Dentist visits crucial before starting cancer treatment

This story first appeared in Healthy You - July 2025, The Gazette’s quarterly health publication.

Cancer treatment often evokes images of hair loss and fatigue, but for patients receiving chemotherapy and radiation, it can also take a toll on their oral health.

Mouth sores, infections and jaw deterioration are among the side effects of cancer treatments that can cause great discomfort for patients. Because a body fighting cancer already has a weakened immune system, pre-existing oral health issues can become far worse during treatment.

“Basically, chemotherapy kills almost all dividing cells,” said Dr. Bharat Jenigiri, oncologist and hematologist with Physicians Clinic of Iowa. “So your mouth and [gastrointestinal] tract are the most commonly affected organs.”

Some patients receive radiation treatments orally, but radiation treatment targeting the head and neck as well as chemotherapy can create a number of oral health problems.

The oral cavity is at particular risk of negative side effects during chemotherapy because the treatment focuses on the fastest growing cells, according to Jenigiri. The most common side effect impacting oral health during cancer treatment is oral mucositis, also referred to as mouth sores.

“The mouth and oral cavity have the highest turnover of cells,” he said. “That’s one of the reasons it causes mucositis. Almost every person who goes through the traditional chemotherapy would have some form of mucositis.”

This inflammation in the mouth results in oral ulcers that create a risk of infection. A persistent long-term infection can lead to more serious conditions like jaw necrosis.

“If the infection gets trapped in the jaw, it can lead to long-term deterioration of the jaw, called osteonecrosis,” Jenigiri said. “You could lose the whole jaw.”

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Osteonecrosis of the jaw is more common for patients receiving treatment with drugs called bisphosphonates, or bone strengtheners. This is because while the drugs are meant to slow down the weakening of bones and strengthen bones, they can also make it more difficult for bones like the jawbone to heal.

While mucositis is a prevalent condition during cancer treatment, cases of severe mucositis, which could lead to osteonecrosis of the jaw, have become less common over the years.

Jenigiri estimated that about 50 percent of cancer patients experienced a severe case of mucositis two decades ago. Today, about 25 percent may have a severe case.

“The main thing is it can be significantly painful if it is not addressed early,” Jenigiri said.

In the last two decades, chemotherapies have undergone a shift that has decreased the prevalence of mucositis. More patients are treated with targeted therapies and immunotherapies, rather than cytotoxic chemotherapy, the form of cancer drug focused on killing rapidly dividing cells.

The most effective way to curb the occurrence of oral health symptoms and conditions is to address oral health before beginning cancer treatment.

Dr. David Gratton, associate professor of oral and maxillofacial surgery at the University of Iowa College of Dentistry and Dental Clinics, said meeting with a dentist before starting treatment is key.

“It is very important to make sure oral health is very pristine prior to going in with the chemotherapy,” Gratton said. “Making sure the mouth is as healthy as possible will help minimize the sores and the discomfort that could result, depending on which drugs are used.”

A visit with the dentist should take place within weeks of beginning treatment to address any outstanding oral health conditions such as gingivitis, tooth decay and loose teeth. A cleaning is also recommended.

“If there is any active disease, that should be taken care of before the chemo treatments start,” Gratton said.

If a patient does experience a condition like mucositis, they will often be prescribed symptomatic relief such as pain medicine, mouth rinse solutions, or antibacterial or antifungal treatments.

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Older patients are generally at greater risk of experiencing oral health symptoms during cancer treatment, Gratton said. The type of cancer a patient is being treated for and the delivery method of treatment can also create greater risks.

“Radiation obviously kills the cancer cells, but it also negatively impacts the salivary glands so that the salivary glands don’t produce saliva,” he said. “The mouth becomes very dry. With the ulcers that’s a problem, but also, you’re getting dental decay because of the change in the oral bacteria that are in the mouth. The effect on the salivary glands and the effect on the jawbones themselves can be a problem.”

During cancer treatment, Gratton recommends eating foods that are unlikely to irritate the mouth, such as soft and bland foods. Hot and spicy foods are more likely to create trauma that would exacerbate oral ulcers.

Gratton and Jenigiri said clinical studies seeing solutions for the oral health problems associated with cancer treatments are ongoing.

“MuGard, which is a mucoadhesive barrier film, again not yet approved, but is something that in the future will come out,” Jenigiri said. “They are using lactobacillus, which is one of the things that you use in yogurt, which reduces mucositis severity. So eating yogurt during treatment is felt to be beneficial.”