Dental and Oral Health

Approved by the Cancer.Net Editorial Board, 06/2019

Listen to the Cancer.Net Podcast: Dental Health During Cancer Treatment, adapted from this content.

Many cancer treatments have side effects that affect a person's mouth, teeth, and salivary glands. Salivary glands make saliva. Dental and oral side effects can make it difficult to eat, talk, chew, or swallow. Fortunately, with good care, you and your doctor can lower the risk of these side effects and manage them if they do happen.

Your general dentist and several other dental health professionals can help with your oral care before, during, and after cancer treatment. These specialists may include:

  • Oral oncologists, who specialize in managing the dental and oral health of people with cancer

  • Oral surgeons, who do surgery of the mouth and jaw

  • Periodontists, who diagnose and treat gum disease

  • Maxillofacial prosthodontists, who replace teeth or other structures in the mouth and jaw

Types of dental and oral side effects

Symptoms or side effects of the mouth caused by cancer or its treatment may include:

  • Dry mouth

  • Thickened saliva

  • Changes in taste

  • Mouth sores

  • Tooth decay

  • Difficulty swallowing

  • Difficulty chewing or opening the mouth

  • Infection

  • Bone disease

  • Inflammation or pain in the lining of the mouth and tongue

  • Higher risk of tooth decay or gum disease

Most of these side effects happen during cancer treatment, but some may start after treatment ends. Either way, most mouth-related side effects are not long-lasting or permanent.

Causes of dental or oral side effects

Not all cancer treatments affect the mouth, teeth, and jaw. But the following treatments may cause specific dental and oral side effects. To learn more about your risk of experiencing these side effects, talk with your health care team.

Radiation therapy to the head and neck. Side effects of radiation therapy to the head and neck may be temporary or continue for several years after treatment. They can include:

  • Dry mouth

  • Decrease in saliva

  • Thickened saliva

  • Infection

  • Increased risk of tooth decay

  • Loss of or change in taste

  • Mouth sores

  • Bone disease

  • Stiffness in the jaw

  • Higher risk of tooth decay and gum disease

Radiation therapy can change the amount and consistency of your saliva. This increases your risk of tooth decay and gum disease. Having good oral hygiene is important in lowering your risk of these conditions. Your dentist may also recommend special fluoride treatments during and after radiation therapy. This treatment, along with a low-sugar diet, can help protect your teeth. Your doctor or dentist may also recommend exercises to prevent stiffness in the jaw.

Learn more about the side effects of radiation therapy.

Chemotherapy. Dental and oral side effects from chemotherapy usually go away soon after treatment ends. They include:

  • Mouth sores

  • Pain in the mouth and gums

  • Peeling or burning of the tongue

  • Infection

  • Changes in taste

  • Temporary decrease in your body’s ability to produce infection-fighting cells

  • Bleeding from your gums

Learn more about the side effects of chemotherapy.

Bone marrow/stem cell transplantation. The high-dose chemotherapy that is usually given before a bone marrow or stem cell transplant may cause dental and oral side effects. These are similar to those described under “chemotherapy” above.

Mouth sores are a common side effect of high-dose chemotherapy used to treat leukemia, lymphoma, or multiple myeloma. People also receive high-dose chemotherapy before a stem cell transplant. The U.S. Food and Drug Administration approved the drug palifermin (Kepivance) to prevent treatment-related mouth sores. People receive palifermin through an intravenous (IV) tube placed into a vein before the transplant.

People who recieve an ALLO bone marrow transplant might also develop a side effect called graft-versus-host disease. This disease may cause:

  • Dry mouth

  • Decreased saliva

  • Mouth sores

  • Sensitivity to spicy or acidic foods

  • Difficulty swallowing

  • Increased risk of tooth decay

Learn more about the side effects of bone marrow transplantation.

Bone-modifying drugs. Medications such as bisphosphonates and other newer drugs are sometimes used to reduce the spread of cancer cells to the bone. They can also be used to treat breast cancer that has spread to the bone or to treat osteoporosis in breast cancer survivors.

An uncommon but serious side effect of these medications is medication-related osteonecrosis of the jaw (MRONJ). MRONJ causes weakening and loss of bone in the jaw. This can sometimes cause pain, infection, loose teeth, and exposed bone around the jaw.

MRONJ can usually be managed with good oral hygiene, antibiotics, or through a simple procedure that removes the piece of bone that is exposed. If your condition does not improve or gets worse, you may need surgery. To lower your risk of MRONJ, visit a dentist before and during cancer treatment that includes bone-modifying drugs to make sure that your mouth is healthy. Learn more about ASCO's recommendations for managing MRONJ on a separate website.

You can also find more information about bone-modifying drugs for breast cancer and multiple myeloma in different sections of this website.

New types of drug therapy. New, effective medicines to treat cancer are being developed all the time. Some of these, called targeted therapies, target specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. Some targeted therapies can have side effects that affect the mouth. For example, drugs called mTOR inhibitors may cause canker sores, a type of mouth sore. Canker sores can be treated with certain gels or rinses prescribed by your health care team.

Immunotherapy. Some types of immunotherapy can cause side effects in the mouth, including mouth sores and salivary gland changes. Learn more about the side effects of immunotherapy.

Other medications. Other medications that help manage cancer symptoms and side effects may also cause dental and oral side effects. For example, pain medications can cause dry mouth. And some mouth rinses that are used to treat infections may discolor teeth.

Preventing dental or oral side effects

People who have good dental health before treatment have a lower risk of these conditions. Therefore, it is important to see a dentist at least 4 weeks before starting cancer treatment so that any possible infections or irritations can be treated.

During these visits, your dentist or oral health specialist can:

  • Treat decayed, broken, or infected teeth and any other dental infection

  • Make sure your dentures fit well and are not irritating your mouth

  • Remove your braces so they do not irritate your cheeks or tongue

Ask your dentist to share details about your oral health with your cancer doctor. This way, both doctors can work together to plan your care.

Typically, you should allow at least 2 weeks for healing between dental surgery and starting cancer treatment. You should also talk with your doctor or another member of your health care team about which mouth problems you should tell your dentist about right away. If you have started cancer treatment and have not seen a dentist, see one as soon as possible.

Regular communication with your health care team is important for preventing dental and oral side effects. If you see a dentist during cancer treatment, it is important that they talk with your oncologist to make sure that any dental treatment you receive is safe for you.

During cancer treatment, the following tips may help improve your oral health and prevent side effects:

  • Gently brush your teeth 2 times a day and floss regularly. Soak an extra-soft toothbrush in warm water to soften the bristles before brushing. Try using a child-size, soft toothbrush if your regular brush is too bulky or uncomfortable. Your doctor may also give you special instructions to lower the risk of bleeding and infection. Ask your dentist if you should use a fluoride gel or rinse. Also, tell your health care team if you notice a lot of bleeding when you floss.

  • Avoid alcohol and extreme textures and flavors in your diet. Your tastes can change due to cancer treatment. In general, see what works for you, but consider eating foods that are soft and mild. Extremely hot, cold, spicy, acidic, or crunchy foods may irritate your mouth. Lower your sugar intake. The bacteria in your mouth use sugar to live, and this process makes the acid that causes tooth decay. If you have specific questions about what to eat, ask a certified dietitian or nutritionist.

  • Promote good bone health. Getting enough vitamin D and calcium each day helps your jaw and teeth stay strong and healthy. Dairy products are good sources of calcium and, if fortified, vitamin D. Other food choices may include fortified juice and fortified breakfast cereals. Talk with your health care team before taking any supplements.

Managing and treating dental or oral side effects

If you have any dental or oral side effects during treatment, let your health care team know right away. Relieving side effects is an important part of cancer care and treatment. This is called palliative care or supportive care.

The specific treatment your doctor recommends will depend on your symptoms. There are several common treatments for dental and oral side effects:

  • Mouth rinses that contain salt and baking soda may help treat mouth sores. However, if you are taking high blood pressure medication, you may need to avoid mouth rinses with salt. There are also a variety of prescription rinses that may soothe sore spots.

  • Pain medications may also be used to treat pain from mouth sores. Medications may be placed directly on the sores, taken by mouth, or given through an IV.

  • Antibiotics, antiviral drugs, and/or antifungal drugs are used to treat infections.

  • Drinking water and sugarless drinks may help manage dry mouth. Sucking on ice chips or having sugar-free chewing gum with xylitol may also help. Avoid things that will dry out the mouth, such as soda, fruit juice, cigarettes, chewing tobacco, and alcohol.

  • Medications that make saliva may help some people prevent or lessen dry mouth. Topical oral gels or other medications may help dry mouth caused by radiation therapy to the head and neck.

Related Resources

Did You Know that Cancer Treatment Can Affect Your Mouth?

Fear of Treatment-Related Side Effects

More Information

International Society of Oral Oncology: Oral Care Education (available in multiple languages)

National Institute of Dental and Craniofacial Research: Cancer Treatments

ASCO answers; Dental and Oral HealthDownload ASCO's free 1-page (front and back) fact sheet on Dental and Oral Health as a printable PDF.