While cancer itself can sometimes affect oral health, it is most often the treatments for cancer that significantly impact teeth and gums, potentially leading to tooth loss. Understanding these connections can help individuals and their healthcare providers proactively manage oral health throughout the cancer journey.
How Cancer Itself Can Affect Teeth
Oral cancers can directly compromise the structures supporting teeth. Tumors developing in the mouth, jaw, or throat may damage bone, gums, and other oral tissues. This can lead to tooth loosening or loss.
Beyond oral cancers, some systemic cancers can indirectly impact oral health. Cancers that spread to the jawbone or certain blood cancers can weaken the jaw, making teeth more susceptible to damage or loss. These conditions can also compromise the body’s ability to maintain healthy oral tissues, increasing vulnerability to dental problems.
The Impact of Cancer Treatments on Oral Health
Cancer treatments are a primary cause of oral complications, including potential tooth loss. These therapies affect rapidly dividing cells throughout the body, including those in the mouth, leading to various side effects.
Chemotherapy often causes mucositis, painful mouth sores and inflammation of the mouth lining. It can also reduce saliva production, leading to dry mouth (xerostomia). Dry mouth increases the risk of tooth decay and gum disease because saliva normally neutralizes acids and washes away food particles. Compromised gum health and increased decay can result in tooth loosening or loss.
Radiation therapy, particularly to the head and neck, can have lasting effects on oral health. It can damage salivary glands, leading to chronic dry mouth, which raises the risk of radiation caries. A serious complication is osteoradionecrosis (ORN) of the jaw, where bone tissue dies. ORN can manifest as exposed bone, pain, swelling, and infection, potentially leading to tooth loss or jaw fracture.
Bone marrow transplants (BMT) can lead to oral complications. Oral mucositis is a common issue. A specific complication of allogeneic transplants is graft-versus-host disease (GVHD), where donor immune cells attack recipient tissues, including those in the mouth. Oral GVHD can cause dryness, sores, sensitivity, and increase the risk of decay and gum disease, potentially leading to tooth problems.
Newer treatments, such as targeted therapies and immunotherapy, can also have oral side effects. These can include mouth sores, dry mouth, oral pain, or jawbone issues, which may contribute to dental problems.
Protecting Oral Health During Cancer Treatment
Taking proactive steps to protect oral health before and during cancer treatment can help minimize complications. A pre-treatment dental evaluation is recommended. Visiting a dentist before starting cancer therapy allows for addressing existing dental issues like cavities, gum disease, or infections, which could worsen during treatment.
Maintaining consistent daily oral hygiene is important throughout treatment. Gentle brushing two to three times a day with a soft-bristle toothbrush and mild fluoride toothpaste is advised. Flossing gently once daily, if approved by the healthcare team, can also help. Regular rinsing with non-alcoholic mouthwashes, or a mixture of salt and baking soda in water, can help keep the mouth clean and reduce irritation.
Managing dry mouth is also important. Strategies include frequent sips of water, chewing sugar-free gum, or using artificial saliva products. Dietary modifications can further support oral health. Avoiding sugary, acidic, or hard foods can prevent irritation and reduce the risk of further tooth decay. Regular communication with the dental team throughout treatment ensures ongoing care and prompt management of any emerging issues.
When to Consult a Dentist
It is important to seek dental attention for specific signs and symptoms during or after cancer treatment. Persistent pain or swelling in the mouth, gums, or jaw needs evaluation. Any new or worsening bleeding from the gums should also be reported.
Difficulty eating, speaking, or swallowing due to oral issues indicates a need for professional assessment. Signs of potential tooth loss, such as loose or shifting teeth, require immediate dental consultation. Non-healing sores, unusual growths, or white patches in the mouth should also be promptly checked. Persistent dry mouth should be discussed with the healthcare team. Proactive communication with both the oncology team and dentist is important for comprehensive care.