Most, if not all, people know someone who has or has had cancer. There are every few 6-letter words that provoke such primal fear and stimulate such a wide range of emotions within the patient and his/her family as "cancer".
With the initial diagnosis comes a flood of concerns, and oftentimes, for patients and their families, dental health is not one of them. But it should be, because the cancer treatment will have an impact on the oral tissues - and on dental treatment planning, prioritization, and timing. Patients also may not realize that visiting the dentist must remain and integral part of their overall health care while they undergo cancer treatment.
Chemotherapy and radiation therapy slow or stop the growth of new cells, including fast-growing cancer cells. Unfortunately, chemotherapy is also toxic to normal fast-growing cells, such as those of the gastrointestinal tract and hair follicles. As a result, typical adverse side effects include nausea, vomiting, and hair loss.
Understanding the Oral Implications
Cancer treatment also has a negative impact on the mouth. Normal cells in the lining of the mouth also are fast-growing, so anticancer treatments can have an impact on these cells too. These treatments slow down the ability of the oral tissues to repair itself by making new cells.
Radiation therapy may directly damage an break down oral tissue, salivary glands, and bone. Chemotherapy and radiation therapy also upset the healthy balance of bacteria in the mouth.
Oral implications from chemotherapy and radiation are the result of direct damage to the oral tissues and the immune system. While chemotherapy causes oral complications that typically resolve following recovery of these damaged tissues, radiation therapy causes not only acute oral toxicity, but also permanent damage that may result in lifelong oral complications for the patient.
Oral complications common to both chemotherapy and radiation include oral mucositis and infection. Oral mucositis is an infection in the lining membrane of the mouth. Normal lining cells undergo complete replacement approximately every 10 days. Chemotherapy impairs the replication of these cells, and radiation causes direct damage to these tissues. If the lining is damaged, it allows a pathway for oral organisms can spread systemically (especially if the patient is immunocompromised), resulting in systemic infection. As a result, these patients are at risk for a number of bacterial, fungal, and viral infections.
Oral complications specific to chemotherapy include neurotoxicity and bleeding while radiation therapy may cause salivary gland dysfunction, radiation related cavities, bone death, tissue death, and jaw joint pain.
Meticulous oral hygiene is essential during cancer treatment. Encouraging the cancer patient to seek to seek routine dental care is also very important.