Cancer is a difficult diagnosis. It affects every person differently. Beyond the prognosis, there’s information to process, treatments to consider, and lifestyle adjustments to make. Cancer treatment itself impacts every part of your body and your life. That includes your mouth and your approach to daily oral care.
During cancer treatment, the first signs of infection often appear in the mouth. If not stopped fast, oral complications can quickly compromise the health of your entire body. Below, MDA dentists share what you need to know about your oral health to help keep you as well as possible during this challenging time.
Cancer Treatment & the Body-Mouth Connection
Michiganders undergoing cancer treatments like radiation and chemotherapy are at high risk for illness and infection—particularly oral infections.1 Radiation and chemotherapy can effectively fight many types of cancers. However, they also take a toll on the body. They suppress the immune system and make it harder to fight infection.
Radiation and chemotherapy work by targeting the fast-growing, rapidly dividing cells associated with cancer. Unfortunately, they also destroy healthy blood and bone marrow cells. White blood cells, the body’s primary infection-fighting cells, may be impacted the hardest.
When your body’s battling cancer and facing treatment, secondary illnesses can quickly become significant health concerns. Diseases that start in the mouth, like cavities, gingivitis, and small ulcers (canker sores), can turn into widespread illnesses. As oral infections spread, they push an already struggling and suppressed immune system to its limits. If not stopped fast, an oral infection may force you to delay cancer treatment until your body is strong enough to resume.
Cancer Treatment: Common Oral Health Complications
Those undergoing immunocompromising cancer treatments are at a higher risk of several oral health conditions,2 including:
- Dry mouth caused by low saliva production. Chronic dry mouth can result in mouth ulcers, inflamed gums, cavities, and oral infection.3 Staying hydrated helps reduce dry mouth conditions where oral bacteria thrive. Taking a prescribed saliva stimulant may help with the overall flow of saliva.
- Soft tissue infections associated with dry mouth and gingivitis. When the tender, soft tissues of your gums cannot fend off the bacteria in your mouth, it can lead to infections that may spread to other areas of the body.
- Mouth ulcers may develop early in chemotherapy, affecting the inner cheek, lips, or tongue. These are very painful and leave you vulnerable to infection. Your MDA dentist can help provide timely treatment to manage and prevent them from worsening.4
- Bleeding gums may signify weakened soft tissue, the early stages of gingivitis, or bacterial infection. Bleeding may be worse just after chemotherapy or radiation. After treatment, platelet cell counts are lower, and your body’s ability to clot is compromised.
- Jaw stiffness and soreness are common in those treated for head and neck cancers. It may be hard to chew and swallow. Your MDA dentist can show you at-home stretching exercises to help reduce pain and tenderness.
- Loss of taste or changing tastes associated with cancer therapies. Foods may taste more acidic or metallic as the result of receptor cells affected by therapies.5
- Tooth pain and sensitivity may be signs of severe tooth decay caused by chemotherapy’s effect on oral bacteria and saliva production. Excessive vomiting from cancer treatment may also weaken tooth enamel (acid erosion) and contribute to tooth decay.
If you experience symptoms of these oral health conditions, contact your MDA dentist as soon as possible.
While the severity of cancer treatment-related oral health complications varies, timely treatment is always essential. Some people may never experience severe symptoms. For others, an oral infection can cause them to delay cancer treatment. That’s why, from the moment you receive a cancer diagnosis, your dentist becomes an important member of your cancer care team.6
Fluoride: Extra Protection During Cancer Treatment
Fluoride helps protect your teeth from excessive decay–and safeguards your oral health–during all phases of cancer treatment. Your MDA dentist may recommend preventative measures like in-office fluoride treatments, prescription toothpastes with high levels of fluoride, or special mouth rinses.
Dental Care Through Every Phase of Cancer Treatment
As a part of your cancer care team, your MDA dentist addresses the oral health implications of your diagnosis. By taking care of your oral health, your dentist helps ensure your mouth stays well enough for your body to undergo cancer treatment.
Here’s what you can expect at routine dental visits before, during, and after treatment:
- Before Treatment: Speak with your dentist as early as four weeks before beginning radiation or chemotherapy.7 At this exam, your MDA dentist will evaluate the overall health of your mouth. They will look for problem areas such as cavities, gum disease, or mouth sores—anything that may worsen after you begin treatment.
- During Treatment: Routine dental checkups are necessary for monitoring your oral and overall health. Your MDA dentist will treat areas of concern before they become larger problems. They will also look for and address common side effects of cancer treatment, like dry mouth or bleeding gums.8 Preventive measures, like in-office fluoride intervention or prescription level fluoride toothpastes, can also be helpful.
- After Treatment: Routine dental care remains essential for cancer survivors. Head and neck cancer survivors may require extended monitoring of their oral health post-treatment.9 Your MDA dentist will ensure that any oral health-related side effects—such as a stiff jaw, gum tenderness, lingering ulcers, and dental changes—get the attention they need.
Throughout your treatment journey, your MDA dentist is here to keep your mouth as healthy as possible. Your dentist and their dental care team are also a resource. They can help by answering your questions and sharing important tips for managing your oral health.
A note about cancer treatment:
The decision to pursue a specific course of cancer treatment is between the person fighting cancer and their medical care team. Address any concerns you have about the side effects of your treatment with your oncologist and care team.
Cancer Care: Maintaining Good Daily Oral Care Habits
Radiation and chemotherapy are intense therapies. It may be hard to take care of yourself during and after treatment. That includes following your regular daily oral care routine. Whether it’s you or a loving caregiver stepping in to help with brushing and flossing, paying close attention to your oral health during this time can help prevent complications.
These simple at-home daily oral care steps can make a big difference:
- Brush twice a day with fluoride toothpaste and a soft toothbrush. For additional defense against tooth decay, talk to your MDA dentist about prescription fluoride toothpaste.
- Floss or use an interdental cleaner daily. Be gentle to avoid hurting sensitive gums.
- Use any dentist-recommended fluoride rinses (alcohol-free).
- Check teeth, tongue, cheeks, and gums for signs of redness and inflammation, infection, patches of discoloration, and areas of pain.
- If you wear dentures, clean them daily.
If you notice anything unusual, contact your MDA dentist as soon as possible to schedule an appointment. Your dentist may recommend additional products or prescribe specific rinses or medications to help care for your mouth, teeth, and gums.
Extra Oral Care Considerations for Head & Neck Cancer Treatment
Michiganders undergoing radiation treatment for head and neck cancers may need to take extra steps.10 These may include applying a special fluoride gel to teeth twice a day and using antibacterial and antifungal rinses or topical anesthetics (as prescribed).
More Mouth-Healthy Tips for Getting Through Cancer Treatment
Practicing a daily oral care routine is an excellent start in keeping yourself healthy throughout your battle with cancer. Beyond brushing, flossing, and rinsing, MDA dentists recommend these additional steps to help improve oral health and ease discomfort:11
- Dry mouth: If you’re suffering from dry mouth, look for ways to stimulate saliva production and protect against bacteria buildup. Sugar-free gum, staying hydrated, using dentist-recommended rinses (alcohol-free), and sucking on ice chips may help. Talk to your MDA dentist about prescription saliva stimulants that may help increase overall saliva flow.
- New soft tissue sensitivity: Avoid foods that may irritate or harm the extra-sensitive soft tissues of your mouth. Sharp, salty foods like chips, pretzels, and hard crackers may irritate your gums and cut the roof of your mouth. Spicy and citrus foods can cause pain in tender areas.
- When it hurts to eat: Chewing and swallowing can become painful after treatment. Stick to softer foods and take smaller bites that are easier to chew. Try nutritious soups and broths; both may help with hydration too. If dental or mouth pain make it too painful to eat or drink, contact your MDA dentist as soon as possible.
- Limit sugar–even juices: Sugar feeds the oral bacteria that cause plaque, tartar, gum disease, and certain oral infections. Cutting down or avoiding sweets and sugary drinks (even those with natural sugars like juice) goes a long way toward protecting your mouth.
- Quit tobacco products: Don’t smoke or use any form of smokeless tobacco products during cancer treatment. All significantly increase the risk of oral infection. The chemicals in cigarettes and other tobacco products may reduce the effectiveness of some chemotherapy drugs.
Your MDA Dentist Is on Your Cancer-Fighting Team
It takes a whole team and a strong support system to battle cancer. No matter the type of cancer you’re facing or the treatment approach you choose, you’re not alone. If you or a loved one are going through cancer treatment, your MDA dentist and their dental care team are here for you.
Michigan Dental Association dentists are medically trained to understand how cancer treatment therapies affect the mouth. They can help you protect yourself from complications that could put your health and cancer treatment at risk. Talk to your MDA dentist about the specific oral health complications that may result from your treatment. With the support of your entire medical care team, you can make the best decisions for your unique needs.
- The American Dental Association & Mark AM. Oral care during cancer treatment (patient handout). J Am Dent Assoc. 2019 Jan;150(1):82. Accessed online: https://doi.org/10.1016/j.adaj.2018.10.019
- National Institute of Dental and Craniofacial Research (NIDCR) & National Institute of Health (NIH). Cancer Treatments & Oral Health. NIDCR/NIH; Reviewed July 2019. Accessed online: https://www.nidcr.nih.gov/health-info/cancer-treatments
- Plemons JM, Al-Hashimi I, Marek CL. Managing xerostomia and salivary gland hypofunction: Executive summary of a report from the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2014 Aug;145(8):867-873. Accessed online: https://doi.org/10.14219/jada.2014.44
- Mayo Clinic. Mouth Sores Caused by Cancer Treatment: How to Cope. Mayo Foundation for Medical Education and Research (MFMER); Reviewed Aug 2020. Accessed online: https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/mouth-sores/art-20045486
- Cancer Treatment Centers of America (CTCA) & City of Hope (COH). Taste and Smell Changes from Cancer and Cancer Treatment. CTCA/COH; Reviewed 29 Apr 2022. Accessed online: https://www.cancercenter.com/integrative-care/taste-and-smell-changes
- Epstein JB, Güneri P, Barasch A. Appropriate and necessary oral care for people with cancer: guidance to obtain the right oral and dental care at the right time. Support Care Cancer. 2014 Jul;22(7):1981-8. Accessed online https://doi.org/10.1007/s00520-014-2228-x
- Yong CW, Robinson A, Hong C. Dental evaluation prior to cancer therapy. Front Oral Health. 18 Apr 2022. Accessed online: https://www.frontiersin.org/articles/10.3389/froh.2022.876941/full
- Elad S, Raber-Durlacher JE, Brennan, MT, et al. Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer. 2015 23:223–236. Accessed online: https://link.springer.com/article/10.1007/s00520-014-2378-x
- PDQ® Supportive and Palliative Care Editorial Board. PDQ Oral Complications of Chemotherapy and Head/Neck Radiation. Bethesda, MD: National Cancer Institute (NCI). Updated 26 Apr 2019. Accessed online: https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq
- Dana-Farber Cancer Institute. Mouth Care for Cancer Patients. Dana-Farber Cancer Institute Health Library. Accessed online: https://www.dana-farber.org/health-library/articles/mouth-care-for-cancer- patients/
- National Institute of Dental and Craniofacial Research (NIDCR) & National Institute of Health (NIH). Chemotherapy and Your Mouth. NIDCR/NIH; NIH Publication No. 13-4361; Aug 2013. Accessed online: https://www.nidcr.nih.gov/sites/default/files/2017-09/chemotherapy-and-your-mouth.pdf