Oral Cancer pp 345-360 | Cite as

Oral and Dental Healthcare for Oral Cancer Patients: Planning, Management, and Dental Treatment

  • Kouji KatsuraEmail author
  • Kumiko Aoki


In recent years, the curability of oral cancers has increased because of improvements in cancer treatments, including radiotherapy, surgery, and chemotherapy. However, these treatments frequently cause dental and oral adverse events, including oral dysfunction, mucositis, salivary dysfunction, rampant dental caries, and osteonecrosis of jaws. Such dental and oral adverse events do not only lead to patient discomfort but also to decreased overall survival rate of patients owing to the required change of treatment regimen. Further, patients’ quality of life is negatively influenced because of pain and oral dysfunction, along with concerns regarding adverse events and recurrence of cancer following cancer treatment. Therefore, the prevention and alleviation of such adverse events is paramount in maintaining oral health of patients with oral cancer. This chapter outlines planning and management procedures required to maintain an oral cancer patient’s oral health.


Chemotherapy Dental management Oral adverse event Oral healthcare Radiotherapy 


  1. 1.
    Sonis ST (2004) A biological approach to mucositis. J Support Oncol 2:21–36PubMedGoogle Scholar
  2. 2.
    Sonis ST, Elting LS, Keefe D et al (2004) Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer 100:1995–2025. doi: 10.1002/cncr.20162 CrossRefPubMedGoogle Scholar
  3. 3.
    Keefe DM, Schubert MM, Elting LS et al (2007) Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109:820–831. doi: 10.1002/cncr.224844 CrossRefPubMedGoogle Scholar
  4. 4.
    Stephens LC, Schultheiss TE, Price RE et al (1991) Radiation apoptosis of serous acinar cells of salivary and lacrimal glands. Cancer 67:1539–1543. doi: 10.1002/1097-0142(19910315)67:6<1539::AID-CNCR2820670613>3.0.CO;2-Q CrossRefPubMedGoogle Scholar
  5. 5.
    Arsenian MA (1991) Cardiovascular sequelae of therapeutic thoracic radiation. Prog Cardiovasc Dis 33:299–311. doi: 10.1016/0033-0620(91)90022-E CrossRefPubMedGoogle Scholar
  6. 6.
    Möller P, Perrier M, Ozsahin M et al (2004) A prospective study of salivary gland function in patients undergoing radiotherapy for squamous cell carcinoma of the oropharynx. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 97:173–189. doi: 10.1016/S1079-2104(03)00473-6 CrossRefPubMedGoogle Scholar
  7. 7.
    Little M, Schipper M, Feng FY et al (2012) Reducing xerostomia after chemo-IMRT for head-and-neck cancer: beyond sparing the parotid glands. Int J Radiat Oncol Biol Phys 83:1007–1014. doi: 10.1016/j.ijrobp.2011.09.004 CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Yamashita H, Nakagawa K, Tago M et al (2006) Taste dysfunction in patients receiving radiotherapy. Head Neck 28:508–516. doi: 10.1002/hed.20347 CrossRefPubMedGoogle Scholar
  9. 9.
    Conger AD (1973) Loss and recovery of taste acuity in patients irradiated to the oral cavity. Radiat Res 53:338–347. doi: 10.2307/3573539 CrossRefPubMedGoogle Scholar
  10. 10.
    Ripamonti C, Zecca E, Brunelli C et al (1998) A randomized, controlled clinical trial to evaluate the effects of zinc sulfate on cancer patients with taste alterations caused by head and neck irradiation. Cancer 82:1938–4195. doi: 10.1002/(SICI)1097-0142(19980515)82:10<1938::AID-CNCR18>3.0.CO;2-U CrossRefPubMedGoogle Scholar
  11. 11.
    Fujita M, Ogawa M, Furuki Y et al (1987) Changes of periodontal tissues followed by Co-60 irradiation. Dental Radiology 27:1–9. doi:org/10.11242/dentalradiology1960.27.1 (Japanese)Google Scholar
  12. 12.
    Kielbassa AM, Beetz I, Schendera A et al (1997) Irradiation effects on microhardness of fluoridated and non-fluoridated bovine dentin. Eur J Oral Sci 105:444–447. doi: 10.1111/j.1600-0722.1997.tb02142.x CrossRefPubMedGoogle Scholar
  13. 13.
    Pioch T (2004) Veränderungen der zahnhartsubstanzen. In: Kielbassa AM (ed) Trahlentherapie im kopf- und halsbereich: implikationen für zahnärzte, HNO-ärzte und radiotherapeuten. Schlütersche, HannoverGoogle Scholar
  14. 14.
    Kielbassa AM, Hinkelbein W, Hellwig E et al (2006) Radiation-related damage to dentition. Lancet Oncol 7:326–335. doi: 10.1016/S1470-2045(06)70658-1 CrossRefPubMedGoogle Scholar
  15. 15.
    Epstein JB, Lunn R, Le N et al (1998) Periodontal attachment loss in patients after head and neck radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86:673–677. doi: 10.1016/S1079-2104(98)90202-5 CrossRefPubMedGoogle Scholar
  16. 16.
    Pow EH, McMillan AS, Leung WK et al (2003) Oral health condition in southern Chinese after radiotherapy for nasopharyngeal carcinoma: extent and nature of the problem. Oral Dis 9:196–202. doi: 10.1034/j.1601-0825.2003.02924.x CrossRefPubMedGoogle Scholar
  17. 17.
    Spak CJ, Johnson G, Ekstrand J (1994) Caries incidence, salivary flow rate and efficacy of fluoride gel treatment in irradiated patients. Caries Res 28:388–393. doi: 10.1159/000262007 CrossRefPubMedGoogle Scholar
  18. 18.
    Papas A, Russell D, Singh M et al (2008) Caries clinical trial of a remineralising toothpaste in radiation patients. Gerodontology 25:76–88. doi: 10.1111/j.1741-2358.2007.00199.x CrossRefPubMedGoogle Scholar
  19. 19.
    Hay KD, Thomson WM (2002) A clinical trial of the anticaries efficacy of casein derivatives complexed with calcium phosphate in patients with salivary gland dysfunction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93:271–275. doi: 10.1067/moe.2002.120521 CrossRefPubMedGoogle Scholar
  20. 20.
    Curi MM, Dib LL (1997) Osteoradionecrosis of the jaws: a retrospective study of the background factors and treatment in 104 cases. J Oral Maxillofac Surg 556:540–544. doi: 10.1016/S0278-2391(97)90478-X CrossRefGoogle Scholar
  21. 21.
    Kluth EV, Jain PR, Stuchell RN et al (1988) A study of factors contributing to the development of osteoradionecrosis of the jaws. J Prosthet Dent 592:194–201. doi: 10.1016/0022-3913(88)90015-7 CrossRefGoogle Scholar
  22. 22.
    Murray CG, Daly TE, Zimmerman SO (1980) The relationship between dental disease and radiation necrosis of mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 492:99–104. doi: 10.1016/0030-4220(80)90299-6 CrossRefGoogle Scholar
  23. 23.
    Katsura K, Sasai K, Sato K et al (2008) Relationship between oral health status and development of osteoradionecrosis of the mandible: a retrospective longitudinal study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:731–738. doi: 10.1016/j.tripleo.2007.10.011 CrossRefPubMedGoogle Scholar
  24. 24.
    Marx RE, Johnson RP (1987) Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg Oral Med Oral Pathol 64:379–390. doi: 10.1016/0030-4220(87)90136-8 CrossRefPubMedGoogle Scholar
  25. 25.
    Marx RE (1983) Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 41:283–288. doi: 10.1016/0278-2391(83)90294-X CrossRefPubMedGoogle Scholar
  26. 26.
    Nabil S, Samman N (2011) Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 113:54–69. doi: 10.1016/j.tripleo.2011.07.042 CrossRefGoogle Scholar
  27. 27.
    Reitemeier B, Reitemeier G, Schmidt A et al (2002) Evaluation of a device for attenuation of electron release from dental restorations in a therapeutic radiation field. J Prosthet Dent 87:323–327. doi: 10.1067/mpr.2002.122506 CrossRefPubMedGoogle Scholar
  28. 28.
    Yamagishi K, Yamada T (2002) The effect of tooth brushing instruction for the high risk patients of dental caries and periodontitis after radiotherapy: the change of DMF incidence and bone resorption index. Meirin JDEOH 5:76–78 (Japanese)Google Scholar
  29. 29.
    Katsura K, Goto S, Sasai K et al (2009) The effect of dental management for maintaining dental health in patients with head and neck cancer after radiotherapy. Head Neck Cancer 35:266–272 (Japanese)Google Scholar
  30. 30.
    Hong CH, Napeñas JJ, Hodgson BD et al (2010) A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer 18:1007–10021. doi: 10.1007/s00520-010-0873-2 CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Lilly JP, Cox D, Arcuri M et al (1998) An evaluation of root canal treatment in patients who have received irradiation to the mandible and maxilla. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86:224–226CrossRefPubMedGoogle Scholar
  32. 32.
    Katsura K, Hayashi T (2005) Non-neoplastic process after neck dissection demonstrated on enhanced CT in patients with head and neck cancer. Dentomaxillofac Radiol 34:297–303CrossRefPubMedGoogle Scholar
  33. 33.
    Ihde S, Kopp S, Gundlach K et al (2009) Effects of radiation therapy on craniofacial and dental implants: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107:56–65. doi: 10.1016/j.tripleo.2008.06.014 CrossRefPubMedGoogle Scholar
  34. 34.
    Esposito M, Hirsch JM, Lekholm U et al (1998) Biological factors contributing to failures of osseointegrated oral implants. (II). Etiopathogenesis. Eur J Oral Sci 106:721–764. doi: 10.1046/j.0909-8836.t01-2-.x CrossRefPubMedGoogle Scholar
  35. 35.
    Keller EE, Tolman DE, Zuck SL et al (1997) Mandibular endosseous implants and autogenous bone grafting in irradiated tissue: a 10-year retrospective study. Int J Oral Maxillofac Implants 12:800–813PubMedGoogle Scholar
  36. 36.
    Granström G (2006) Placement of dental implants in irradiated bone: the case for using hyperbaric oxygen. J Oral Maxillofac Surg 64:812–818. doi: 10.1016/j.joms.2006.01.012 CrossRefPubMedGoogle Scholar
  37. 37.
    Saadeh CE, Pharm D (2005) Chemotherapy- and radiotherapy-induced oral mucositis: review of preventive strategies and treatment. Pharmacotherapy 25(4):540–554CrossRefPubMedGoogle Scholar
  38. 38.
    Rogers BB (2001) Mucositis in the oncology patient. Nurs Clin N Am 36:745–760Google Scholar
  39. 39.
    Sánchez-Lara K, Sosa-Sánchez R, Green-Renner D, Rodríguez C, Laviano A, Motola-Kuba D, Arrieta O (2010) Influence of taste disorders on dietary behaviors in cancer patients under chemotherapy. Nutr J 9:15. doi: 10.1186/1475-2891-9-15 CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Aoki K, Obata K, Kurihara M, Kuniyasu H, Kirita T, Takaki M (2013) Possible peripheral mechanism for taste disorder in rats administered S-1. Int J Clin Oncol. doi: 10.1007/s10147-013-0572-3 Google Scholar
  41. 41.
    Potting CMJ, Uitterhoeve R, Op Reimer WS, Van Achterberg T (2006) The effectiveness of commonly used mouthwashes for the prevention of chemotherapy-induced oral mucositis: a systematic review. Eur J Cancer Care 15:431–439CrossRefGoogle Scholar
  42. 42.
    Chandu A, Stulner C, Bridgeman AM, Smith AC (2002) Maintenance of mouth hygiene in patients with oral cancer in the immediate post-operative period. Aust Dent J 47:170–173CrossRefPubMedGoogle Scholar
  43. 43.
    Zenda S, Matsuura K, Tachibana H, Homma A, Kirita T, Monden N, Iwae S (2011) Multicenter phase II study of an opioid-based pain control program for head and neck cancer patients receiving chemoradiotherapy. Radiother Oncol 101:410–414. doi: 10.1016/j.radoncs CrossRefPubMedGoogle Scholar
  44. 44.
    Carew JF, Singh B, Shah JP (2003) Work and staging. In: Jatin P (ed) Oral cancer, 1st edn. Mratin Dunitz, LondonGoogle Scholar
  45. 45.
    Hayter JP, Cawood JI (1996) Oral rehabilitation with endosteal implants and free flaps. Int J Oral Maxillofac Surg 25:3–12CrossRefPubMedGoogle Scholar
  46. 46.
    Korfage A, Schoen PJ, Raghoebar GM, Roodenburg JL, Vissink A, Reintsema H (2010) Benefits of dental implants installed during ablative tumour surgery in oral cancer patients: a prospective 5-year clinical trial. Clin Oral Implants Res 21:971–979. doi: 10.1111/j.1600-0501.2010.01930.x PubMedGoogle Scholar

Copyright information

© Springer Japan 2015

Authors and Affiliations

  1. 1.Division of Oral and Maxillofacial RadiologyNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
  2. 2.Department of Oral and Maxillofacial SurgeryNara Medical University, School of MedicineNaraJapan

Personalised recommendations