Cancer treatments can affect your entire body, including your teeth and gums. Side effects of treatment may include inflammation of the mucous membranes in the mouth (mucositis), infections, taste changes, dry mouth, pain, tooth decay, gum disease, and sores inside your mouth.

Therefore, good dental health practices are especially important for people living with cancer. Good communication is important, too. Make certain that you inform your dentist about your cancer treatment. You should also inform your oncologist about your dental history and any planned dental work.

As a patient living with cancer, you should:

• Schedule a dental exam and cleaning before cancer treatment begins and periodically during the course of your treatment
• Discuss dental procedures, such as the pulling of teeth or insertion of dental implants, with your oncologist before you start your cancer treatment
• Have your dentist check and adjust removable dentures, if you have them
• Tell your physician about any bleeding of the gums, pain, or unusual feeling in your teeth or gums, or any dental infections

Regular dental hygiene is not that different for people with cancer than it is for people who don't have cancer, but because cancer treatments can affect the teeth and gums, it can be even more important.

If you have cancer, your routine dental hygiene should include:

• Brushing your teeth and tongue after every meal and at bedtime, using a soft toothbrush and gentle stroke
• Gentle flossing once a day to remove plaque (if your gums bleed or hurt, the area that is sore should be avoided, but the other teeth still should be flossed)
• Keeping your mouth moist by rinsing often with water (many medicines cause 'dry mouth,' which can lead to decay and other dental problems)
• Avoiding use of mouthwash that contains alcohol

Use a mirror to check your teeth and gums daily for any changes, such as sores or bleeding gums. If you notice a problem or a change, or experience pain in your mouth, teeth, or jaws, report it to your dentist or oncologist immediately.

Osteonecrosis of the Jaw

Osteonecrosis (pronounced OSS-tee-oh-ne-KRO-sis) of the jaw is an uncommon condition that may involve the loss, or breakdown, of the jaw bone. It can be a serious condition. Symptoms include, but are not limited to:

• Pain, swelling, or infection of the gums
• Loosening of teeth
• Poor healing of the gums
• Numbness or the feeling of heaviness in the jaw

If you experience any of these or other dental symptoms, tell both your oncologist and your dentist immediately and follow your oncologist's recommendations regarding continuation of your cancer treatment. Your oncologist may refer you to an oral surgeon or dental oncologist with experience in osteonecrosis of the jaw.

To diagnose osteonecrosis of the jaw, doctors may use x-rays or tests for infection (microbial cultures). Treatments for osteonecrosis of the jaw may include antibiotics, oral rinses, and removable mouth appliances. Minor dental work may be necessary to remove injured tissue and reduce sharp edges of the bone. Surgery is typically avoided because it may make the condition worse.

Scientists do not know exactly what causes osteonecrosis of the jaw or how often it occurs. This disease has been reported in some cancer patients receiving bisphosphonates. However, a causal relationship between bisphosphonates and osteonecrosis of the jaw has not been established. Some possible factors that may increase the risk of osteonecrosis include:

• Radiation therapy to the head or neck
• Chemotherapy
• Steroid therapy (for example, cortisone)
• Underlying cancer
• Anemia (low blood count) and other blood related disorders
• Infection
• A history of poor dental health
• Gum disease or dental surgery (such as pulled teeth)
• Alcohol abuse or cigarette smoking
• Poor nutrition
• Poor blood circulation or clotting problems

Once your cancer treatment has started, if you experience pain in your mouth, teeth, or jaw—or any other symptom of possible dental problems—tell both your oncologist and dentist immediately.

Dental care is an important element of your overall cancer care. Beginning as soon as possible after your cancer diagnosis, your treatment team should involve your regular dentist or a dental oncologist (a dentist who is specially trained to treat people with cancer).

• Be sure to tell your regular dentist that you are being treated for cancer
• Update your medical history record with your dentist to include your cancer diagnosis and treatments
• Provide your dentist and your oncologist with each other's name and telephone number for consultation

Print form to record information to give to your dentist and oncologist.