Each year, many people are treated for
oral cancer.
Chemotherapy treatments for cancer and radiation treatment for head and neck
cancer often cause oral complications. About half of chemotherapy patients
experience oral complications, particularly those being treated for leukemia and
those who receive bone marrow transplants.
These
oral cancer complications significantly decrease quality of life and can lead
to serious systemic problems, complications, septicemia, eating difficulty,
nutritional deficiencies, and dehydration. The following are descriptions of
oral problems that can occur with cancer treatment:
Infections of the oral cavity can be caused by the usual organisms found
in the mouth or by opportunistic organisms not usually found in the mouth. These
infections can lead to serious systemic infections. The risk is higher for
individuals who have reduced numbers of circulating white blood cells (leukopenia).
Candidiasis is the overgrowth of candida albicans, a fungal organism that
normally is found in the mouth.
Musositis is painful and causes problems with eating and speaking. Soft
tissues are red, ulcerated, and inflamed. The oral cavity is susceptible to
mucositis because of its high cell turnover.
Hemorrhage or bleeding of the oral cavity can occur when clotting factors
are affected and during bone marrow suppression.
Xerostomia or dry mouth is associated with decreased, sticky, or
thickened saliva. Dry soft tissues are more susceptible to pain, infection, and
irritation. Dry mouth is associated with a high number of dental caries.
Altered taste or loss of taste is common and is related to the reduced saliva
volume, as well as its altered consistency.
Developmental abnormalities such as altered craniofacial growth and
dental/tooth deformities occur with cancer treatment during developmental
periods.
Trismus, fibrosis, and scarring of the chewing muscles and
temporomandibular joint (TMJ, the joint that moves the lower jaw) that were in
the radiation field may make opening the mouth difficult and limited.
Osteoradionecrosis (soft tissue and bone necrosis) can be spontaneous or
secondary to trauma, extractions, or dental prostheses. The radiated tissues
have reduced blood vessels, decreased cells, and decreased oxygen that
predisposes the tissues for years after the radiation therapy to this
compromised state that makes oral surgical procedures risky. Therefore, prior to
and post oral surgery, patients who have had head and neck radiation may require
hyperbaric oxygen treatments and antibiotic therapy to prevent
osteoradionecrosis.
Radiation dental caries is a term used for rapid tooth demineralization
and severe cavities that occur with head and neck radiation, particularly when
the parotid, submandibular, submental, or submaxillary salivary glands are in
the radiation field.
Pain accompanies oral infection, mucositis, xerostomia, trismus, dental
caries, osteoradionecrosis, candidiasis and dental caries.
To reduce risk for
oral cancer complications, a dentist should perform a
pretreatment oral examination, as well as necessary dental treatment before
initiating chemotherapy or head and neck radiation. It is important that the
dentist consult with the physician or oncologist before dental treatment because
people who are about to undergo treatments for cancer may be immunosuppressed or
thrombocytopenic (blood clotting disorder).
The goals of the dental examination and dental treatment are to eliminate
existing or potential oral infection and potential for trauma. Infection,
potential infection, and trauma can be associated with soft tissue lesions,
decayed or broken teeth, dental implants with poor prognosis, periodontal
disease, and poorly fitting full or partial dentures. The oral examination
consists of hard and soft tissue examinations, periodontal assessment, and
necessary radiographs. Since long-term effects of head and neck cancer radiation
treatments will be harmful to the bone in the radiated area (field), patients
who undergo head and neck radiation treatment should have teeth and implants
with potential for future problems considered for extraction before the cancer
treatment begins.
The patient's ability and interest in maintaining oral health, as well as
the ability to comply with an
oral cancer prevention routine, should be factors that are
considered as the dentist develops and discusses dental treatment
recommendations with the patient.
