Head & Neck

Dental and Oral Side Effects

Oral and dental complications are common during treatment for head and neck cancer. Radiation therapy, drug therapy and surgery can cause side effects ranging from dry mouth to painful mouth sores, even life-threatening infections. Cancer treatment to this part of the body can affect breathing, speaking, eating, swallowing and other vital functions, which is why it is crucial to prevent, minimize and successfully manage oral and dental side effects.

It’s important to see a dentist before treatment begins to address any decayed teeth, infected gums or mouth infections, particularly if radiation therapy is scheduled. Daily attention to good oral hygiene habits will be essential. Having a healthy mouth during cancer treatment may reduce the severity of side effects and help prevent complications, allowing you to complete your regimen and get the full benefit of your therapies.

A dietitian/nutritionist, speech therapist, dental specialists including your dentist, and supportive care professionals may be involved in your care. They will work with you and your health care team to improve your quality of life and help minimize any oral or dental complications that may arise. Check your mouth daily once treatment begins, as many problems can be seen or felt. Common oral and dental side effects follow.

Dry mouth, or xerostomia (zeer-oh-STOH-mee-uh), occurs when the salivary glands don’t produce enough saliva because of damage from radiation therapy, chemotherapy or other medications. This is uncomfortable and increases your risk of both oral infections and tooth decay (see Nutrition). Ask your doctor about medications that may help.

Infections are a greater risk for many reasons related to cancer treatments, including damage to mouth tissues, a lower white blood cell count (neutropenia) or a weakened immune system (see Side Effects). These therapies, as well as steroids and antibiotics, can also alter the balance of bacteria in your mouth, making you susceptible to a fungal infection commonly called thrush. It typically forms thick white patches on the tongue, throat or lining inside the mouth. Prescription medication will likely be needed, so contact your doctor right away if symptoms appear.

Jaw and/or mouth stiffness can be caused by surgery, radiation therapy or even stress. Often painful, it can interfere with healing and lead to malnutrition. Prevention is very important because the condition is difficult to treat. Ask your health care team about jaw muscle exercises, such as opening your mouth as far as possible without pain, then closing it to repeat. If stiffness occurs, ask about medication to help relax your jaw and mouth muscles.

Mouth pain and soreness can result from surgery, a tumor pressing on a nerve, damaged bone, mouth sores and other causes. Unrelieved oral pain can make eating, chewing and swallowing difficult, preventing you from getting adequate nutrition. Pain can also slow the healing process (see Side Effects). Controlling mouth pain is essential to the success of your treatment as well as your quality of life, so contact your doctor or nurse if your mouth hurts. They may recommend topical medications or other remedies to make you more comfortable.

Oral mucositis (myoo-koh-SY-tis), or mouth sores, can occur when mucous membranes become inflamed. This is common with chemotherapy and is also possible with radiation therapy. Tiny sores begin in the mouth lining and become red, burn-like sores or ulcer-like sores. They can be extremely painful, making it difficult to eat, drink or swallow. Ask your doctor about medications to prevent or minimize them. Report symptoms immediately, as mouth sores are more easily and effectively resolved with early treatment.

Swallowing difficulties, called dysphagia (diz-FAY-jee-uh), and painful swallowing can make getting adequate nutrition a real challenge. Your health care team will examine you to determine the underlying cause, which could be related to treatment or to the cancer itself. You will likely be referred to a speech therapist to learn techniques that will help make swallowing easier. Thickened fluids may also help. Call your doctor right away if you cough or choke while eating.

Taste changes are common for people receiving radiation therapy to the head or neck because cells in the salivary glands and/or taste buds can become damaged. Your sense of smell may also be affected. The condition generally goes away, at least to some degree, gradually within a few months after treatment ends (see Nutrition).

Tooth decay and gum disease are more likely to occur in people who have undergone treatment for head and neck cancer. It’s important to find a dentist experienced in treating cancer survivors and discuss how frequently you should schedule routine dental visits from now on — then stick to the schedule. To help prevent cavities, ask about fluoride gel, and avoid sugary foods and drinks. Sip water throughout the day to help with dry mouth, which contributes to tooth decay.


10 Steps to a Healthier Mouth During Cancer Treatment

  1. Check your mouth daily, and alert your health care team immediately about changes.
  2. Brush your teeth, tongue and gums every four hours and at bedtime with a soft-bristled toothbrush and fluoride toothpaste for sensitive teeth.
  3. Floss daily. Contact your doctor if bleeding occurs.
  4. Rinse your mouth several times a day and always after eating.
  5. Buy alcohol-free mouthwash to avoid irritating your mouth lining.
  6. Wear dentures that fit properly, and leave them out whenever possible to expose your gums to air.
  7. Use unscented lip balm, avoiding oil-based products.
  8. Aim to drink 64 to 80 ounces of caffeine-free beverages a day.
  9. Avoid alcohol and all forms of tobacco.
  10. Find a dentist with expertise in treating cancer survivors.

Additional Resources


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