Good Oral Health Can Prevent or Reduce the Severity of Oral Toxicities in Cancer Therapies

The mouth is an important target of cancer therapies, while oral supportive oncology has emerged as a new field in dentistry.

Head and neck radiotherapy, including the oral structures, the teeth, the jawbones, the mandible, and the salivary glands may have a deleterious effect for the patient. Mucositis, oral and systemic infections through the disruption of the oral mucosa, xerostomia, radiation dental decay, radiation-related necrosis of the jawbone, fibrosis, difficulty in food intake, speech problems, sleep problems, work, and other socioeconomic issues are important sequalae related to head and neck radiotherapy [Figure 1]. Bhandari et al. [1] showed that 5 years after radiotherapy to head and neck 97% of the teeth will have developed extensive dental caries if no supportive dental health care measures have been applied (see Figure 1).

A study from Australia described the high nutritional load of patients with head and neck and oral cancer. Some patients described their difficulties in food intake as “a battle to eat”, having oral pain, numbness, taste problems, and dry mouth [2]. The inability to take food may be related to negative effects on patients and their treatment, such as treatment delays, therapy interruptions, and emergency admissions to hospital.

Chemotherapy and hormonal therapies may also have adverse side effects on dental and periodontal disease, while patients with good oral and periodontal health have decreased risk for oral toxicities [3,4,5]. Non-surgical periodontal treatment during chemotherapy can prevent exacerbations of periodontitis and reduce the markers of inflammatory disease [3]. Patients with good oral care and oral health had lower risk of periodontal disease [4]. The above findings are particularly important since dental or periodontal infection are the most important risk factors for medication-related osteonecrosis of the jaw.

Hormonal therapy may affect dental health, too (see Figure 2).

A study showed that patients who receive tamoxifen experience increased tooth loss [5].

New therapies in oncology, such as targeted biological therapies, inhibitors of angiogenesis, immunotherapy, and other drugs, which may be administered in combinations, have changed the profile of oral, dental, and jawbone toxicities [6,7]. Painful oral mucosal ulcers, bleeding, and oral mucosal infections during cancer therapy, or necrosis of the jaw bones, weeks, and months after therapy, may appear as new toxicities, and need our attention to early and effective diagnosis and management [8]. Cases of dental infection and abscess may be representing an early-stage osteonecrosis of the jaw [9].

Based on study findings and science, we can confirm that good oral health can prevent or reduce the oral toxicity of cancer therapies.

Well-informed patients on potential oral problems due to cancer therapy, who were also educated by their dentists to perform good oral hygiene, had less oral toxicity [10]. In another study, preventive oral care protocol, including patient education, prevented or reduced cancer therapy toxicity in adults as well as in pediatric patients [11] (see Figure 3).