Description and Causes

Chemotherapy and radiation therapy to the head and neck may each cause different oral side effects.

Some of the oral complications caused by chemotherapy include the following:

• Nerve damage
• Changes in the growth and development of teeth and jaws in children.
• Mucositis (an inflammation of the mucous membranes in the digestive tract) in the stomach or intestines.
• Easy bleeding in the mouth.

Some of the oral complications caused by radiation therapy to the head and neck include the following:

• Fibrosis (growth of fibrous tissue) in the mucous membrane in the mouth.
• Tooth decay and gum disease.
• Breakdown of tissue in the radiated area.
• Breakdown of bone in the radiated area.
• Fibrosis of muscle in the radiated area.

Radiation therapy and chemotherapy may cause some of the same oral side effects, including the following:

• Mucositis in the mouth.
• Infections in the mouth or that travel through the bloodstream, reaching and affecting cells all over the body.
• Taste changes.
• Dry mouth.
• Pain.
• Changes in dental growth and development in children.
• Malnutrition (lack of nutrients needed by the body for health, often caused by the inability to eat).
• Dehydration (lack of water needed by the body for health, often caused by the inability to drink).
• Tooth decay and gum disease.

Complications may be caused directly or indirectly by anticancer therapy.

Oral complications associated with chemotherapy and radiation therapy may be caused directly by the treatment or may result indirectly from side effects of the treatment. Radiation therapy may directly damage oral tissue, salivary glands, and bone. Areas treated may scar or waste away.

Slow healing and infection are indirect complications of cancer treatment. Both chemotherapy and radiation therapy can affect the ability of cells to reproduce, which slows the healing process in the mouth. Chemotherapy may reduce the number of white blood cells and weaken the immune system (the organs and cells that defend the body against infection and disease), making it easier for the patient to develop an infection.

Complications can be acute or chronic.

Acute complications are those that occur during therapy. Chemotherapy usually causes acute complications that heal after treatment ends.

Chronic complications or late effects are those that continue or develop months to years after therapy ends. Radiation can cause acute complications but may also cause permanent tissue damage that puts the patient at a lifelong risk of oral complications. The following chronic complications commonly continue or occur after radiation therapy to the head and/or neck has ended:

• Dry mouth.
• Tooth decay.
• Infections.
• Taste changes.
• Problems using the mouth and jaw due to tissue and bone loss and/or the growth of benign tumors in the skin and muscle.

Total-body radiation can cause permanent damage to the salivary glands. This can change the way foods taste and cause dry mouth.

Invasive dental procedures can cause additional problems. The dental care of patients who have undergone radiation therapy will therefore need to be adapted to the patient's ongoing complications.