oral cancer سمنار

Muhammed Askar

Mustafa Farhad
Taha Hashim
Mahmoud fadhil
Oral Complications of Cancer Treatment:What the Dental Team Can Do

With over 1.4 million new cases of cancer diagnosed each year and a shift to outpatient management, you will likely see some of these patients in your practice. Because cancer treatment can affect the oral tissues, you need to know about potential oral side effects. Preexisting or untreated oral disease can also complicate cancer treatment. Your role in patient management can extend benefits beyond the oral cavity.
Oral complications from radiation to the head and neck or chemotherapy for any malignancy can compromise patients’ health and quality of life, and affect their ability to complete planned cancer treatment.

For some patients,the complications can be so debilitatingthat they may tolerate only lower doses oftherapy, postpone scheduled treatments,or discontinue treatment entirely. Oralcomplications can also lead to serious systemicinfections. Medically necessary oral carebefore, during, and after cancer treatment canprevent or reduce the incidence and severityof oral complications, enhancing both patientsurvival and quality of life.

Oral Complications Related

to Cancer Treatment

Oral complications of cancer treatment arisein various forms and degrees of severity,depending on the individual and the cancertreatment. Chemotherapy often impairs thefunction of bone marrow, suppressing theformation of white blood cells, red bloodcells, and platelets (myelosuppression).

Oral complications common toboth chemotherapy and radiation

• Oral mucositis: inflammation andulceration of the mucous membranes; canincrease the risk for pain, oral and systemicinfection, and nutritional compromise.• Infection: viral, bacterial, and fungal; resultsfrom myelosuppression, xerostomia, and/ordamage to the mucosa from chemotherapyor radiotherapy.


• Xerostomia/salivary glanddysfunction: dryness of the mouth dueto thickened, reduced, or absent salivaryflow; increases the risk of infection andcompromises speaking, chewing, andswallowing. Medications other thanchemotherapy can also cause salivarygland dysfunction. Persistent dry mouthincreases the risk for dental caries.
• Functional disabilities: impaired abilityto eat, taste, swallow, and speak because ofmucositis, dry mouth, trismus, and infection.

• Taste alterations: changes in tasteperception of foods, ranging fromunpleasant to tasteless.
• Nutritional compromise: poor nutrition from eating difficulties caused bymucositis, dry mouth, dysphagia, and loss of taste.

Other complicationsof chemotherapy• Neurotoxicity: persistent, deep achingand burning pain that mimics a toothache,but for which no dental or mucosal sourcecan be found. This complication is a sideeffect of certain classes of drugs, such asthe vinca alkaloids.• Bleeding: oral bleeding from the decreasedplatelets and clotting factors associated withthe effects of therapy on bone marrow.

Other complications ofradiation therapy• Radiation caries: lifelong risk of rampantdental decay that may begin within3 months of completing radiation treatmentif changes in either the quality or quantityof saliva persist.• Trismus/tissue fibrosis: loss of elasticityof masticatory muscles that restrictsnormal ability to open the mouth.• Osteonecrosis: blood vessel compromiseand necrosis of bone exposed to high-doseradiation therapy; results in decreasedability to heal if traumatized.

Oral Care DuringCancer TreatmentCareful monitoring of oral health is especiallyimportant during cancer therapy to prevent,detect, and treat complications as soon aspossible. When treatment is necessary,consult the oncologist before any dentalprocedure, including dental prophylaxis.

• Examine the soft tissues for inflammationor infection and evaluate for plaque levelsand dental caries.• Review oral hygiene and oral careprotocols; prescribe antimicrobialtherapy as indicated.• Provide recommendations for treatingdry mouth and other complications

Other factors to rememberSchedule dental work carefully. If oralsurgery is required, allow at least 7 to 10days of healing before the patient receivesmyelosuppressive chemotherapy. Electiveoral surgery should not be performed forthe duration of radiation treatment.

Determine hematologic status. If thepatient is receiving chemotherapy, have theoncology team conduct blood work 24hours before dental treatment to determinewhether the patient’s platelet count, clottingfactors, and absolute neutrophil count aresufficient to recommend oral treatment.

Consider oral causes of fever. Feverof unknown origin may be related to anoral infection. Remember that oral signsof infection or other complications may bealtered by immunosuppression relatedto chemotherapy.
evaluate need for antibioticprophylaxis. If the patient has a centralvenous catheter, consult the oncologist todetermine if antibiotics are needed beforeany dental treatment to prevent endocarditis