soda rinses
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Suck on sugar-free gum, candies, or ice chips
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Drink plenty of fluids throughout the day (at least 2 liters daily)
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Avoid acidic, spicy, hot, or very cold foods
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Use a humidifier in the room
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Consider saliva-stimulating medications prescribed by your doctor
Dietary Recommendations
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Choose moist, soft foods that are easier to swallow
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Avoid alcohol and tobacco
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Maintain good hydration and a soft diet to minimize oral trauma
Lifelong Fluoride Therapy After Radiotherapy
For patients undergoing head and neck radiotherapy:
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Lifelong fluoride application is critical to protect remaining teeth and prevent bone loss.
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Use custom fluoride trays:
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Apply fluoride gel to trays
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Wear for at least 5 minutes
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Do not eat, drink, or brush for at least 30 minutes afterward
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Use once or twice daily
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When to Seek Help
Despite all preventive efforts, if you notice any changes in how your mouth feels, looks, or tastes, notify your doctor, nurse, or dentist immediately.