Finding and treating oral problems before anticancer therapy begins can prevent or lessen the severity of oral complications.

Oral complications in patients undergoing treatment for head and neck cancer may be reduced by aggressive prevention measures taken before treatment begins. This will get the mouth and teeth in the best possible condition to withstand treatment.

Preventive measures include the following:

• Eating a well-balanced diet. Proper nutrition can help the body tolerate the stress of cancer treatment, maintain energy, fight infection, and rebuild tissue.



• Learning how to care for the mouth and teeth during and after anticancer therapy. Good dental hygiene helps prevent cavities, mouth sores, and infections.



• Having a complete oral health exam by a dentist familiar with the oral side effects of anticancer treatments.

The cancer care team should include the patient's dentist. It is important to choose a dentist familiar with the oral side effects of chemotherapy and/or radiation therapy. An evaluation of the patient's oral health at least a month before treatment begins usually provides enough time for the mouth to heal after dental work. The dentist will identify and treat teeth at risk for infection or decay, so the patient may avoid having invasive dental treatment during anticancer therapy. The dentist may also provide appropriate preventive care to lessen the severity of dry mouth, a common complication of radiation therapy to the head and neck.

A preventive oral health exam will check for the following:

• Mouth sores or infections.
• Tooth decay.
• Gum disease.
• Dentures that do not fit well.
• Problems moving the jaw.
• Problems with the salivary glands.

Patients undergoing high-dose chemotherapy, stem cell transplant, and/or radiation therapy need an oral care plan in place before treatment begins.

The goal of the oral care plan is to find and treat oral disease that may produce complications during treatment and to continue oral care throughout treatment and recovery. Different oral complications may occur during the different phases of transplantation. Steps can be taken ahead of time to prevent or lessen the severity of these side effects.

Ongoing oral care during radiation therapy will depend on the specific needs of the patient; the dose, locations, and duration of the radiation treatment; and the specific complications that occur.

It is important that patients who have head or neck cancer stop smoking.

Continued smoking slows recovery and increases the risk that the head or neck cancer will recur or that a second cancer will develop. (Refer to the PDQ summary on Smoking Cessation and Continued Risk in Cancer Patients ¹ for more information.)

Glossary Terms

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.

Treatment with drugs that kill cancer cells.

In medicine, a medical problem that occurs during a disease, or after a procedure or treatment. The complication may be caused by the disease, procedure, or treatment or may be unrelated to them.

A health professional who specializes in caring for the teeth, gums, and other tissues in the mouth.

The things a person eats and drinks.

The amount of medicine taken, or radiation given, at one time.

The tissue of the upper and lower jaws that surrounds the base of the teeth. Also called gingiva.

Cancer that arises in the head or neck region (in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx [voice box]).

The science of health, and the practice of cleanliness that promotes good health and well-being.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

A medical procedure that invades (enters) the body, usually by cutting or puncturing the skin or by inserting instruments into the body.

The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.

By or having to do with the mouth.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

Used to prevent disease.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

To come back or to return.

A gland in the mouth that produces saliva.

Refers to a new primary cancer in a person with a history of cancer.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A method of replacing immature blood-forming cells that were destroyed by cancer treatment. The stem cells are given to the person after treatment to help the bone marrow recover and continue producing healthy blood cells.

The response of the body to physical, mental, or emotional pressure. This may make a person feel frustrated, angry, or anxious, and may cause unhealthy chemical changes in the body. Untreated, long-term stress may lead to many types of mental and physical health problems.

A group or layer of cells that work together to perform a specific function.