Dental and Oral

Complications of Cancer
Treatment Facts
No. 29 in a series providing the latest information for
patients, caregivers and healthcare professionals

www.LLS.org • Information Specialist: 800.955.4572

Introduction Chemotherapy. Chemotherapy drugs slow or stop the

growth of fast-growing cells such as cancer cells. They may
Most people are aware of common side effects of cancer also harm normal, healthy fast-growing cells, including cells in
treatment such as nausea and hair loss. However, most people the mouth. Chemotherapy can prevent the growth of normal
do not know that one-third of patients who undergo cancer cells in the lining of the mouth, which affects the ability of oral
treatment develop complications that affect the mouth. tissue to repair itself by making new cells. This results in
Complications are medical problems that occur as a result of mouth sores.
a procedure, treatment or illness. Oral complications affect
the mouth. Chemotherapy may also cause a decrease in the number of
white blood cells. These are the cells that fight infection. As
Cancer patients have a high risk of oral complications. Many
a patient’s white blood cell count gets lower, infections may
cancer treatments, including chemotherapy and radiation,
occur more frequently. Over time, it can become more difficult
can affect an individual’s dental and oral health. Dental
for the body to fight off bacterial, viral and fungal infections.
and oral health refers to the well-being of the entire mouth,
including the teeth, gums, lining of the mouth (mucosa), and Chemotherapy may disturb the healthy balance of bacteria
glands that produce saliva (salivary glands). in the mouth. There are many kinds of bacteria in the
Oral complications can make it difficult to eat, talk, chew mouth. Some bacteria are helpful and some are harmful.
or swallow. These problems can affect a patient’s health and The “good” bacteria keep the “bad” bacteria in balance. If
quality of life. They can even affect a patient’s ability to that balance is disrupted, the resulting changes may lead to
complete treatment. problems with a patient’s oral health.

In some cases when oral complications are severe, the effects Most of the oral complications caused by chemotherapy are
on cancer treatment can be significant, for example short term and typically resolve after treatment ends. Oral
complications caused by chemotherapy include
l Treatment doses may need to be lowered.
l Treatment schedules may be changed. l M
 outh sores (oral mucositis)—Inflammation and
ulceration of the mucous membranes cause pain and
l Treatment may be delayed. increase the risk of infection.
l Treatment may be stopped altogether.
l B
 leeding in the mouth—Oral bleeding may result from
Oral complications occur in nearly 40 percent of patients the decreased number of platelets in the blood due to
who receive chemotherapy, approximately 80 percent who the effects of chemotherapy on bone marrow.
have a stem cell transplant, and in nearly all patients who
receive radiation for head and neck malignancies. l D
 ry mouth (xerostomia)/salivary gland dysfunction—
Xerostomia occurs as a result of less saliva in the mouth
Before treatment begins, it is important for patients to and can affect speaking, chewing, opening the mouth
understand the causes of oral complications and how to treat and swallowing. Dry mouth for long periods of time can
them in order to reduce symptoms and improve quality of life. also increase the risk of tooth decay and cavities.
l Tooth decay and gum disease—Both can become
Understanding How Treatment significant issues.
Affects Oral Health l I nfection—Viral, bacterial and fungal infections can
Many cancer patients are at high risk for oral complications become problematic because of low white blood cell
due to their cancer treatment or the side effects of their counts, dry mouth, or damage to the mucosa (lining of
cancer treatment. The severity of side effects depends on the the mouth). Infections that start in the mouth can travel
individual and on the cancer treatment itself. The following throughout the bloodstream and affect cells in other
treatments may cause specific oral complications. parts of the body.

FS29 Dental and Oral Complications of Cancer Treatment Facts I page 1

Revised September 2016
 Dental and Oral Complications of Cancer Treatment Facts

l Pain—Pain is associated with nearly all oral problems. the mouth or throat. Some people may gag, cough, or
choke when trying to swallow, while others may feel like
l D
 ifficulty swallowing (dysphagia)—Occurs when a person food is stuck in the throat.
has trouble getting food or liquid to pass down the mouth or
l C
 hanges in taste—These changes can be a side effect of
throat. Some people may gag, cough or choke when trying to
radiation therapy.
swallow, while others may feel like food is stuck in the throat.
l C
 hanges in dental growth and development occur in children.
l C
 hanges in taste—These changes can be a side effect of
chemotherapy. l M
 alnutrition or dehydration—Both can develop when
a person cannot eat or drink due to mouth sores, dry
l N
 eurotoxicity—This is a side effect of a certain class of mouth, pain, changes in taste, or difficulty swallowing.
drugs used in chemotherapy that causes a constant aching, Cancer cells are particularly sensitive to radiation and are
burning pain similar to toothache. damaged by it; however, normal tissue cells will eventually
repair themselves. Therefore, most of the side effects caused
l C
 hanges in dental growth and development occur in
by radiation therapy will subside, in time, after treatment is
children. completed.
l M
 alnutrition or dehydration—Both can develop when a Stem cell transplant. The high doses of chemotherapy
person cannot eat or drink due to mouth sores, dry mouth, typically used before a stem cell transplant may cause dental
pain, changes in taste, or difficulty swallowing. and oral side effects. Patients who receive an allogeneic stem
cell transplant have an increased risk of graft-versus-host disease
Radiation to the head and neck. Radiation therapy may (GVHD). GVHD occurs when transplanted donor cells attack
directly damage oral tissue, salivary glands and bone. Areas the patient’s body. Symptoms of oral GVHD include:
treated by radiation may scar or atrophy (waste away). While
radiation therapy may cause short-term complications, it l mouth sores that are red and ulcerated
can also cause permanent tissue damage that puts a patient l dry mouth due to a decrease in saliva flow
at risk for lifelong oral complications. Oral complications
caused by radiation therapy include: l pain from spices, alcohol, or other flavorings

l B
 reakdown of tissue, bone or muscle in the area
l problems swallowing
receiving radiation—This can make it difficult for l change in taste
patients to open their mouths.
l tightness in the skin or in the lining of the mouth.
l T
 ooth decay and gum disease—Both can become
significant issues. Bone-modifying drugs. Bisphosphonates are a class of
drugs that prevent bone loss. They are often prescribed to
l M
 outh sores (oral mucositis)—Inflammation and myeloma patients, because myeloma can dissolve, weaken
ulceration of the mucous membranes cause pain and and even break bones. Bisphosphonates can help bones
increase the risk of infection. stay strong by slowing down this destructive process. The
standard bisphosphonates for treating bone problems
l I nfection—Viral, bacterial and fungal infections can in people with myeloma are pamidronate (Aredia®) and
become problematic because of low white blood cell zoledronic acid (Zometa®). Patients should understand that
counts, dry mouth, or damage to the mucosa. Infections although bisphosphonates are effective, these drugs also carry
that originate in the mouth can travel throughout the risk to their dental health.
bloodstream and affect cells in other parts of the body.
Bisphosphonate treatment can cause a rare but serious side
l Pain—Pain is associated with nearly all oral problems. effect called “osteonecrosis of the jaw (ONJ).” ONJ causes
l D
 ry mouth (xerostomia)/salivary gland dysfunction—
part of the jaw bone to die, which can lead to pain, open
Xerostomia occurs as a result of less saliva in the mouth. sores and higher risk of tooth loss and infection. Patients
It can affect speaking, chewing, opening the mouth and should have a dental check-up before starting treatment with
swallowing. Dry mouth for long periods of time can also this class of drugs and address any dental problems before
increase the risk of tooth decay and cavities. treatment begins. Doctors will stop the bisphosphonate
treatment if ONJ occurs.
l D
 ifficulty swallowing (dysphagia)—Occurs when a
person has trouble getting food or liquid to pass down

FS29 Dental and Oral Complications of Cancer Treatment Facts I page 2

 Dental and Oral Complications of Cancer Treatment Facts

Before Cancer Treatment l U

 se a lip-care product to prevent your lips from drying
and cracking.
Good dental hygiene, before and during cancer treatment,
may help to either prevent or decrease the associated oral l B
 rush dentures every day, clean with a denture cleaner

complications. Patients should learn about proper dental care recommended by the dentist, and keep dentures moist
so that they can lessen side effects and manage symptoms. when not being worn.
The goal is to treat existing oral problems before treatment
l Pay attention to diet. Try to
begins and to become educated about the potential risks, side
effects and complications of therapy. {{ Choose healthy foods that are mild, soft, and easy to
When treatment is not urgent, patients should visit a dentist chew and swallow.
at least four weeks before treatment starts. A pretreatment oral {{Avoid hot, spicy, highly acidic and crunchy foods that
evaluation will identify problems such as cavities, fractured teeth, may irritate your mouth.
loose crowns or fillings, or gum disease. These problems should
{{Avoid sugary foods, like candy or soda, that can cause
all be addressed in order to reduce the risk of complications.
cavities.
During the pretreatment evaluation, the patient and dentist
{{Avoid alcohol and tobacco products.
should discuss
l potential oral complications caused by cancer treatments l K
 eep your mouth moist during cancer treatments so that
you are more likely to avoid mouth sores. You can
l ways to improve dental and oral health during treatment
{{Drink a lot of water.
l steps to maintain healthy nutrition
{{Suck on ice chips to prevent dryness.
l how to prevent infection and decrease risks
{{Use sugarless gum or hard candy.
l any concerns regarding oral health.
{{Use a saliva substitute.
It is important that patients tell their dentists about all of
their medications and cancer treatments so that they can l A
 sk about fluoride treatments that may be recommended

avoid adverse side effects during dental treatment. to prevent cavities or tooth sensitivity.
Cancer treatment can lower the body’s immune response, l T
 alk with your doctor about ways to improve bone
making it easier for bacteria to spread. Since dental cavities health with vitamin D and/or calcium supplements.
and gum disease are bacterial infections, they should be
treated before, during and after cancer therapies to reduce l L
 ook in your mouth every day and note sores or other

the risk of bacteria infecting other parts of the body. If dental changes. Take steps to help prevent and treat a sore mouth.
problems are treated before cancer treatments begin, there
may be fewer or less severe oral complications. Management of Complications
Call your doctor, nurse, or dentist if you notice oral
During Cancer Treatment complications. The patient and doctor or dentist should work
To decrease the risk of complications such as cavities, mouth together to manage symptoms and treat complications, either
sores and infections during treatment, it is important to with medication or supportive care.
keep the mouth, teeth and gums clean. Patients can take the Mouth rinses. Doctors may suggest mouth rinses to treat
following steps to help improve their oral health: mouth sores. Mouth rinses that contain baking soda and salt,
l Brush teeth and gums two to three times a day. over-the-counter brands, or prescription rinses may soothe
sore spots in the mouth.
l U
 se a fluoride toothpaste with a mild taste—flavorings
can irritate the mouth. Pain medications. Pain medications, including some
narcotics, may be used to relieve mouth pain.
l Gently floss once a day.
Antibiotics. Antibiotics, antiviral drugs, or antifungal drugs
l E
 very 2 hours, rinse the mouth with a solution of water, are used to treat infections.
salt and baking soda to prevent soreness.
Other prescription medications. Oral gels and
l U
 se an antibacterial rinse two to four times a day to medications that will increase saliva may be prescribed
prevent gum disease. because they can help to prevent or lessen mouth sores and
tooth decay.

FS29 Dental and Oral Complications of Cancer Treatment Facts I page 3

 Dental and Oral Complications of Cancer Treatment Facts

Financial Implications l C
 all: (800) 955-4572 (M-F, 9 a.m. to 9 p.m. EST)

Paying for dental care is a concern for many cancer patients. Not l E
 mail: [email protected]

everyone can afford dental insurance, and dental benefits are not l L
 ive chat: www.LLS.org
always an option. This lack of dental healthcare coverage and
financial strain have made access to proper dental care for cancer l V
 isit: www.LLS.org/informationspecialists.

patients a common problem in the United States.

Free Information Booklets. LLS offers free education
It is important that patients educate themselves about their and support booklets that can either be read online or
medical and dental insurance coverage and its limitations downloaded. Free print versions can be ordered. For more
before they begin cancer treatments. For instance, Medicare information, please visit www.LLS.org/booklets.
does not cover dental care. Medicaid may not either, depending
on your state. Patients should share their financial concerns Información en Español (LLS information in Spanish).
with their medical and dental teams and find out if there are For more information, please visit www.LLS.org/espanol.
any financial resources available to them. See Other Resources
on page 5, for organizations that may be able to help. Telephone/Web/Video Education Programs. LLS
offers free telephone/Web/Video education programs for
patients, caregivers and healthcare professionals. For more
Acknowledgement information, please visit www.LLS.org/programs,
LLS gratefully acknowledges www.LLS.org/educationvideos, and www.LLS.org/professionaled.
Online Blood Cancer Discussion Boards and Chats.
Larry Coffee, DDS, Founder, Dental Lifeline Network Online discussion boards and moderated online chats can
and provide support and help cancer patients to reach out to
others in similar circumstances and share information. For
Nevin Waters, DDS, Cancer Survivor more information, please visit www.LLS.org/chat or
for their review of Dental and Oral Complications of Cancer www.LLS.org/discussionboard.
Treatment Facts and for their important contributions to the
material presented in this publication. LLS Community. LLS Community is an online social
network and registry for patients, caregivers and supporters
of those with blood cancer. It is a place to ask questions, get
We’re Here to Help informed, share your experience and connect with others.
To join, visit www.LLS.org/community.
LLS is the world’s largest voluntary health organization
dedicated to funding blood cancer research, education and Sign Up For an E-newsletter. Read the latest
patient services. LLS has chapters throughout the United disease-specific news, learn about research studies and clinical
States and in Canada. To find the chapter nearest to you, visit trials, and find support for living with blood cancer. Please visit
our Web site at www.LLS.org/chapterfind or contact www.LLS.org/signup.
The Leukemia & Lymphoma Society LLS Chapters. LLS offers community support and services
3 International Drive, Suite 200 in the United States and Canada including the Patti Robinson
Rye Brook, NY 10573 Kaufmann First Connection Program (a peer-to-peer support
Contact an Information Specialist at (800) 955-4572 program), in-person support groups, blood cancer conferences
Email: [email protected]. and other great resources. For more information, please
LLS offers free information and services for patients and l Call: (800) 955-4572
families touched by blood cancers. The following lists
l Visit: www.LLS.org/chapterfind.
various resources available to you. Use this information to
learn more, to ask questions, and to make the most of your Clinical Trials (Research Studies). New treatments for
healthcare team’s knowledge and skills. patients are ongoing. Patients can learn about clinical trials
and how to access them. For more information, please
Consult with an Information Specialist. Information
call (800) 955-4572 to speak with our LLS Information
Specialists are master’s level oncology social workers, nurses
Specialists who can help conduct clinical-trial searches.
and health educators. They offer up-to-date disease and
treatment information. Language services for non-English Advocacy. The LLS Office of Public Policy (OPP)
speakers are available. For more information, please engages volunteers who advocate for policies and laws that

FS29 Dental and Oral Complications of Cancer Treatment Facts I page 4

 Dental and Oral Complications of Cancer Treatment Facts

encourage the development of new treatments and improve References

access to quality medical care. For more information, please
Dental and oral health. Cancer.Net [online].
l Call: (800) 955-4572 www.cancer.net/navigating-cancer-care/side-effects/dental-and-
oral-health. Accessed August 9, 2016.
l Visit: www.LLS.org/advocacy.
Epstein JB, Murphy BA. Late effects of cancer and cancer
therapy on oral health and quality of life [review]. Journal of the
Other Resources Massachusetts Dental Society. 2010;59(3):22-27.

Bureau of Primary HealthCare Gilliam, K. What the dental professional must know about
http://bphc.hrsa.gov/about/index.html bisphosphonate medications. RDH Journal [online]. www.
(877) 974-2742 rdhmag.com/articles/print/volume-26/issue-10/feature/what-
the-dental-professional-must-know-about-bisphosphonate-
HRSA Health Centers are for patients, even if they do not have
medications.html. Accessed August 9, 2016.
health insurance. Patients pay what they can afford based on
income. Health centers provide services that include checkups National Institute of Dental and Craniofacial Research,
and treatment but also may provide oral health services. National Cancer Institute, National Institute of Nursing
Patients should contact the health center organization directly Research, Centers for Disease Control and Prevention.
to confirm the availability of specific services and to make an Oral health, cancer care, and you Series. www.nidcr.nih.gov/
appointment. OralHealth/Topics/CancerTreatment/. Accessed August 9,
2016.
Dental Lifeline Network
www.dentallifeline.org National Institutes of Health; National Cancer Institute.
(888) 471-6334 Oral complications of chemotherapy and head/neck radiation.
www.cancer.gov/about-cancer/treatment/side-effects/mouth-
To provide access to comprehensive dentistry for society’s most
throat/oral-complications-pdq. Accessed July 2016.
vulnerable individuals with disabilities or those who are elderly
or medically at-risk and have no other way to get help.
This publication is designed to provide accurate and authoritative information
in regard to the subject matter covered. It is distributed as a public service by
Medicare Rights Center The Leukemia & Lymphoma Society (LLS), with the understanding that LLS is
www.medicarerights.org not engaged in rendering medical or other professional services.
(800) 333-4114
The Medicare Rights Center works to ensure access to
affordable healthcare for older adults and people with
disabilities through counseling and advocacy, educational
programs and public policy initiatives.

FS29 Dental and Oral Complications of Cancer Treatment Facts I page 5