Dental Care Before, During and After Cancer Treatment

Cancer treatment can affect the mouth in ways many patients do not expect. Chemotherapy and radiation therapy can cause mouth sores, infection, dry mouth, taste changes and pain. Some of these problems can be serious enough to affect the treatment itself. The good news is that planning ahead with a dentist, and keeping up careful daily care, can make many of these problems less severe.

This guide summarizes patient information from the National Cancer Institute (NCI). It is not a substitute for your oncology team’s instructions. Always follow the plan your doctors and dentist give you.

Why cancer treatment affects the mouth

NCI explains that chemotherapy and radiation therapy slow or stop the growth of fast-growing cells such as cancer cells. The cells lining the mouth also grow quickly, so treatment can slow the mouth’s ability to repair itself. NCI also notes that:

• Radiation therapy may directly damage and break down oral tissue, salivary glands and bone.
• Chemotherapy and radiation therapy can upset the healthy balance of bacteria in the mouth.
• Chemotherapy may lower white blood cell counts and weaken the immune system, which makes infection easier.

NCI lists the most common oral complications as oral mucositis (inflamed mucous membranes in the mouth), infection, salivary gland problems, change in taste and pain. These can lead to further problems such as dehydration and malnutrition.

Some complications are short-term and others are long-lasting. NCI says chemotherapy usually causes acute complications that heal after treatment ends. Radiation can also cause permanent tissue damage and a lifelong risk of oral complications.

The three phases of dental care

NCI describes different goals at each stage:

• Before treatment: prepare by treating existing oral problems.
• During treatment: prevent oral complications and manage the problems that occur.
• After treatment: keep teeth and gums healthy and manage long-term side effects.

Before treatment: see a dentist early

According to NCI, finding and treating oral problems before cancer treatment begins can prevent oral complications or make them less severe. Cavities, broken teeth, loose crowns or fillings, and gum disease can get worse or cause problems during treatment.

NCI says a checkup at least a month before cancer treatment begins usually allows enough time for the mouth to heal if dental work is needed. A preventive oral exam checks for:

• Mouth sores or infections
• Tooth decay
• Gum disease
• Dentures that do not fit well
• Problems moving the jaw
• Salivary gland problems

NCI recommends that patients receiving high-dose chemotherapy, a stem cell transplant or radiation therapy have an oral care plan in place before treatment begins. For patients whose treatment affects the head and neck, care should be planned by a team. The oncologist works closely with the dentist and may involve an oncology nurse, dental specialists, a dietitian, a speech therapist and a social worker. NCI also says it is important for patients with head or neck cancer to stop smoking.

If dental X-rays are part of the pre-treatment exam, our dental X-rays guide explains the common types.

Questions to bring to the pre-treatment visit

• Which of my teeth or gums could cause problems during treatment?
• What needs to be done now, and how long will it take to heal?
• Will my dentist and oncologist share information directly?
• What daily routine and products should I use during treatment?

During treatment: daily mouth care

NCI gives practical home-care guidance. Your team may adjust it for you.

Brushing

• Brush 2 to 3 times a day with a soft-bristle brush. NCI suggests a foam brush only if a soft-bristle brush cannot be used.
• Let the toothbrush air-dry between brushings.
• Use a fluoride toothpaste with a mild taste. Flavoring, especially mint, may irritate the mouth.
• If toothpaste irritates your mouth, NCI suggests brushing with a mixture of 1/4 teaspoon of salt in 1 cup of water.

Rinsing

• NCI suggests a rinse every 2 hours to decrease soreness: 1/4 teaspoon of salt and 1/4 teaspoon of baking soda dissolved in 1 quart of water.
• An antibacterial rinse may be used 2 to 4 times a day for gum disease, rinsing for 1 to 2 minutes.
• If dry mouth occurs, rinsing alone may not clean teeth well enough after meals, so brushing and flossing may be needed.

Flossing and lips

• Floss gently once a day. NCI notes that most patients can safely brush and floss while blood counts are low. Ask your team what applies to you.
• Use lip care products, such as a cream with lanolin, to prevent drying and cracking.

Common problems and what they mean

Mouth sores (mucositis)

NCI describes oral mucositis as inflammation of the mucous membranes in the mouth. Care includes cleaning the mouth and relieving pain. Tell your team about mouth pain, because pain control improves quality of life.

Infection and bleeding

Damage to the mouth lining and a weakened immune system make infection easier. Infections may be bacterial, fungal or viral. Our guide to oral thrush covers one common fungal infection. Some anticancer drugs also make the blood less able to clot, which can cause bleeding.

Dry mouth and decay

NCI says salivary glands usually return to normal after chemotherapy ends but may not recover completely after radiation therapy. Careful oral hygiene can help prevent the mouth sores, gum disease and tooth decay that dry mouth can cause. See our guide to dry mouth for more.

Taste changes

Changes in taste are common during chemotherapy and radiation therapy, according to NCI. If eating becomes hard, ask about nutrition support.

After treatment: long-term care

NCI lists chronic complications that may continue after radiation therapy to the head or neck. These include dry mouth, tooth decay, infections, taste changes, and problems in the mouth and jaw from tissue and bone loss. NCI also cautions that oral surgery or other dental work can cause problems for patients who have had head or neck radiation. Make sure every dentist you see knows your health history and the cancer treatments you received.

Bone-related medicines

NCI notes that certain drugs used for cancer and other bone problems are linked to bone loss in the jaw, called osteonecrosis of the jaw (ONJ). These include bisphosphonates, denosumab and angiogenesis inhibitors. If you have taken any of these, tell your dentist before any dental procedure.

Ongoing screening also matters. Our oral cancer screening guide explains what dentists look for at routine visits. If you need a dentist who will coordinate with your cancer care team, you can search for a dentist.

Frequently asked questions

How soon before cancer treatment should I see a dentist?

NCI says a checkup at least a month before treatment begins usually allows enough time to heal if dental work is needed. If your treatment starts sooner, tell your dentist so they can prioritize.

Can I keep brushing and flossing during chemotherapy?

NCI says most patients can safely brush and floss while blood counts are low. Use a soft brush and floss gently, and follow any specific instructions from your oncology team.

Why does mint toothpaste sting now?

NCI notes that flavoring, especially mint, may irritate the mouth during treatment. A mild-tasting fluoride toothpaste, or a salt-water mixture, may be gentler.

Will my dry mouth go away?

According to NCI, salivary glands usually recover after chemotherapy. After radiation therapy they may not recover completely, so long-term care for dry mouth may be needed.

Does my dentist need to know about my cancer treatment years later?

Yes. NCI notes that dental work can cause problems for people who had head or neck radiation and that certain bone drugs are linked to jaw problems. Share your history with every dentist.

Sources

• National Cancer Institute: Oral Complications of Cancer Therapies (PDQ), Patient Version
• NIDCR: Oral Cancer

By the Dentist Review Editorial Team.

This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.

Featured image: “UW Therapy room” by Ikiwaner, via Wikimedia Commons, licensed CC BY-SA 3.0. Resized and compressed for the web.