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Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®)

  • Updated: 04/23/2014

Table 2. Oral Complications of Cancer Chemotherapy

Complication  Direct Risk Factor Indirect Risk Factors 
DIC = disseminated intravascular coagulation; HSV = herpes simplex virus.
Oral mucositisMucosal cytotoxicityDecreased local/systemic immunity: local infections, reactivation of HSV
Physical/chemical trauma
Oral infections:
ViralDecreased systemic immunity
FungalDecreased oral mucosal and/or systemic immunity
Salivary gland dysfunction
Altered oral flora (decreased bacterial flora)
BacterialInadequate oral hygieneDecreased oral mucosal and/or systemic immunity
Mucosal breakdownSalivary gland dysfunction
Acquired pathogens
Taste dysfunctionTaste receptor toxicity
XerostomiaSalivary gland toxicityAnticholinergic drugs
NeuropathiesVinca alkaloid, thalidomide, bortezomib drug use; risk for specific drug toxicity variesAnemia, dental hypersensitivity, temporomandibular dysfunction/myofascial pain
Dental and skeletal growth and development (pediatric patients)Specific drug toxicityStage of dental and skeletal maturation
Gastrointestinal mucositis causing secondary changes in oral status including taste, hygiene, and dietary intakeMucosal cytotoxicity: radiation, chemotherapyNausea and vomiting
HemorrhageOral mucositisThrombocytopenia
Physical traumaDecreased clotting factors (e.g., DIC)
Infections (e.g., HSV)