Oral Complications Related To
Chemotherapy and Radiation in The Head and Neck
radiation therapy are often the first weapon used to fight several types of cancer, including cancer of the head
and neck. These therapies aim at reducing or slow the progression of the cancer cells in order to eliminate or
shrink the tumor. Some patients can find great results when they associate the chemotherapy and radiation with a
healthy lifestyle. Unfortunately, these therapies are not without side effects or
The most common oral complications
related to cancer therapies are mucositis, infection, salivary gland dysfunction, taste dysfunction, and pain.
These complications can lead to secondary complications such as dehydration, dysgeusia, and malnutrition. In
myelosuppressed cancer patients, the oral cavity can also be a source of systemic infection. Radiation of the
head and neck can irreversibly injure oral mucosa, vasculature, muscle, and bone, resulting in xerostomia,
rampant dental caries, trismus, soft tissue necrosis, and osteonecrosis.
Severe oral toxicities can compromise
delivery of optimal cancer therapy protocols. For example, dose reduction or treatment schedule modifications
may be necessary to allow for resolution of oral lesions. In cases of severe oral morbidity, the patient may no
longer be able to continue cancer therapy; treatment is then usually discontinued. These disruptions in dosing
caused by oral complications can directly affect patient survivorship.
Management of oral complications of
cancer therapy includes identification of high-risk populations, patient education, initiation of pretreatment
interventions, and timely management of lesions. Assessment of oral status and stabilization of oral disease
before cancer therapy are critical to overall patient care. Care should be both preventive and therapeutic to
minimize risk for oral and associated systemic complications.
Future research targeted at developing
technologies is needed to:
Reduce incidence and severity of oral
Improve infection management.
Protect salivary gland function.
Minimize risk of chronic sequelae.
Development of new technologies to
prevent cancer therapy–induced complications, especially oral mucositis, could substantially reduce the risk of
oral pain, oral and systemic infections, and number of days in the hospital; and could improve quality of life
and reduce health care costs. New technologies could also provide a setting in which new classes of
chemotherapeutic drugs, used at increased doses, could lead to increased cancer cure rates and longer
It is essential that a multidisciplinary approach be used for oral management of
the cancer patient before, during, and after cancer treatment. This collaboration is pivotally important for the
advancement of basic, clinical, and translational research associated with oral complications of current and
emerging cancer therapies. The pathobiologic complexity of oral complications and the ever-expanding science
base of clinical management require this comprehensive interdisciplinary approach.
In this summary, unless otherwise
stated, evidence and practice issues as they relate to adults are discussed. The evidence and application to
practice related to children may differ significantly from information related to adults. When specific
information about the care of children is available, it is summarized under its own heading.
For additional information about effects of cancer and
chemo please visit cancer effects
Brennan MT, Schubert MM: Oral complications of cancer therapy. In: Yagiela JA, Dowd FJ, Johnson BS, et al.,
eds.: Pharmacology and Therapeutics for Dentistry. 6th ed. St. Louis, Mo: Mosby Elsevier, 2011, pp
Schubert MM, Elting LS, et al.: Updated clinical practice guidelines for the prevention and treatment of
mucositis. Cancer 109 (5): 820-31, 2007.
CA, Woo SB, Hewson I, et al.: A systematic review of bisphosphonate osteonecrosis (BON) in cancer. Support Care
Cancer 18 (8): 1099-106, 2010.
Williams PM, Stevenson-Moore P, et al.: A systematic review of dysgeusia induced by cancer therapies. Support
Care Cancer 18 (8): 1081-7, 2010.
Latortue MC, Hong CH, et al.: A systematic review of oral fungal infections in patients receiving cancer
therapy. Support Care Cancer 18 (8): 985-92, 2010.
Zadik Y, Hewson I, et al.: A systematic review of viral infections associated with oral involvement in cancer
patients: a spotlight on Herpesviridea. Support Care Cancer 18 (8): 993-1006, 2010.
Napeñas JJ, Hodgson BD, et al.: A systematic review of dental disease in patients undergoing cancer therapy.
Support Care Cancer 18 (8): 1007-21, 2010.
DE, Doerr W, Hovan A, et al.: Osteoradionecrosis in cancer patients: the evidence base for treatment-dependent
frequency, current management strategies, and future studies. Support Care Cancer 18 (8): 1089-98, 2010.
RJ, Riesenbeck D, Lockhart PB, et al.: A systematic review of trismus induced by cancer therapies in head and
neck cancer patients. Support Care Cancer 18 (8): 1033-8, 2010.
JB, Hong C, Logan RM, et al.: A systematic review of orofacial pain in patients receiving cancer therapy.
Support Care Cancer 18 (8): 1023-31, 2010.
Pedersen AM, Vissink A, et al.: A systematic review of salivary gland hypofunction and xerostomia induced by
cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 18 (8): 1039-60,
website of the National Cancer Institute (http://www.cancer.gov)