Chemotherapy and radiation therapy may cause changes in the lining of the mouth and the salivary glands, which make saliva. This can upset the healthy balance of bacteria. These changes may lead to mouth sores, infections, and tooth decay.
Chemotherapy may cause a temporary decrease in immune cells, increasing your risk of gum disease and causing them to become red, swollen, and tender. Brushing and eating may become painful, and, in some cases, the gums may also pull away from the teeth, increasing the risk of tooth loss.
Chemotherapy and radiotherapy may have serious effects on developing teeth such as delayed dental development, microdontia, hypoplasia, agenesis and V-shaped and shortened roots [8–10].
Bisphosphonate treatment can cause a rare but serious side effect called “osteonecrosis of the jaw (ONJ).” ONJ causes part of the jaw bone to die, which can lead to pain, open sores and higher risk of tooth loss and infection.
Removing teeth before chemotherapy reduces the risk that tooth decay will spread in the mouth and cause cavities to develop. Treating cavities is extremely difficult in cancer patients, so many dentists and oral surgeons recommend extracting the teeth which eliminates the problem.
Problems such as cavities, broken teeth, loose crowns or fillings, and gum disease can get worse or cause problems during cancer treatment. Bacteria live in the mouth and may cause an infection when the immune system is not working well or when white blood cell counts are low.
You should use toothpaste that contains fluoride. You should also floss your teeth daily. If flossing causes bleeding or soreness, you should avoid that area but continue to floss all of your other teeth. You should avoid using alcohol and tobacco products.
Loose teeth can occur for several reasons, usually some type of trauma to the mouth. However, when you have loose teeth with no apparent cause, this can be a sign of oral cancer.
Patients with head & neck cancer may experience problems with teeth and oral health due to many different causes. While it may seem obvious that the tumor itself may cause damage or destruction of the teeth and jaw, other causes can be implicated.
Oral cancer can present itself in many different ways, which could include: a lip or mouth sore that doesn't heal, a white or reddish patch on the inside of your mouth, loose teeth, a growth or lump inside your mouth, mouth pain, ear pain, and difficulty or pain while swallowing, opening your mouth or chewing.
For most people the side effects were worst in the first few days after treatment, then they gradually felt better until the next treatment. Some said the effects were worse with each successive treatment. Most side effects don't persist and disappear within a few weeks after the end of treatment.
Most chemotherapy side effects go away in time, but some can linger and require monitoring or treatment. Possible long-term side effects of chemo include damage to your heart and peripheral neuropathy, in which damaged nerves can cause pain, weakness or numbness in the extremities – arms, hands, legs and feet.
Remember: Visit your dentist before your cancer treatment starts. Take good care of your mouth during treatment. Talk regularly with your oncologist and dentist about any mouth problems you may have.
Certain treatments like head and neck radiation and chemotherapy can also cause tooth discoloration. Other factors include medications, genetics, and environmental effects. It can also happen naturally, as with age, the enamel gets worn out and the yellow layer of dentin is revealed.
If there's a metallic taste, sometimes a little sweetener, like maple syrup, can help,” Katz said. “If foods taste too sweet, you can add drops of lemon or lime until that's muted. If it tastes too salty, then ¼ teaspoon of lemon juice can erase that. If it's too bitter, you have to add a little bit of sweet.
Oral cancer may present as: patches of rough, white, or red tissue. a hard, painless lump near the back teeth or in the cheek. a bumpy spot near the front teeth.
When white blood cells counts are reported by your physician to be low, avoid dental treatment. Avoid dental treatment for about a week after chemotherapy. Inflammation starts with red gums that may bleed.
If you have this decay-causing bacteria on one tooth, it's possible it could also settle in nearby teeth if the conditions are right. This bacteria can also be spread from person to person in a number of ways, including through sharing food, using the same eating utensils, kissing, sneezing, and coughing.
Special concerns during cancer treatment
Radiation and chemotherapy may trigger more serious dental problems, so keep following the healthy routine you started before treatment. You should also: Rinse more often to ease the effects of dry mouth, which can open the door to tooth decay.
Toothpastes containing SLS should be avoided if you have sore mouth (mucositis), oral ulcers or dry mouth. Biotene 'Dry Mouth Toothpaste' is SLS free, contains fluoride and important salivary enzymes. CTX4 is also SLS free, as is MI paste, and both are good for sensitive mouths.
To help prevent dental caries, a prescription-level fluoride toothpaste is a great recommendation, such as Colgate PreviDent 5000 Dry Mouth.
Tap water should be safe when it comes from a city water supply or a city well that supplies many people with water. It does not need to be filtered. You should boil water that comes from a private well or a small local well, even if you have a filter.