EC Dental Science

Anticancer therapy is associated with a wide range of systemic symptoms, including oral pathologies, such as dry mouth, mucositis, masticatory spasm, osteoradionecrosis, dental caries, opportunistic infections, dysphagia, hypogeusia, dysgeusia, and hyposalivation. Dental professionals are the most qualified experts in the diagnosis and treatment of oral pathologies, as well as their prevention and control in cancer patients receiving radiation therapy or chemotherapy. The aim of the review was to assess domestic and international literature on primary oral complications associated with anticancer therapy. The review also aimed to highlight the importance of dental care in improving the quality of life of these patients, as well as to provide practical guidelines for managing these complications. The search was performed using electronic databases PubMed, eLIBRARY.RU, and Google Scholar. The search yielded 55 literature sources, which were included in the review. Anticancer therapy may result in significant oral pathologies, including mucositis, infections, hyposalivation, changes in taste, and pain. These symptoms can affect various functions of the oral cavity and oropharynx, causing dry mouth and difficulties chewing and swallowing, which impairs nutrition. Moreover, they can affect speech, oral hygiene, denture treatment, and appearance, all of which can be detrimental to oral health, as well as social and emotional wellbeing. These side effects may also reduce compliance with anticancer therapy, affecting treatment outcomes, overall health, and therapy costs. When examining cancer patients, a dental professional must consider the prescribed therapy, as well as potential long-term complications similar to those in patients receiving bisphosphonates. As a result, a cancer patient will continue to receive the necessary treatment, and any new problems will be identified early.

Keywords: Radiation Therapy; Chemotherapy; Complications; Oral Cavity; Dental Patients

1. Shakhzadova AO., et al. “Cancer care to the population of Russia in 2022”. Siberian Journal of Oncology5 (2023): 5-13.
2. Nurieva NS. “The stomatologic complications arising after carrying out of complex treatment of malignant formations of an oral cavity and drinks”. Stomatology1 (2012): 35-39.
3. Eremina AO., et al. “Oral mucositis in patients with oncological pathology of the oropharyngeal region: review”. Head and Neck Tumors (HNT) 3 (2020): 72-80.
4. Kochurova E and Mukhanov A. “Local complications during radiation and chemotherapeutic treatment of patients with squamous cell carcinoma of the oral mucosa”. Voprosyi Onkologii2 (2018): 166-170.
5. Makeeva IM., et al. “Oral status of patients in need of cancer chemotherapy”. Medical Alphabet 22 (2022): 32-37.
6. Brook I. “Early side effects of radiation treatment for head and neck cancer”. Cancer Radiotherapy5 (2021): 507-513.
7. Zurnachyan AA. “Oral complications of radiotherapy: approaches to prevention and treatment”. Kazan Medical Journal3 (2015): 397-400.
8. O’Neill EA., et al. “Dental complications of radiation therapy in children with neoplasms in the head and neck”. Pediatricheskiy Vestnik Yuzhnogo Urala 1 (2022): 39-45.
9. Lalla RV., et al. “Oral mucositis due to high-dose chemotherapy and/or head and neck radiation therapy”. Journal of the National Cancer Institute Monographs 53 (2019): 011.
10. Senesse P., et al. “Head and neck cancer patients treated with concomitant chemoradiotherapy involving the oral cavity and oropharynx: is another choice possible than prophylactic gastrostomy?” Current Opinion in Oncology 3 (2024): 128-135.
11. Obukhov Yu A., et al. “Radiation caries in patients receiving cancer therapy: a review of the literature and their own clinical observations”. Russian Journal of Pediatric Hematology аnd Oncology4 (2018): 40-50.
12. McCaul LK., et al. “Oral prehabilitation for patients with head and neck cancer: getting it right — the Restorative Dentistry-UK consensus on a multidisciplinary approach to oral and dental assessment and planning prior to cancer treatment”. British Dental Journal 9 (2022): 794-800.
13. Makeeva IM., et al. “Xerostomia and means that facilitate its symptoms”. Stomatology5 (2013): 12-13.
14. Motamed B., et al. “Comparison of the 1 and 2% pilocarpine mouthwash in a xerostomic population: a randomized clinical trial”. BMC Oral Health1 (2022): 548.
15. Abed H., et al. “The association between dental arch length and oral health-related quality of life in head and neck cancer patients post-radiotherapy”. Special Care in Dentistry2 (2023): 111-118.
16. Bykov IM., et al. “Radiation-associated changes in salivation of patients with cancer of maxillofacial region”. Stomatology1 (2018): 67-70.
17. Bhandari S, et al. “Radiotherapy-induced oral morbidities in head and neck cancer patients”. Special Care in Dentistry 3 (2020): 238-250.
18. Lutskaia IK., et al. “Dental prevention of complications of chemotherapy hematologic diseases in children”. Journal of Modern Oncology 2 (2015): 61-66.
19. Tayyar R and Ho D. “Herpes simplex virus and varicella zoster virus infections in cancer patients”. Viruses 2 (2023): 439.
20. Grigorievskaya ZV., et al. “The microbiota of the oral cavity and its significance in the genesis of cancer of the oropharyngeal zone”. Malignant Tumors3 (2020): 54-59.
21. Daveshwar SR., et al. “Quantitative polymerase chain reaction analysis of cariogenic Streptococcus mutans in saliva of oral and laryngeal cancer patients undergoing radiotherapy: a clinical study”. International Journal of Applied and Basic Medical Research 2 (2020): 91-96.
22. Dmitrieva EF and Nurieva NS. “Radiation caries: clinical picture, treatment issues”. Problems of Dentistry 2 (2014): 9-12.
23. Sroussi HY., et al. “Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis”. Cancer Medicine 12 (2017): 2918-2931.
24. de Rabello DGD., et al. “Clinical efficacy of endodontic protocols on reducing cultivable bacteria and endotoxin in infected root canal in patients submitted to head and neck radiotherapy: a randomised clinical trial”. Clinical Oral Investigations 12 (2023): 7199-7207.
25. Wei X., et al. “Nurses’ practice and educational needs in oral care for postoperative patients with oral cancer in ICUs: a multicenter cross-sectional study”. BMC Oral Health1 (2022): 389.
26. Ferrández-Pujante A., et al. “Prevention and treatment of oral complications in hematologic childhood cancer patients: an update”. Children (Basel) 4 (2022): 566.
27. Ribeiro ILA., et al. “Oral mucositis in pediatric patients in treatment for acute lymphoblastic leukemia”. International Journal of Environmental Research and Public Health 12 (2017): 1468.
28. Colella G., et al. “Interventions for the prevention of oral mucositis in patients receiving cancer treatment: evidence from randomised controlled trials”. Current Oncology1 (2023): 967-980.
29. Gevorkov AR., et al. “Supportive care is mandatory for successful radiotherapy and chemoradiotherapy in patients with head and neck tumors”. A. Herzen Journal of Oncology 7.3 (2018): 75-84.
30. Cotomacio CC., et al. “Wound healing process with different photobiomodulation therapy protocols to treat 5-FU-induced oral mucositis in hamsters”. Archives of Oral Biology 131 (2021): 105250.
31. Kadakia KC., et al. “Supportive cryotherapy: a review from head to toe”. Journal of Pain and Symptom Management 6 (2014): 1100-1115.
32. Sedova ES., et al. “The effectiveness of low level laser therapy for prevention and treatment of radiation- induced mice”. Siberian Journal of Oncology2 (2018): 11-17.
33. Treister NS., et al. “A feasibility study evaluating extraoral photobiomodulation therapy for prevention of mucositis in pediatric hematopoietic cell transplantation”. Photomedicine and Laser Surgery 34 (2016): 178-184.
34. Soto M., et al. “Pilot study on the efficacy of combined intraoral and extraoral low-level laser therapy for prevention of oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation”. Photomedicine and Laser Surgery11 (2015): 540-546.
35. Ramos-Pinto MB., et al. “Intraoral versus extraoral photobiomodulation therapy in the prevention of oral mucositis in HSCT patients: a randomized, single- blind, controlled clinical trial”. Support Care in Cancer11 (2021): 6495- 6503.
36. Sur D., et al. “A comprehensive review of the use of antioxidants and natural products in cancer patients receiving anticancer therapy”. Anti-Cancer Agents in Medicinal Chemistry 8 (2022): 1511-1522.
37. Gevorkov AR., et al. “Supportive care is mandatory for successful radiotherapy and chemoradiotherapy in patients with head and neck tumors”. Herzen Journal of Oncology3 (2018): 75-84.
38. Bragante KC., et al. “Efficacy of exercise therapy during radiotherapy to prevent reduction in mouth opening in patients with head and neck cancer: A randomized controlled trial”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 1 (2020): 27-38.
39. Chellappa D and Thirupathy M. “Comparative efficacy of low-level laser and TENS in the symptomatic relief of temporomandibular joint disorders: a randomized clinical trial”. Indian Journal of Dental Research 1 (2020): 42-47.
40. Ren H., et al. “Comparative effectiveness of low-level laser therapy with different wavelengths and transcutaneous electric nerve stimulation in the treatment of pain caused by temporomandibular disorders: a systematic review and network meta-analysis”. Journal of Oral Rehabilitation 2 (2022): 138-149.
41. Slettvoll S., et al. “Tooth extraction prior to radiotherapy for oropharyngeal cancer increases the risk of osteoradionecrosis”. Journal of Oral Science 2 (2023): 87-89.
42. Ruggiero SL., et al. “American association of oral and maxillofacial surgeons’ position paper on medication- related osteonecrosis of the jaws-2022 update”. Journal of Oral and Maxillofacial Surgery 5 (2022): 920-943.
43. Polkin VV., et al. “Osteoradionecrosis of the facial skull: current evidence (literature review)”. Radiation and Risk (Bulletin of the National Radiation Epidemiological Register)2 (2023): 142-156.
44. Teremov DD and Rumyantsev VA. “Osteonecrosis of the lower jaw as a complication of antiresorptive therapy”. Osteoporosis and Osteopathy1 (2023): 40-46.
45. Spevak EM. “Assessment of the information content and effectiveness of new approaches in the diagnosis of bisphosphonate osteonecrosis of the jaws [dissertation]”. Tver (2017).
46. Ramires MCCH., et al. “A combination of phototherapy modalities for extensive lip lesions in a patient with SARS-CoV-2 infection”. Photodiagnosis and Photodynamic Therapy 33 (2021): 102196.
47. Ribeiro GH., et al. “Osteoradionecrosis of the jaws: case series treated with adjuvant low-level laser therapy and antimicrobial photodynamic therapy”. Journal of Applied Oral Science 26 (2018): e20170172.
48. Campos L., et al. “Antimicrobial photodynamic therapy using optical fiber for oral fistula resulting from mandibular osteoradionecrosis”. Photodiagnosis and Photodynamic Therapy 34 (2021): 102247.
49. Carvalho CG., et al. “Guide for health professionals addressing oral care for individuals in oncological treatment based on scientific evidence”. Support Care in Cancer8 (2018): 2651-2661.
50. Epstein JB., et al. “Appropriate and necessary oral care for people with cancer: guidance to obtain the right oral and dental care at the right time”. Support Care in Cancer 7 (2014): 1981-1988.
51. Smirnov DF and Sidorenko LV. “Dental disorders in patients recovered from malignant neoplasms in childhood”. Russian Journal of Pediatric Hematology and Oncology3 (2021): 86-96.
52. Harris JA., et al. “An overview of clinical oncology and impact on oral health”. Frontiers in Oral Health 3 (2022): 874332.
53. Lanzetti J., et al. “Management of oral hygiene in head-neck canсer patients undergoing oncological surgery and radiotherapy: a systematic review”. Dentistry Journal 3 (2023): 83.
54. Levi LE and Lalla RV. “Dental treatment planning for the patient with oral cancer”. Dental Clinics of North America 1 (2018): 121-130.
55. Koster M and Bergsma J. “Problems and coping behaviours of facial cancer patients”. Social Science in Medicine 30 (2019): 569-578.
56. Neilson K., et al. “A longitudinal study of distress (depression and anxiety) up to 18 months after radiotherapy for head and neck cancer”. Psychooncology8 (2013): 1843-1848.
57. Nayak MG., et al. “Quality of life among cancer patients”. Indian Journal of Palliative Care 4 (2017): 445-450.