Chemotherapy, a medical treatment for cancer, uses drugs to destroy cancer cells or slow their growth. These drugs circulate throughout the body, affecting both cancerous and healthy cells. While effective, this systemic approach can lead to side effects impacting various bodily systems. Oral health can be significantly affected, presenting unique challenges for patients.
How Chemotherapy Can Affect Oral Health
Chemotherapy drugs target rapidly dividing cells. However, many healthy cells, including those in the mouth lining and salivary glands, also divide quickly. When affected, this disrupts their normal function, leading to various oral issues.
The treatment can also suppress bone marrow activity, reducing white blood cell production. This weakens the body’s immune system, making the mouth susceptible to infections and opportunistic pathogens. Chemotherapy can also alter the natural balance of oral bacteria, contributing to further problems.
Common Dental and Oral Complications
Dry mouth, or xerostomia, is a common oral complication. It occurs when chemotherapy drugs affect salivary glands, reducing saliva production. Insufficient saliva makes eating, swallowing, and speaking difficult, and increases the risk of tooth decay and gum disease. Saliva normally cleanses the mouth and neutralizes acids, and its reduction can also alter the mouth’s microbial environment.
Oral mucositis is a frequent and painful side effect, characterized by inflammation and sores in the mouth, on the tongue, and gums. These ulcers can appear within 5 to 10 days of starting chemotherapy, making eating, drinking, and oral hygiene challenging. Severity ranges from redness to open, debilitating sores.
Patients often face an increased risk of infections due to a weakened immune system. Fungal infections, particularly candidiasis (oral thrush), are common, appearing as white patches or red, macular lesions. Bacterial and viral infections, such as reactivated herpes simplex virus (HSV), can also occur, sometimes resembling mucositis. These infections can exacerbate pain and compromise overall oral health.
Changes in taste, or dysgeusia, are prevalent, with about half of chemotherapy patients experiencing alterations in how food tastes. Foods may taste bland, bitter, or metallic, and some chemotherapy drugs can directly damage taste buds or alter saliva composition, affecting taste perception. This can lead to reduced appetite and nutritional deficiencies.
Gum problems, including increased sensitivity, bleeding (gingivitis), and inflammation, are common, especially in patients with pre-existing conditions. Chemotherapy can also increase the risk of tooth sensitivity and decay due to dry mouth and changes in saliva’s protective qualities. While less common, osteonecrosis of the jaw, a more severe complication involving bone tissue, can occur, particularly with certain agents or in combination with other treatments.
Strategies for Maintaining Oral Health
Before initiating chemotherapy, a comprehensive dental check-up is recommended to identify and address any existing oral issues. Treating problems like cavities, gum disease, or infections beforehand can prevent them from worsening and causing complications during treatment when the immune system is compromised. Dentists and oncologists should collaborate to ensure optimal oral health.
Maintaining diligent daily oral hygiene throughout chemotherapy is important. This involves gentle brushing with a soft-bristle toothbrush two to three times a day using a mild, fluoride toothpaste. Flossing should be continued gently if tolerated and if platelet counts are not too low. Regularly rinsing the mouth with non-alcoholic solutions, such as a mixture of salt and baking soda in water, can help keep the mouth clean and soothe irritation.
To manage dry mouth, frequent sips of water throughout the day are beneficial. Saliva substitutes, available as sprays, gels, or lozenges, can provide temporary relief by lubricating the oral cavity. Chewing sugar-free gum or sucking on sugar-free hard candies can also stimulate saliva flow. Dietary modifications, such as avoiding acidic, spicy, or crunchy foods, can reduce irritation and make eating more comfortable.
Regular dental follow-ups during chemotherapy allow for monitoring oral health and addressing any emerging issues promptly. Informing the dental team about the ongoing cancer treatment is important for tailored care. For pain management, over-the-counter options or prescription solutions, such as topical pain relievers, can help alleviate discomfort from mouth sores.
Unique Considerations for Pediatric Patients
Chemotherapy administered during childhood can uniquely impact developing teeth, potentially leading to distinct long-term dental issues not typically seen in adults. This is because the treatment interferes with the ongoing processes of tooth formation and calcification.
Children may experience developmental abnormalities such as changes in tooth shape or size, or even the complete absence of some teeth. Enamel hypoplasia, characterized by thinning, pitting, or discoloration of the tooth enamel, is another common effect, making teeth more susceptible to decay. Additionally, chemotherapy can result in delayed tooth eruption or abnormalities in root development, such as root stunting. These effects underscore the need for specialized dental care in pediatric cancer patients.