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Jill Meyer-Lippert and Jennifer Brown are co-authors of a series of in-depth articles on the oral side effects of cancer treatment and the importance of getting prompt medical/dental treatment. Treatment delays can compromise outcomes. Being a knowledgeable patient is a must!
Oral and Oropharyngeal cancers include those that occur within the mouth, lips and throat including the base of the tongue, tonsils, soft palate, and the walls of the pharynx. For the purpose of this article, we will encompass these cancers to be called oral cancer.
Cancers occurring in these locations can pose significant side effects during treatments as well as long-term damage to oral health. The severity of oral side effects can depend on many factors, including the type of cancer, the stage, dose and duration of treatment, and current status of overall and oral health of the patient. Also, lifestyle habits including oral hygiene, tobacco and alcohol use can significantly impact the severity of side effects.
Most oral cancers will require surgery, radiation therapy or chemotherapy. Many times a combination of these treatments is required. Each of these forms of treatment have potential to affect the health of the teeth and oral tissue. Some can also affect taste, speech, the ability to swallow and reduce the range of motion of the jaw. Oral cancers and necessary therapies can also potentially have a significant impact on appearance and function in social situations, resulting in self-esteem and psychosocial issues.
Ideally, treatment would be approached by a team of professionals, including oral healthcare professionals to provide education and preventive strategies. This should be done prior to beginning treatments (when possible) to help reduce the severity of potentially dangerous side effects. If this is not offered through the facility and physicians who are providing cancer therapy, it is wise for the newly diagnosed to seek guidance from dental professionals, registered dieticians and speech pathologists for their expertise.
Oral health issues that may be experienced during treatments for oral cancers include, but are not limited to:
• Dry mouth
A lack of salivary flow may be a short-term issue or a lifelong problem due to permanent damage to salivary glands. Learn more about the concerns of dry mouth and tips to alleviate the discomfort and resulting damage to oral health at 11 Ways to Reduce Dry Mouth Discomfort
• Oral Mucositis (OM)
Pain, inflammation and ulcerations of the tissue inside of the mouth is called stomatitis or oral mucositis. OM is normally limited to the timeframe while treatments are taking place, but can be a significant limitation to treatments causing pain, nutritional issues and posing risks for infection. Visit Cancer Treatment and Mouth Sores
• Restricted or limited function of the muscles involved with opening and closing the mouth, chewing and swallowing
A speech and language pathologist who is knowledgeable in this area can provide exercises to minimize or prevent these complications. It is important to begin the prescribed exercises as early as possible and continue through treatment to achieve the greatest success. As impairment of muscle function progresses, treating the issues become increasingly difficult.
• Tooth decay and infections
Teeth are especially susceptible to cavities and infection with a dry mouth environment. Exposure to radiation in the head and neck region can lead to a condition called Radiation Caries where teeth can form cavities very quickly and become severe in a short amount of time. Your dental professional can fabricate custom trays to bathe the teeth in a prescription-strength fluoride to help keep the enamel strong. He or she can also recommend other enamel-protecting agents along with homecare instructions to reduce risks for developing radiation caries, resulting infections or potentially ORN.
• Osteoradionecrosis (ORN)
Radiation therapy to the head and neck can potentially damage the blood flow to the jaw bone and reduce its ability to heal properly. This impairment in healing can result in bone death. This is why removing teeth at high risk may be necessary prior to starting radiation. Once the jaw bone becomes damaged, the likelihood of developing ORN increases dramatically if the jaw bone is traumatized in any way, especially if extractions are needed in these areas. Treating ORN is quite difficult and can result in pain, infections and disfigurement.
Knowledge is power. Understanding potential complications of oral cancer therapies is the best defense to reduce your risks. A proactive and preventive approach to oral health is vital to reduce the impact of these life changing side effects.