Oral health’s hidden role in cancer care

Dental care plays a vital role in the health and well-being of cancer patients and survivors. According to oral medicine specialist Tiffany Tavares, DDS, DMSc, maintaining the health of your teeth and mouth before, during and after cancer treatment can significantly reduce complications, improve treatment tolerance and enhance a patient's quality of life.

Oral complications

Life-saving cancer treatments such as conventional chemotherapy and radiation work in part by targeting rapidly dividing cancer cells, said Tavares, an assistant professor/clinical at the UT Health San Antonio School of Dentistry. But cancer cells are not the only fast-growing cells in the body.

Tiffany Tavares, DDS, DMSc

"Epithelial cells, like those of the lining inside of the mouth have rapid turnover - hair and blood cells also rapidly turnover," Tavares said. "So, there are side-effects from these treatments such as hair loss and oral sores, or what we call chemotherapy-induced or radiation-induced mucositis."

"Mucositis can make it difficult for patients to eat, talk or even swallow. When combined with a weakened immune system, since immune cells also have rapid turnover, there is a higher risk of infections such as candidiasis (oral thrush) and herpes infection because the mouth is exposed to bacteria, fungi and viruses," she said. It's important to prevent and, when possible, recognize and manage such complications to protect a patient's overall health."

Immunotherapy, which uses a patient's immune system to attack cancer cells, can impact salivary gland function and the soft tissues in the mouth. It's not uncommon for a patient to experience reduced saliva production or red and white lesions in the mouth due to the immune system's enhanced response.

Osteonecrosis of the jaw is another concern, particularly for patients undergoing treatments that include radiation to the head and neck region or those who are taking bisphosphonates or VEGF (vascular endothelial growth factor) inhibitors. Osteonecrosis occurs when the blood supply to the jaw bone is reduced leading to bone death, which can be caused by these treatments.

"Patients receiving these medications and treatments are at risk for serious dental complications if they have oral trauma or undergo procedures like tooth extractions while on therapy," Tavares said. "That's why a dental evaluation before starting treatment and maintaining good oral hygiene is so important - it helps mitigate these risks."

Critical care before treatment

Before beginning any cancer therapy, dental care is essential. A thorough dental evaluation allows dentists to address any preexisting conditions, such as gum disease, cavities or infections, which could worsen during treatment.

"Having untreated dental issues before starting cancer treatment puts patients at a higher risk of developing serious complications," Tavares said. "Your body's immune system will already be weakened, and if an infection starts in the mouth, it can spread quickly, becoming much harder to manage."

In some cases, Tavares pointed out that therapies such as radiation, especially for head and neck cancers, can affect the salivary glands, leading to chronic dry mouth, which can increase the risk for cavities and infections.

"That's why it's vital to address oral health issues beforehand, so patients can go into treatment with the lowest risk possible," she said.

Maintaining health during treatment

Once cancer treatment begins, maintaining oral hygiene is crucial to prevent complications from arising.

"Good oral hygiene and regular professional cleanings during treatment can help reduce the risk of infections," Tavares said. Because many cancer therapies decrease the body's ability to fight off infections, the mouth can become a breeding ground for bacteria and fungi.

"We recommend patients brush with fluoride toothpaste, use mouth rinses prescribed by their dentist and stay hydrated to maintain saliva production," she said. Dentists can also provide tips on managing dry mouth, including using saliva substitutes.

For patients experiencing oral sores, working with both their oncologist and dentist is essential.

"The oncologist manages the cancer treatment, while we focus on minimizing the oral side effects, so patients can continue eating and receiving their therapies without too much disruption," Tavares said. "The goal is to keep patients as comfortable as possible throughout their cancer journey."

Post-treatment dental care

After cancer treatment, patients may continue to experience oral health issues due to the lingering effects of their therapies.

"Patients need to remain vigilant even after treatment ends. Cancer treatments can have long-lasting effects and addressing oral health issues promptly can prevent them from becoming more serious later on," Tavares said.

"Some patients may have long-term symptoms like dry mouth or an increased risk of oral cancer, especially if they've undergone bone marrow transplants. Regular dental checkups are crucial for catching and managing these late effects," she said.

Tavares values the collaborative role between dental professionals and oncologists in managing cancer patients' overall health.

"It's all about planning ahead and staying on top of potential issues," she said. "If we address oral health before treatment starts, monitor it closely during treatment and manage any late effects afterward, we can significantly improve oral health outcomes and quality of life for cancer patients."

Ultimately, oral health is an essential part of comprehensive cancer care.

"We play a role at every stage, from diagnosis through survivorship, ensuring patients can stay as healthy and comfortable as possible," she added.

To learn more about the School of Dentistry or why they are donning pink this October, visit their website.

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