Impact of radiotherapy and chemotherapy on oral health

General
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Cancer treatment procedures like chemotherapy and radiotherapy preserve lives, yet they are often accompanied by voids in oral health consideration thereby resulting in complications that affect the quality of life of the patient, nutrition and the continuation of treatment without any impediments.

  1. Oral Mucositis
    • Most common side effect especially with the head and neck radiotherapy and certain chemotherapeutic drugs.
    • Painful inflammation and ulceration of the oral mucosa appear usually 7 to 14 days after the onset of treatment.
    • Eating, speaking and risk of solution to infection are interfered with.

  2. Xerostomia (Dry Mouth)
    • Radiotherapy delivered to salivary glands leads to a permanent drop in salivary flow.
    • Chemotherapy may cause temporary dysfunction of the salivary glands.
    • It causes difficulty in swallowing, enhanced chances of caries and oral discomfort.

  3. Opportunistic Infections
    • Immunosuppression predisposes fungal, bacterial and viral infections (most commonly by Candida albicans).
    • These infections aggravate mucositis or may appear on their own.

  4. Taste Alterations (Dysgeusia)
    • A frequent and often disregarded side effect.
    • Leads to loss or distortion of the normal taste sensation thereby affecting appetite and ultimately nutrition.

  5. The Increased Risk of Dental Caries and Periodontal Disease
    • Dry mouth, poor oral hygiene due to pain or fatigue and dietary changes are all known to predispose the patient to these.
    • Rampant caries and gingival inflammation may develop rapidly.

  6. Osteoradionecrosis
    • It is the dreaded complication in radiotherapy of jaws particularly the mandible.
    • If in hypovascularity, the bone becomes necrotic; minor trauma will set it off (even extractions).

  7. Healing
    • Chemo and radio treatments hamper the healing capacity of oral tissues.
    • So, time any dental extractions and surgical interventions in full collaboration with the oncology team.

Dental Management Guidelines:
• Pre-treatment dental evaluation: Eliminate sources of infection, extract hopeless teeth.
• During treatment: Emphasize gentle oral hygiene, use bland rinses (e.g., saline or baking soda) and manage symptoms proactively.
• Post-treatment: Long-term follow-up, fluoride therapy and salivary substitutes may be necessary.