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Oncology. #Oral Health in the Oncologycal Patient (I)

* Many cancer treatments can have side effects that affect a patient’s mouth, teeth and salivary glands.

* These side effects can cause complications when eating, talking, chewing or swallowing.

* Fortunately, with good care, the risk of these side effects can be reduced or managed if they occur.

Oral complications due to chemotherapy and radiotherapy.

Complications are added medical problems that we encounter due to the illness or the adverse effects of a treatment. These complications may appear over time:

• Early complications, during the active moment of the disease itself or due to the immediate effect of the treatment.

• Late complications, due to the residual effects of the disease and the treatments received.

The appearance of these complications makes recovery slower and more difficult

Why is the oral cavity affected?

Cancer patients have a high risk of suffering oral complications for several reasons:

• Chemotherapy and radiation therapy affect the fast-growing cell renewal cycle (cancer cells), slowing down the creation of new neoplastic cells, and since the cells of the entire gastrointestinal tract have this characteristic (rapid growth and renewal), they look directly affected, diminishing their ability to repair. By not producing new cells at the necessary speed, the capacity of the tissues of the mouth and throat is affected, in order to maintain a state of structural integrity in the face of attacks by bacteria, fungi, viruses, traumatisms by rubbing, etc.

• Radiotherapy and chemotherapy alter the healthy balance of the oral flora. There are many bacteria in the mouth, some good and others bad, if the environment where they live (the mouth) is altered, due to decreased saliva production or tissue alterations (mucous membranes), there will be superinfection, dental caries, etc. This imbalance will also be exploited by fungi (appearing candidiasis), or by viruses (reactivation of a herpes simplex, appearance of herpangina, etc.).

• Radiation therapy also produces direct damage to bone, soft tissues of the mouth (mucous membranes) and salivary glands.

What are the most frequent oral complications due to chemotherapy and radiotherapy? When do they appear? Are they reversible?

The most frequent complications are:

• Mucositis: is the inflammation and painful ulceration of the mucous membranes that line the digestive tract, although it is more common at the level of the mouth, receiving the name of oral mucositis. It is reversible: at the end of the treatment, the mucosa will need between 2-6 weeks to heal completely.

• Alterations of taste: alterations of taste occur in almost 70% of patients undergoing chemotherapy, this alteration is more frequent for salty flavors. Patients receiving chemotherapy may feel an unpleasant taste secondary to the diffusion of the drug into the oral cavity. Likewise, radiation reduces the sharpness of the sensation of sweet, sour, bitter and salty flavors. It is reversible: usually, normality is recovered 2-3 months after cessation of treatment.

• Decreased salivary flow and / or dry mouth: these are the most frequent and disabling sequelae in patients undergoing head and neck radiotherapy. The radiation can cause irreversible damage to the glandular tissue, logically affecting the secretion of saliva. As the accumulated dose increases, the saliva becomes more sparse, sticky and viscous, which causes difficulties in speaking, chewing and / or swallowing. In addition, the dryness of the mucosa increases susceptibility to caries, to infections, mainly mycotic (fungal), and also favors lesions in the mucosa before minimal trauma or friction.

• Osteonecrosis: osteorradionecrosis (ORN) is an aseptic necrosis of irradiated bone, it is presented as exposed bone that does not heal in a period of three months in a patient undergoing irradiation of bone structures. Chemotherapy usually produces acute or immediate alterations (osteoquimionecrosis) that revert at the end of the treatment cycle while radiation, in addition to acute alterations, can cause sequelae in the medium and long term that are sometimes irreversible. The necessary irradiation of the jaw in many tumors of the head and neck, makes this the most frequent location of osteoradionecrosis.

Medications such as bisphosphonates and other newer drugs are sometimes used to reduce the spread of cancer cells in the bone.

An uncommon but serious side effect of these medications is osteonecrosis of the jaw, which causes the weakening and loss of bone in the jaw. This can cause pain, swelling and infection of the jaw, loose teeth and exposed bones.

These are the most frequent oral alterations derived from chemotherapy and radiotherapy of the head and neck and shortly we will tell you a series of recommendations and cares to be taken into account to minimize them as well as how to prevent them and not stop struggling to smile at life.

Sources:
Dr. Marco Antonio Herrera Ruiz

Odontólogo General y Prostodoncista.

AECC (Asociación Española Contra el Cáncer) / Cancer.net / FCOEM (Fundación del Colegio de Odontólogos y Estomatólogos de Madrid)