Dental care and cancer

Systemic Anti-Cancer Therapy (SACT) can cause soreness and inflammation of the mouth or throat (mucositis). It can make eating and drinking uncomfortable, but there are treatments and self-care measures on the mucositis page that can help while it heals.

Dry mouth (Xerostomia): Reduced saliva production leaves the mouth feeling parched and uncomfortable. Over time, a persistently dry mouth can increase the risk of tooth decay and gum problems.

Infections: The combination of a compromised immune system and changes to the oral environment can make patients more susceptible to fungal infections such as oral candidiasis (oral thrush), as well as bacterial and viral infections.

Gum sensitivity and bleeding: Gum tissues may become more sensitive, and some patients notice bleeding when brushing their teeth.

Pre-chemotherapy dental assessment

Many oncology teams recommend that patients have a dental assessment before starting chemotherapy if this is clinically feasible. Addressing existing dental problems prior to treatment can reduce the risk of complications arising during chemotherapy, when the mouth may be more vulnerable and dental procedures more complex to manage safely.

A pre-treatment dental check may include:

• Identifying and treating active tooth decay or gum disease
• Removing sources of potential infection, such problematic wisdom teeth
• Providing oral hygiene instruction tailored to the patient’s needs
• Discussing preventative strategies, such as fluoride applications, to protect teeth during treatment
• Offering guidance on managing a dry mouth

Self-management tips

Keep your mouth clean

• Brush your teeth or dentures gently with a soft toothbrush at least twice daily with a toothpaste containing fluoride.
• Change your toothbrush every 3 months.
• Check with your cancer team if it is safe to use dental floss. You may experience low platelet levels which can make it difficult to stop any bleeding caused by flossing. This is common with high dose chemotherapy courses for leukaemia or lymphoma.
• Leave your dentures steeping overnight as this can help keep your mouth clean.
• Use a mild toothpaste if regular toothpaste stings.
• Avoid alcohol-based mouthwashes. Alternatively, you can try a salt-water mouthwash by mixing one teaspoon of salt in one glass of tepid water. Remembering not to swallow it.
• Smoking and alcohol can irritate your mouth and make side effects worse. Consider reducing alcohol and speak to your local pharmacy, GP, or cancer team if you would like support to stop smoking (or call the National Quitline on 0800 169 0169). For more information, see the smoking and alcohol webpages.

Tips for a dry mouth

• Sip water regularly throughout the day. You can also suck on ice or sugar-free ice lollies.
• Eat soft, wet foods such as yoghurt, porridge, soup, mashed potatoes, scrambled eggs, and smoothies.
• Use gravy and sauces to make your food easier to swallow.
• Cut food into small pieces & chew slowly.
• Cold foods and drinks can be soothing (Please do not try this if you are on a drug called oxaliplatin).
• Use lip balm to keep your lips from drying out.
• If you’re not eating or drinking normally, wet your mouth at least every 2 hours with mouthwash or a foam.

Post-Chemotherapy Dental Care

• A comprehensive dental examination to assess the current state of teeth and gums
• Professional cleaning to remove plaque and tartar build up that may have accumulated during treatment
• Monitoring for any areas of tooth decay that may have developed
• Personalised preventative advice going forward
• Continued support for dry mouth management if this remains an ongoing issue.
• When to contact your healthcare team
• Seek advice if you are unable to eat or drink enough, mouth pain is severe or worsening, you develop a fever or signs of infection, notice bleeding/significant swelling, or are losing weight.

Bisphosphonates, Denosumab, Anti-angiogenics and Radiotherapy to the jaw

Bisphosphonates (e.g. Zoledronic Acid also called Zometa), denosumab and anti-angiogenics (such as Bevacizumab, Sorafenib or Sunitinib) and radiotherapy to the jaw area can specifically affect your dental health by increasing the risk of a rare but serious condition called osteonecrosis of the jaw (ONJ). ONJ is a rare but serious side effect.  Good oral hygiene and careful dental planning are essential to protect your jawbone.

This booklet provides more information on dental advice for people having anti-resorptive/bone strengthening medication.

Call your cancer team urgently if you experience any of the following:

• Ear pain
• Discharge from your ear
• An ear infection
• Pain in the mouth, teeth or jaw
• Loosening of a tooth

Seek advice if:

• Your dentist advises that you need a tooth extraction or any invasive dental work (contact your cancer team before the procedure goes ahead).

Plan your dental visits

• Have a full dental check-up and complete any necessary dental work before starting bisphosphonates, denosumab and anti-angiogenics, if possible.
• Always inform your dentist that you are receiving bisphosphonates, denosumab, anti-angiogenics or radiotherapy to the jaw before any appointment or check-up.
• Continue with routine dental check-ups during your treatment.

Avoid invasive dental procedures

Try to avoid tooth extractions or dental implants while on these treatments, as this increases the risk of jawbone complications. Routine procedures such as fillings, scaling, and crowns are generally safe, but always consult both your dentist and cancer team first.

Resources

Macmillan resources about mouth problems and cancer

Mouth care after head and neck cancer