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!
This article focuses on the impact of metastasized cancer to the bone on oral health.
When cancer advances, certain types of cancer have better chances of spreading (or metastasizing) to specific areas. Cancers that are most likely to spread to the bone include:
- Advanced breast
- Prostate cancer
Other types include
- Cancers of the lung
Treatments used for bone metastases can depend on:
- Where the cancer originated (the primary site)
- Which bones and how many are affected
- The extent of bone damage that has occurred and any Skeletal Related Events, such as bone pain, bone weakness and fractures
- Prior treatments received
- Your general health and quality of life
Treatment options can include, but are not limited to:
- Hormone therapy
- “Bone-building” medications
We will focus on these treatments because of their potential for oral health related side effects.
Chemotherapy poses several potential side effects within the mouth, including dry mouth, mouth sores, loss of taste/taste changes and an increased risk for tooth decay and infections. There are many factors that determine which of these side effects occur:
- The type of chemotherapy
- The dosage
- The duration of treatments
- Current status of overall and oral health of the patient
- Lifestyle habits including oral care, tobacco and alcohol use can have a tremendous impact
Learn more about dry mouth and mouth sores at: 11 Ways to Reduce Dry Mouth Discomfort.
Learn more about cancer treatment and mouth sores at Cancer Treatment and Mouth Sores.
Prostate cancer and some types of breast cancer “feed” off of hormones that are naturally produced in our bodies. In these cases, medications may be given to reduce or prevent production of the hormones. These same hormones also play a role in keeping our bones strong and preventing bone loss.
When hormone levels are reduced, bone loss can occur, including alveolar bone which is the bone structure in your jaw that supports the teeth. When bone loss of the jaw occurs, it results in a condition called periodontal disease. Periodontal disease, if left untreated, can lead to gum infections and tooth loss affecting over-all health and quality of life.
Bone Building Medications
The bones in our body are going through a constant cycle of breakdown (resorption) and rebuilding (remodeling). When bones become weakened due to metastatic cancers or other diseases like osteoporosis, certain medications can slow down or stop the resorption part of the cycle, leading to an increase of new bone development. These drugs are called Bisphosphonates and Denosumab.
As new bone develops with help of medications, it does not form the same blood supply that would occur with normal bone formation. This can put one at risk for a rare side effect called Medication Related Osteonecrosis of the Jaw, also known as MRONJ. Osteonecrosis means “bone death”. The reduced blood supply to the new bone does not provide the same healing abilities and can lead to the death of the bone tissue that makes up the jaw and supports the teeth. MRONJ can have devastating effects that are extremely difficult to manage and treat.
- Pain in the mouth
- A feeling of numbness or heaviness in the jaw
- Swelling in the mouth
- Drainage in the mouth
- Loosening of teeth
- Exposed bone in the mouth
Most cases occur as a result of some type of trauma or invasive dental procedure like a tooth extraction. This is why a thorough dental examination and proactive dental care is so essential BEFORE starting these medications.
Also, a “new normal” of oral health care and prevention will be essential. A meticulous and proactive approach to your daily oral care routine will help prevent dental problems that may lead to complications making traumatic treatments necessary. You should develop a close relationship with your dental professional team that can help you identify your unique needs to prevent oral disease.
More information about Bisphosphonates can be found at Beyond Bisphosphonates – A Closer Look at MRONJ and Cancer Therapy.
Ideally, treatment for metastatic cancers to the bones would include 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 for their expertise.
Knowledge is power. Understanding potential oral complications of 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.