Radiation treatment (RT) is a primary or adjuvant therapeutic approach that improves patient survival when treating malignant neoplasms in the head and neck areas.⁸

The undesirable effects of radiation on the skin, salivary glands, bone, teeth, and other parts of the stomatognathic apparatus, in addition to the oral mucosa, result in radiotherapy-induced damage to the oral mucosa.⁹Ionising radiation and chemotherapy, either alone or in combination, can seriously harm oral structures and surrounding tissues, regardless of the end result of the therapy.¹⁰ A study was conducted to determine the level of awareness among cancer patients at a particular hospital in Bangalore about the adverse effects of chemotherapy. According to the survey, 70% of cancer patients had information that was at least somewhat competent, whereas 30% had insufficient understanding.¹¹ The pharmacokinetic parameters of a drug plays a very essential role in determining the therapeutic success.¹²

Side effects on dental health:

a) Hyposalivation and xerostomia:

a chronic and frequent side effect of radiation treatment on the head and neck. Hyposalivation can cause oral problems like dental caries and functional limitations like difficulty speaking, swallowing, or sleeping.¹³

This change in saliva and salivary flow may raise the likelihood of bacterial plaque accumulation, oral tissue infections, and the development of "radiation caries," which can cause problems with speech, taste, chewing, and swallowing.¹⁴ Patients with radiation-induced xerostomia are recommended to stay away from substances that might decrease salivary flow, including alcohol and tobacco. It is advised to rinse your mouth often, drink lots of water, chew sugar-free gum. Salivary gland stimulants, such as 2% pilocarpine, are an additional option that can make swallowing and chewing more comfortable.¹⁵ Patients who have had radiation therapy typically see a recovery of their salivary function two to six months or even a year after treatment finishes.¹⁶

(b) Fungal Infections:

The most frequent microbe associated with oral infections in cancer patients is Candida albicans. Candida albicans lesions on the oral mucosa might manifest as detachable white plaques with a reddish underside that remains visible after removal. The patient treatment regimen includes topical antifungal drugs such as ketoconazole and nystatin as well as frequent mouth rinses with chlorhexidine. Chlorhexidine should be given at least 30 minutes before or after administering any antifungal to ensure its effectiveness. Candida albicans is the most common microorganism linked to oral infections in cancer patients.On the oral mucosa, Candida albicans lesions might appear as removable white plaques that, when removed, leave a reddish base behind. The patient's treatment includes topical antifungal drugs like ketoconazole and nystatin as well as frequent mouth washes with chlorhexidine. Chlorhexidine should be given at least 30 minutes before or after administering any antifungal to ensure its effectiveness.¹⁷

c) Viral Infections:

Due to their compromised immune systems, these individuals are more vulnerable to opportunistic infections. Herpes simplex virus (HSV) infection during myelosuppression is one of the most frequent viral problems in HSV-seropositive patients; acyclovir cream, compressed pills, or lyophilized powder for infusion are used to treat these patients.¹⁸

d) Bacterial infection:

Prior to radiation therapy, patients with oral cancer had a high frequency of Streptococcus sp.; however, substantial pathogens were recovered from cancer patients after radiation therapy, including Candida albicans, and Klebsiella species.¹⁹

e) Radiation caries:

The Oral Care Study Group of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology (MASCC/ISOO) reviewed the literature and included 37 head and neck cancer trials. They discovered that the prevalence of dental caries in patients receiving radiation treatment was 24% for those receiving chemoradiation treatment and 21% for those receiving treatment with conventional radiation.²⁰ If a patient with head and neck cancer does not practise good oral hygiene, radiation-associated dental caries can advance rapidly.²¹ In addition to at-home treatment and routine dental check-ups, rigorous oral hygiene is recommended. The occurrence of cavities can be effectively prevented by topical fluoride treatments on a daily basis. This is true for both mouthwash and neutral gel (1% sodium fluoride).

f) Periodontal disease:

Periodontitis is linked to anaerobic Gram-negative bacteria in the tooth biofilm. It causes the tissues that support teeth to irreversibly degrade; this is clinically evident as periodontal pockets and loss of alveolar bone. Above all, it has been demonstrated that treating periodontal infections can both prevent and reverse systemic harmful effects.²² Prior to radiation therapy, instructions on proper dental hygiene and procedures like scaling and root planing should ideally be provided.

g) Oral mucositis:

Patients receiving chemotherapy or radiation therapy may develop inflammatory lesions in their oral mucosa, a disease known as oral mucositis. Acute mucositis is a known side effect of some conventional chemotherapy medications, including fluorouracil, methotrexate, and doxorubicin .²³ Oral mucositis, now believed to be the most dangerous side effect of anticancer treatment, affects 40–80% of chemotherapy patients and almost all head and neck radiation patients.²⁴

h) Trismus:

tonic contraction of the masticatory muscles, which restricts the opening of the mouth, is the hallmark of trismus.²⁵ After extensive head and neck surgery, patients develop severe mastication problems.²⁶ As Radiotherapy doses rise, trismus becomes more common; doses more than 60 Gy have a higher risk of causing trismus. ²⁷ Individuals undergoing treatment for a recurrence who have previously had radiation therapy seem to be more susceptible to trismus than those starting treatment for the first time.²⁸

I) Osteoradionecrosis (ORN):

This is perhaps the most dangerous side effect of radiation therapy and a possible long-term side effect. A region of exposed, devitalized, irradiated bone that does not mend within three to six months in the absence of local tumour illness is defined as osteoradionecrosis.²⁹The incidence rates of ORN recorded over the last few decades demonstrate a substantial relationship between the development of ORN and the RT technique and the given radiation dosage. Early radiotherapy treatments have produced high ORN incidence numbers, frequently above 50%, by administering significant doses to tissues other than the tumour target. Intensity-modulated radiotherapy (IMRT), one of the technological advancements in radiation therapy, has made it possible to administer large doses of radiation directly to the tumour target while sparing nearby healthy tissues.³⁰ Osteonecrosis has already been linked to trastuzumab as a separate risk factor.³¹Radiation therapy induces Xerostomia by either directly damaging salivary acini and ducts, which influence saliva production and secretion, or by indirectly damaging the epithelium and connective tissue.³²The radiation therapy field directly affects the loss of periodontal attachment of the teeth, and it has been demonstrated that this loss is larger when the jaws are incorporated in the irradiated area.³³ Considering the onset of ORN may result in a significant decline in quality of life, it is important to take all preventative and therapeutic measures.³⁴

j) Neurotoxicity:

Radiation, chemotherapy, and surgery are the direct causes of several neurologic side effects that are linked to cancer therapy. Cancer treatment may impact the central and peripheral nervous systems.³⁵ One of the main factors affecting cancer patients' quality of life, particularly in long-term survivors, is neurotoxicity after cancer therapy. Immunotherapies including checkpoint inhibitors and chimeric antigen receptor T cells are linked to distinct and dangerous patterns of neurotoxicity.³⁶ In order to treat neurotoxicity, systemic analgesics are given, and stopping the chemotherapeutic medication frequently relieves symptoms.

Chemotherapeutic drugs:

Understanding the biology of cancer has advanced significantly over time, resulting in the creation of a variety of therapeutic strategies.³⁷Chemotherapy is scheduled according to the kind of cells, how quickly they divide, and how long a particular medication is expected to work. Chemotherapy is therefore usually administered in cycles. The most efficient use of chemotherapy is to destroy quickly dividing cells.³⁸A large number of patients undergoing cancer treatment uses antioxidants but antioxidants alone cannot be used as chemotherapeutic agent but it is proved to improve the therapeutic outcome and improvement in patient complaints when used as an adjuvant in chemotherapy.³⁹

a. Docetaxel:

There were four cases of nausea, two cases of vomiting, stomatitis, and dizziness.⁴⁰

b. Cyclophosphamide:

The most common side effects of the DCP (Dexamethasone‐cyclophosphamide) regimen were oral candidosis and pyogenic infections of the skin, which mostly occurred during phase I and only when the patient had ulcers on their skin and mouth mucosa.⁴¹

c. Carboplatin:

Changes in the parameters of peripheral blood cells, liver and renal function, oral mucosa, nausea, vomiting, and pain were among the assessment items.⁴²

During the tooth development stage, patients receiving antineoplastic therapy frequently exhibit microdontia and agenesis.⁴³

Chemotherapeutic drugs like methotrexate, cyclophosphamide, and cisplatin decrease adult salivary flow which invariably leads to caries.⁴⁴

d. Vincristine, vinblastine, and cyclophosphamide:

The hypo mineralized enamel defects caused by these medicines are attributed to the disruption of the ameloblast microtubule calcium transport system. This is probably because the patients were frequently given chemotherapeutic agents like vincristine, vinblastine, and cyclophosphamide.⁴⁵

Dental intervention:

Pre-chemotherapy:

All potential side effects of chemotherapy that might occur both during and after treatment should be explained to the patient. It is imperative that youngsters receive fissure sealing and crack restoration for newly erupted teeth, particularly molars and premolars.⁴⁶

Counselling and education of all potential oral issues resulting from chemotherapy are crucial for the patient. This need to cover the patient's present state of oral hygiene as well as the pre-, during-, and post-chemotherapy protocols. Chemical substances that cause mutations in cells by damaging their genetic information are said to be genotoxic. An in vitro and in vivo genotoxicity investigation can be used to determine a chemical entity's undesirable effects. It aids in determining the location of DNA damage and the routes of healing. Numerous regulatory bodies in the pharmacy industry are trying to limit genotoxic contaminants and their effects.⁴⁷

Prior to administering chemotherapy, adequate oral health conditions should be sought because the latter's side effects are less severe when the oral cavity is healthy.

.⁴⁸

The patient's overall health state determines whether endodontic therapy or extraction is preferred for acute periapical infections.⁴⁹

Teeth having a doubtful or bad prognosis need to be removed. The best time to do extractions is two to three weeks before to the initiation of chemotherapy.

After a tooth is extracted, the main incision should be closed and sutured. Intra-alveolar haemostatic agents are avoided. If the platelet count is less than 40,000/mm3, platelet transfusion is necessary.

Prophylactic antibiotic use is also required if the granulocyte-to-mm3 ratio is less than 2,000. Furthermore, major surgery should be performed 4-6 weeks before to the start of chemotherapy, and less invasive treatments should be carried out at least 2 weeks beforehand.⁵⁰

During chemotherapy:

It is important to have a proactive preventive treatment strategy for patients with head and neck cancer, since the significance of oral hygiene and basic dental care cannot be overstated. Before receiving radiation therapy and chemotherapy, dentate patients should use 10ml of 0.2% chlorhexidine gluconate mouthwash twice a day for a week in order to treat any gingivitis and keep their mouths free of plaque.⁵¹

When radiation therapy is combined with maxillary surgery, an obturator may be a viable option for maxillary defect rehabilitation; this would need to be scheduled in conjunction with the surgical team. Patients who are dentate or somewhat dentate can have applicator trays manufactured for them to use later in the treatment process when fluoride or chlorhexidine gel is applied.⁵² Dental treatments that are painful and invasive have to be discontinued. Therefore, it is best to avoid doing any extractions or even little surgical operations. Due to the elevated risk of infection, root planing and tooth scaling are not recommended.

Post chemotherapy:

Following chemotherapy, the oncologist is consulted to schedule dental care. The goal of the treatment is to eliminate any residual infection foci and to repair any functional and aesthetic damage. oral hygiene must be maintained post chemotherapy by continuing the usage of fluoridated toothpaste and mouth rinses.

It is recommended to refrain from extractions and other invasive operations for a minimum of one year. But if there is no way to delay the treatments, care must be exercised. Getting covered for antibiotics is the most crucial protection. 48 hours before to the surgery, the antibiotic should be started, and it should last for 7–15 days.

It is advised to use hyperbaric oxygen both before and after extractions. For a year, denture usage should be avoided.⁵³ By choosing and prescribing medications for each individual patient, the pharmacogenomics study addresses variations that make therapy safer and more effective. The medication's toxicity and variable efficacy in each patient are related to it.⁵⁴

CONCLUSION:

Social interaction, mental health, and oral health may all be negatively impacted by speech, oral hygiene, the usage of dental prosthesis, attractiveness, and oral health. Proactive preventive therapy is necessary, and patients with head and neck cancer must emphasise oral hygiene and general dental care. By lowering risk factors through dietary modifications, immunizations, and routine screenings, prevention initiatives can dramatically reduce the occurrence of cancer. The field of personalised medicine has made significant strides in treatment techniques by developing customised medicines based on the unique genetic profiles and characteristics of individual cancers. When these are combined with supportive care, patients' quality of life is improved while meeting their emotional and physical needs. The fight against cancer is still being advanced by ongoing research and cooperation between patients, researchers, and healthcare providers. We can lessen the impact of cancer and improve outcomes for those afflicted by this difficult disease by promoting a comprehensive strategy that incorporates prevention, early identification, individualised treatment, and supportive care.

REFERENCES:

1. Bray F et al. Global cancer statistics, GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2018; 68(6): 394–424. https://doi.org/10.3322/caac.21492

2. R Sangeetha, D Rajendiran, R Soniya, S Savithri. Therapeutic Strategies in Oral Cancer - A Review. Research Journal of Pharmacy and Technology. 2024; 17(3): 1398-2. doi: 10.52711/0974-360X.2024.00221

3. K Swapnil, S Vijay, M Chandrakant. Targeted Drug Delivery: A Backbone for Cancer Therapy. Asian Journal of Pharmaceutical Research. 2013; 3(1): 40-6. available on https://www.indianjournals.com/ijor.aspx?target=ijor:ajpr&volume=3&issue=1&article=009

4. UK Ramavat, PM Suneesh. A Study to Assess the Effectiveness of Flavoured Ice Cube on Level of Oral Mucositis among Cancer patients receiving Chemotherapy in selected Hospital, Rajkot. A and V Pub International Journal of Nursing and Medical Research. 2024; 3(2): 61-3. https://doi.org/10.52711/ijnmr.2024.12

5. Kalsi H, McCaul LK, Rodriguez JM. The role of primary dental care practitioners in the long-term management of patients treated for head and neck cancer. British Dental Journal. 2022; 233(9): 765-8. https://doi.org/10.1038/s41415-022-5148-z

6. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA: A Cancer Journal for Clinicians. 2023; 73(1): 17-48. (3) https://doi.org/10.3322/caac.21763

7. Marci Lee Nilsen et al. Late and long-term treatment-related effects and survivorship for head and neck cancer patients. Current Treatment Options in Oncology. 2020; 21: 1-4. https://doi.org/10.1007/s11864-020-00797-x

8. Brook I. Early side effects of radiation treatment for head and neck cancer. Cancer/ Radiotherapie. 2021; 25(5): 507-13. https://doi.org/10.1016/j.canrad.2021.02.001

9. Cardoso MD et al. Prevention and control of sequels in the mouth of patients treated with radiation therapy for head and neck tumors. Radiologia Brasileira. 2005; 38: 107-15. https://doi.org/10.1590/S0100-39842005000200006

10. Parra-Rojas S J et al. Oral Complications and Management Strategies for Cancer Patients: Principles of Supportive Oncology in Dentistry. Current Oncology Reports. 2024; 26(4): 391-9. https://doi.org/10.1007/s11912-024-01518-5

11. Rani RU. A Study to Assess the Knowledge regarding the side Effects of Chemotherapy among Cancer patients in selected Hospital, Bangalore. Asian Journal of Nursing Education and Research. 2021; 11(1): 83-5. http://dx.doi.org/10.5958/2349-2996.2021.00021.5

12. Singh M et al. Pharmacokinetic screening to Estimate the drug likeliness characteristics of selected Herbal Anticancer Drugs. Research Journal of Pharmacy and Technology. 2023; 16(7): 3422-6. http://dx.doi.org/10.52711/0974-360X.2023.00566

13. Deeming GM, Collingwood J, Pemberton MN. Methotrexate and oral ulceration. British dental journal. 2005; Jan; 198(2): 83-5. https://doi.org/10.1038/sj.bdj.4811972

14. De Pauli Paglioni M et al. The impact of radiation caries in the quality of life of head and neck cancer patients. Supportive Care in Cancer. 2020; Jun; 28: 2977-84. https://doi.org/10.1007/s00520-019-05171-8

15. Basu T et al. Toxicity with radiotherapy for oral cancers and its management: A practical approach. Journal of Cancer Research and Therapeutics. 2012; 8 (Suppl 2): S72-84. https://doi.org/10.4103/0973-1482.92219

16. Vives-Soler A, Lopez-Lopez J, Jane-Salas E. Radiation-induced xerostomia: update. Radiation-induced xerostomia: update. Revista Colombiana de Cancerología. 2017; 21(1): 26-32 https://doi.org/10.1016/j.rccan.2016.06.001

17. Hancock PJ, Epstein JB, Sadler GR. Before Treatment OA. Oral and dental management related to radiation therapy for head and neck cancer. J Can Dent Assoc. 2003; 69(9): 585-90.

18. Ribeiro IL et al Oral mucositis in pediatric patients in treatment for acute lymphoblastic leukemia. International Journal of Environmental Research and Public Health. 2017; 14(12): 1468. https://doi.org/10.3390/ijerph14121468

19. R Tayyar D Ho. Herpes simplex virus and varicella zoster virus infections in cancer patients. Viruses. 2023; 15(2): 439. https://doi.org/10.3390/v15020439

20. K Anjali et al. Oral microbial profile in oral cancer patients before and after radiation therapy in a cancer care center - A prospective study. Journal of Oral and Maxillofacial Pathology. 2020; 24(1): 117-24. https://doi.org/10.4103/jomfp.jomfp_213_19

21. Jawad H, Hodson NA, Nixon PJ. A review of dental treatment of head and neck cancer patients, before, during and after radiotherapy: part 1. British Dental Journal. 2015; 218(2): 65-8. https://doi.org/10.1038/sj.bdj.2015.28

22. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008; 454(7203): 436-44. https://doi.org/10.1038/nature07205

23. Epstein JB et al. Oral complications of cancer and cancer therapy: from cancer treatment to survivorship. CA: A Cancer Journal for Clinicians. 2012; 62(6): 400-22. https://doi.org/10.3322/caac.21157

24. da Cruz Campos MI, Neiva Campos C, Monteiro Aarestrup F, Vieira Aarestrup BJ. Oral mucositis in cancer treatment: Natural history, prevention and treatment. Molecular and Clinical Oncology. 2014; 2(3): 337-40. https://doi.org/10.3892/mco.2014.253

25. Dijkstra PU, Kalk WW, Roodenburg JL. Trismus in head and neck oncology: a systematic review. Oral oncology. 2004; Oct 1; 40(9): 879-89. https://doi.org/10.1016/j.oraloncology.2004.04.003

26. Vaughan E D. An analysis of morbidity following major head and neck surgery with particular reference to mouth function. J Maxillofac Surg 1982; 10: 129–134. (21) https://doi.org/10.1016/s0301-0503(82)80027-1

27. Teguh DN et al. Trismus in patients with oropharyngeal cancer: relationship with dose in structures of mastication apparatus. Head and Neck: Journal for the Sciences and Specialties of the Head and Neck. 2008; 30(5): 622-30. https://doi.org/10.1002/hed.20760

28. Dijkstra PU, Huisman PM, Roodenburg JL. Criteria for trismus in head and neck oncology. International Journal of Oral and Maxillofacial Surgery. 2006; 35(4): 337-42. https://doi.org/10.1016/j.ijom.2005.08.001

29. Lopes MA et al. Reconhecendo e controlando os efeitos colaterais da radioterapia. Rev. Assoc. Paul. Cir. Dent. 1998:241-4.

30. De Almeida Silva LA et al. The incidence of osteoradionecrosis of the jaws in oral cavity cancer patients treated with intensity-modulated radiotherapy: A systematic review and meta-analysis. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2024; 18. https://doi.org/10.1016/j.oooo.2024.04.008

31. Taichman LS, Gomez G, Inglehart MR. Oral health-related complications of breast cancer treatment: assessing dental hygienists' knowledge and professional practice. American Dental Hygienists' Association. 2015; 89(2): 22-37. (1)

32. Baum BJ. et al. Therapy‐induced dysfunction of salivary glands: implications for oral health. Special Care in dentistry. 1985; 5(6): 274-7. https://doi.org/10.1111/j.1754-4505.1985.tb00593.x

33. Epstein JB, Lunn R, Le N, Stevenson Moore P. Periodontal attachment loss in patients after head and neck radiation therapy. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 1998; 86(6): 673-7. https://doi.org/10.1016/s1079-2104(98)90202-5

34. Barclay SC, Turani D. Current practice in dental oncology in the UK. Dental update. 2010; 37(8): 555-61. https://doi.org/10.12968/denu.2010.37.8.555

35. Chamberlain MC. Neurotoxicity of cancer treatment. Current oncology reports. 2010; 12(1): 60-7. https://doi.org/10.1007/s11912-009-0072-9

36. Dietrich J. Neurotoxicity of cancer therapies. Continuum: Lifelong Learning in Neurology. 2020; 26(6): 1646-72. https://doi.org/10.1212/con.0000000000000943

37. Sen A et al. Current Therapy in Cancer: Advances, Challenges, and Future Directions. Asian Journal of Nursing Education and Research. 2024; 14(1): 77-84. http://dx.doi.org/10.52711/2349-2996.2024.00016

38. Kaur S, Mayanglambam P, Bajwan D, Thakur N. Chemotherapy and its adverse effects-A systematic review. International Journal of Nursing Education and Research. 2022; 10(4): 399-402. http://dx.doi.org/10.52711/2454-2660.2022.00090

39. B Arya, K Krishnaveni, R Sambathkumar. Review on Antioxidant Supplements use in Cancer Chemotherapy. Research Journal of Pharmacology and Pharmacodynamics. 2020; 12(1): 21-4. https://doi.org/10.5958/2321-5836.2020.00005.1

40. Umeda M et al. Lack of survival advantage in patients with advanced, resectable squamous cell carcinoma of the oral cavity receiving induction chemotherapy with cisplatin (CDDP), docetaxel (TXT) and 5-fluorouracil (5FU). Kobe Journal of Medical Sciences. 2004; 50(5/6): 189. (11) available on https://pubmed.ncbi.nlm.nih.gov/16107776/

41. Pasricha JS et al. Dexamethasone‐cyclophosphamide pulse therapy for pemphigus. International Journal of Dermatology. 1995; 34(12): 875-82. (12) https://doi.org/10.1111/j.1365-4362.1995.tb04430.x

42. Fuwa N et al. A combination therapy of continuous super selective intraarterial carboplatin infusion and radiation therapy for locally advanced head and neck carcinoma: a phase I study. Cancer: Interdisciplinary International Journal of the American Cancer Society. 2000; Nov 15; 89(10): 2099-105 available on https://pubmed.ncbi.nlm.nih.gov/11066051/

43. Dahllof G, Barr M, Bolme P. Disturbances in dental development after total body irradiation in bone marrow transplant recipients. Oral Surg Oral Med Oral Pathol. 1988; 65(1): 41-4. doi: 10.1016/0030-4220(88)90189-2. PMID: 2963247

44. Jensen SB, Mouridsen HT, Reibel J, Brunner N, Nauntofte B. Adjuvant chemotherapy in breast cancer patients induces temporary salivary gland hypofunction. Oral Oncol. 2008; 44(2): 162-73. doi: 10.1016/j.oraloncology.2007.01.015. Epub 2007; Jun 27. PMID: 17588802.

45. Çetiner D et al. Oral and dental alterations and growth disruption following chemotherapy in long-term survivors of childhood malignancies. Supportive Care in Cancer. 2019; 27: 1891-9 https://doi.org/10.1007/s00520-018-4454-0

46. Poulopoulos A, Papadopoulos P, Andreadis D. Chemotherapy: oral side effects and dental interventions-a review of the literature. Stomatological Disease and Science. 2017; 29; 1: 35-49. https://doi.org/10.20517/2573-0002.2017.03

47. Debnath S et al. Impurity Linked Genotoxicity assessment of the Antineoplastic Chemotherapy agent using Ames model. Research Journal of Pharmacy and Technology. 2023; 16(7): 3339-42 http://dx.doi.org/10.52711/0974-360X.2023.00551

48. Lopez BC, Esteve CG, Perez MS. Dental treatment considerations in the chemotherapy patient. J Clin Exp Dent. 2011; 3(1): 31-42.

49. Hong CH et al. Dental Disease Section, Oral Care Study Group, Multi-national Association of Supportive Care in Cancer (MASCC) /International Society of Oral Oncology (ISOO). A systematic review of dental disease in patients undergoing cancer therapy. Supportive care in cancer. 2010; 18: 1007-21. https://doi.org/10.1007/s00520-010-0873-2

50. Caribe Gomes F et al. Dental management of the complications of radio and chemotherapy in oral cancer. Medicina Oral. 2003; 8(3): 178-87.

51. S A Fayle . M S Duggal. S A Williams. Oral problems and the dentist's role in the management of paediatric oncology patients. Dental Update. 1992; 19(4): 152-6.

52. Kumar N et al. The oral management of oncology patients requiring radiotherapy, chemotherapy and or bone marrow transplantation. Faculty Dental Journal. 2013; 4(4): 200-3. https://doi.org/10.1308/204268513x13776914744952

53. McCaul LK. Oral and dental management for head and neck cancer patients treated by chemotherapy and radiotherapy. Dental update. 2012; 39(2): 135-40. https://doi.org/10.12968/denu.2012.39.2.135

54. Jisha K et al. The Influence of Pharmacogenetics in Cancer Chemotherapy. Research Journal of Pharmacology and Pharmacodynamics. 2020; 12(1): 29-33 http://dx.doi.org/10.5958/2321-5836.2020.00007.5

Received on 26.07.2024 Revised on 17.12.2024

Accepted on 19.02.2025 Published on 05.09.2025

Available online from September 08, 2025

Research J. Pharmacy and Technology. 2025;18(9):4597-4602.

DOI: 10.52711/0974-360X.2025.00660

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Side Effect	Cause	Impact on Dental Health	Management/Prevention
Hyposalivation and Xerostomia	Radiation Therapy (RT)	Dry mouth, difficulty with speech, chewing, and swallowing; increased caries risk.	Encourage hydration with water/saliva substitutes, sugar-free gum, salivary stimulants (e.g., pilocarpine), and fluoride treatments (daily 1% sodium fluoride gel).
Fungal Infections	RT, Chemotherapy	Candida albicans causes white, removable plaques in the mouth.	Antifungal therapy (e.g., ketoconazole, nystatin) and regular mouth rinses with chlorhexidine (30 minutes before/after antifungal use).
Viral Infections	Chemotherapy, Immunosuppression	Increased susceptibility to HSV and other viral infections.	Antiviral medications (e.g., acyclovir) for HSV.
Bacterial Infections	RT, Chemotherapy	Increased bacterial load, particularly Streptococcus and Klebsiella.	Maintain good oral hygiene, use antibiotics when necessary.
Radiation Caries	RT	Rapid tooth decay due to reduced saliva production.	Fluoride treatments, regular dental check-ups, good oral hygiene practices.
Periodontal Disease	RT	Periodontitis	Pre-treatment scaling, root planing, regular periodontal care.

Side Effect	Cause	Impact on Dental Health	Management/Prevention
Trismus	RT	Limited mouth opening due to muscle contraction.	Jaw exercises, physiotherapy, early intervention if indicated.
Osteoradionecrosis (ORN)	RT	Bone necrosis in irradiated areas, potentially severe and long-term.	Preventive care, early identification, and careful dental management.
Neurotoxicity	Chemotherapy, RT, Surgery	Nerve damage affecting chewing and mastication.	Symptom monitoring, pain management, modifying treatment protocols.
Nausea and Stomatitis	Chemotherapy	Nausea, vomiting, and painful oral sores leading to difficulty eating.	Antiemetic treatments, pain management, frequent oral hygiene.
Tooth Development Issues	Chemotherapy (children)	Microdontia, agenesis, enamel defects during tooth development.	Early dental intervention, fluoride treatments, prosthetic options for tooth loss.
Enamel Defects	Chemotherapy	Hypo-mineralized enamel, increased caries susceptibility.	Topical fluoride treatments, monitoring for early decay.
Oral Mucositis	Chemotherapy, RT	Painful oral sores, inflammation of the mucosa.	Pain management, mouth rinses with soothing solutions (e.g., sodium bicarbonate).