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

Patient Version
Last Modified: 04/24/2014

Oral Complications Not Related to Chemotherapy or Radiation Therapy



Certain drugs used to treat cancer and other bone problems are linked to bone loss in the mouth.

Some drugs break down bone tissue in the mouth. This is called osteonecrosis of the jaw (ONJ). ONJ can also cause infection. Symptoms include pain and inflamed lesions in the mouth, where areas of damaged bone may show.

Drugs that may cause ONJ include the following:

It's important for the health care team to know if a patient has been treated with these drugs. Cancer that has spread to the jawbone can look like ONJ. A biopsy may be needed to find out the cause of the ONJ.

ONJ is not a common condition. It occurs more often in patients who receive bisphosphonates or denosumab by injection than in patients who take them by mouth. Taking bisphosphonates, denosumab, or angiogenesis inhibitors increases the risk of ONJ. The risk of ONJ is much greater when angiogenesis inhibitors and bisphosphonates are used together.

The following may also increase the risk of ONJ:

  • Having teeth removed.
  • Wearing dentures that do not fit well.
  • Having multiple myeloma.

Patients with bone metastases may decrease their risk of ONJ by getting screened and treated for dental problems before bisphosphonate or denosumab therapy is started.

Treatment of ONJ usually includes treating the infection and good dental hygiene.

Treatment of ONJ may include the following:

  • Removing the infected tissue, which may include bone. Laser surgery may be used.
  • Smoothing sharp edges of exposed bone.
  • Using antibiotics to fight infection.
  • Using medicated mouth rinses.
  • Using pain medicine.

During treatment for ONJ, you should continue to brush and floss after meals to keep your mouth very clean. It is best to avoid tobacco use while ONJ is healing. (See the PDQ summary on Smoking in Cancer Care for information on why it's important for cancer patients to quit smoking.)

You and your doctor can decide whether you should stop using medicines that cause ONJ, based on the effect it would have on your general health.