Oral diseases and quality of life
Common oral conditions in cancer patients
As the population ages and cancer treatments evolve, a growing number of people are living with some type of cancer. Some of these are diagnosed early, and in such cases, treatment is becoming increasingly successful; others, however, are sadly diagnosed too late for the cancer to be cured. Even then, the development of the disease can be controlled and the quality of life maintained for extended periods of time.
Regardless of the time of diagnosis, most people with cancer suffer a considerable loss of quality of life caused by the side effects of treatment or by the actual cancer itself affecting the mouth and by subsequent oral and dental conditions. If left untreated, oral and dental infections may spread and impair the treatment of the cancer, resulting in a poor overall prognosis for the patient.
Potential side effects of chemotherapy and radiation therapy include dryness of the mouth and reduced saliva production, which greatly impair quality of life and result in common infectious conditions in the mouth, including cavities (dental caries), diseases of the gums (gingivitis) and connective tissue (periodontitis), and fungal and viral infections.
After stem cell transplantation, often performed in patients with a blood cancer (leukaemia and preleukaemic conditions) and in patients with severe aplastic anaemia, a graft-versus- host rejection nearly always occurs in the mouth and the GI tract (gastrointestinal tract from the mouth to the intestines). In a graft-versus-host rejection, the transplanted cells attack the tissues in the body, at least initially. The severity of the condition may vary, but the reaction needs to be managed with medication. Such medications weaken the immune system’s ability to fight infection in the body, including the mouth. Oral cancer, which is difficult to treat if not diagnosed at an early stage, may also occur in connection with cancer treatment, although this is rare.
Medication that influences the continuous remodelling of bone tissue is used, particularly in the treatment of advanced prostate and breast cancers that have spread to bone tissue, and also in the treatment of multiple myeloma. One possible side effect of this therapy is localised osteonecrosis (death of bone tissue), particularly in the jawbone. This complication makes the affected area susceptible to infection and often spreads if left untreated. Oral and dental infections increase the risk of the complication, which is often chronic and sometimes difficult to treat. Osteonecrosis of the jawbone also occurs fairly commonly as a side effect of radiation therapy.
Cancer therapy and adjuvant therapies reduce saliva production. Even after successful treatment of the cancer, reduced saliva production makes even previously healthy teeth susceptible to rapid decay without proper care, negatively affecting quality of life. Similarly, the mucous membrane in the mouth is nearly always damaged during both chemotherapy and radiation therapy, making the patient susceptible to both localised and generalised infections, which impair treatment of the cancer.
Maintaining quality of life and oral health
Maintaining good oral health improves quality of life for practically all cancer patients and may also increase life expectancy.
Dry mouth and related problems reduce quality of life, while life expectancy can be affected by infections of oral and dental origin, which may spread and may cause severe complications during the immunodeficiency (impaired immunity) caused by cancer therapies.
With the help of experienced clinical experts, oral and dental infections can usually be treated at one or more timely standard visits while also preserving most teeth and chewing ability. Working together with the treating oncologist is key, particularly in relation to surgical procedures of the mouth, as scheduling these correctly with consideration for the appropriate healing period is essential from the point of view of both chemotherapy and radiation therapy.
Here, too, prevention is always the best and most affordable treatment. Untreated oral and dental infections, often without symptoms, are fairly common. The primary goal is to minimise the risks caused by these infections with either conservative or surgical treatment right after the cancer diagnosis. A secondary option is to use antimicrobial medicines during cancer therapy to prevent the infection from becoming generalised and then to perform the actual treatment for the infection as soon as the patient’s general condition allows. Healthy teeth and a healthy mouth offer a good biological starting point for cancer therapies with respect to the risk and control of infectious complications as well as oral nutrition and general quality of life, including social life.
Diseases of the mucous membrane usually resolve after the cancer treatment ends and the body’s immunity begins to return. Supportive treatment may nonetheless be required for months or years until the body’s immunological response reaches a sufficient level. With the appropriate prevention covering the entire duration of cancer therapy and the subsequent aftercare, most diseases of the teeth and the connective tissue of the mouth, and the often significant dental care costs arising from these, can be avoided.