Complications, Causes, And Preventive Measures For Oral Cancer

Overview

Oral cancer treatment presents a difficult path, and it is essential to comprehend the potential side effects. Throughout chemotherapy, radiation therapy, or surgery, patients frequently face a range of oral complications. These adverse effects not only influence physical health but also impact overall well-being and quality of life.

This article will examine the typical oral complications linked to cancer treatment, discuss preventive actions, and offer guidance to assist patients in effectively handling these obstacles. Whether you are a patient, caregiver, or healthcare provider, this resource is designed to equip you with information and useful tactics for addressing oral health concerns during cancer treatment.

Oral complications

Chemotherapy complications

A growing number of individuals are now undergoing cancer chemotherapy as outpatients. Hence, it is crucial for dentists to have knowledge about the potential repercussions of cancer chemotherapy. ¹

• Inflammation and sores on the mucous membranes^2,3
• Excessive bleeding in the oral cavity
• Impairment of the nerves

Radiation therapy complications

• Fibrous tissue growth in the mucous membrane of the oral cavity
• Dental caries and periodontal disease
• Degeneration of tissue in the irradiated region
• Deterioration of bone in the irradiated region
• Muscle fibrosis in the irradiated region
• Pain (Oral Mucositis) is an iconic example of a clinically significant and common complication of head and neck radiotherapy⁴

Complications caused by either chemotherapy or radiation therapy

• Inflamed mucous membranes within the oral cavity.^.6 Infections within the oral cavity or that spread through the bloodstream, potentially impacting cells throughout the body
• Modifications in dental growth and development among children
• Malnutrition results from the inability to consume adequate nutrients for health
• Dehydration is due to the inability to intake sufficient water for health
• Dental caries and periodontal disease
• Taste changes⁵
• Dry mouth
• Pain (Oral Mucositis)⁶

Direct and indirect order complication

Radiation therapy has the potential to harm oral tissue, salivary glands, and bone directly. The treated areas may experience scarring or deterioration. Permanent damage to the salivary glands can occur with total-body radiation, leading to alterations in taste perception and dry mouth.

Delayed healing and infection are secondary effects of cancer treatment. The division of cells can be inhibited by both chemotherapy and radiation therapy, resulting in a slower healing process in the oral cavity. Chemotherapy can reduce white blood cell count and compromise the immune system, making individuals more susceptible to infections.

Oral complications in second cancers

Cancer survivors who have undergone chemotherapy, transplants, or radiation therapy are at an increased risk of developing a second cancer later in life. Among transplant patients, oral squamous cell carcinoma is the second most common oral cancer, with the lips and tongue being the most commonly affected areas.

Patients treated for leukaemia or lymphoma have a higher likelihood of developing second cancer. For instance, multiple myeloma patients who have undergone a stem cell transplant using their own stem cells may develop oral plasmacytoma. Transplant patients need to consult a doctor if they experience swollen lymph nodes or lumps in soft tissue areas, as these could be signs of a second cancer.

Causes of oral complications

Chemotherapy and radiation therapy have a significant impact on the oral tissues, causing various complications. The following explains how these treatments affect the mouth:

Inhibition of cell growth

Both chemotherapy and radiation therapy can slow down or halt the growth of rapidly dividing cells, including cancer cells. Unfortunately, this also affects the normal cells in the lining of the mouth, which also grow at a fast pace. Consequently, the growth of these normal cells is hindered, impairing the oral tissues' ability to repair themselves by generating new cells.

Direct damage to oral tissues

Radiation therapy directly causes damage to the oral tissues, salivary glands, and even the bone structure. This damage can result in complications such as the development of mouth sores, infections, and tooth decay.

Altered bacterial balance

Some of these are beneficial while others are harmful. Chemotherapy and radiation therapy can disrupt the healthy balance of bacteria in the mouth and salivary glands by altering their lining. This imbalance can lead to issues such as dry mouth, impacting oral health negatively.

Weakened immune system

Chemotherapy has the potential to reduce the number of white blood cells and weaken the immune system, making it more susceptible to infections in the oral cavity. It is crucial to prevent and manage oral complications during cancer treatment to preserve overall health and enhance the quality of life. Effective management of these challenges can be achieved through proper planning involving a team of healthcare professionals and specialists.

Preventive measures

When it comes to preventing and managing oral complications during cancer treatment, it is crucial to take a proactive approach. Here are some evidence-based preventive measures:

Pre-treatment dental assessment

Before initiating cancer treatment, it is important for all patients to undergo a comprehensive dental check-up. This assessment helps in identifying any existing oral health issues and potential risk factors. Addressing dental concerns at an early stage ensures that patients can receive necessary treatments without any limitations during their cancer therapy

Oral hygiene maintenance

Maintaining regular oral care is essential throughout the treatment process. Patients should follow proper brushing and flossing techniques. Professional dental cleanings play a significant role in maintaining oral health and preventing complications

Saliva substitutes and moisturizers

Xerostomia (dry mouth) is a common side effect. It is important to encourage patients to use saliva substitutes or artificial saliva products. Staying hydrated and using lip balms can also help alleviate dry mouth symptoms

Nutrition recommendations

Altered taste perceptions due to treatment can impact appetite. It is advisable to provide dietary guidance to address these changes. For patients experiencing swallowing difficulties, it is recommended to consume soft, moist, and easily digestible foods

Managing pain

Despite the availability of various treatment options, there remains a lack of agreement on how to prevent Oral Mucositis, particularly in young individuals. The current guidelines for managing Oral Mucositis are extremely restricted, and the approach to addressing this complication has primarily focused on providing palliative care. ⁷ Discomfort caused by oral mucositis and other complications can be alleviated through pain management strategies, including the use of topical anesthetics and analgesics. Regular follow-ups with the dental team allow for necessary adjustments to be made

Continuing dental check-ups

Following treatment, it is important for patients to maintain regular dental visits. This is crucial for long-term oral health maintenance. Monitoring for potential late effects, such as osteoradionecrosis, ensures timely intervention when needed

Summary 

Cancer treatments, such as radiotherapy, chemotherapy, immunotherapy, and targeted therapy, often result in unavoidable side effects or complications. The oral cavity is particularly susceptible to these effects due to the rapid turnover of oral mucosal cells and the intricate structures within and surrounding it, such as the jawbones, teeth, periodontium, and salivary glands. Since the oral structures play vital roles in essential functions like eating, speaking, and swallowing, the short and long-term adverse effects on oral health can significantly impact the overall health and quality of life of patients. It is crucial to comprehend the epidemiology, risk factors, and mechanisms that contribute to oral complications, as well as stay updated on advancements in oral care and management for these patients.

FAQs

Does oral chemo have side effects?

While oral chemotherapy attains comparable efficacy to IV chemotherapy, it can induce similar side effects. Each patient and medication varies in their response.

What are the 2 most common side effects of radiation?

The primary initial symptoms that are frequently experienced include fatigue (feeling exhausted) and alterations in the skin. Additional early symptoms typically pertain to the specific region undergoing treatment, such as hair loss and oral complications when radiation therapy is administered to that particular area. Late side effects may manifest after several months or even years.