|Head and Neck Cancer|
Head and neck cancers commonly develop in the mouth, nose, neck, throat or sinuses. About 40,000 new cases of head and neck cancer develop each year. This type of cancer typically is treated with surgery, radiation therapy and/or chemotherapy. Each of these treatments can affect your oral health.
Anyone with head and neck cancer should visit a dentist before treatment begins. Your dentist may repair or remove severely decayed or infected teeth. These teeth could become sources of infection during cancer treatment.
While you are being treated for your cancer, see your dentist every two or three months. At these visits, your dentist often will clean your teeth and check your mouth for any new problems. Your dentist also will show you how to use daily fluoride treatments to keep your teeth free of decay. This is especially important if you have had radiation therapy.
Radiation destroys cancer cells, but it also affects normal cells. The effects that radiation therapy can have on your oral health include:
- Permanent destruction of salivary glands — Radiation therapy can cause your salivary glands to work poorly or stop working. Radiation therapy near your lower jaw may destroy the largest salivary glands, called the parotid glands. Salivary glands usually do not recover from large amounts of radiation therapy. Your dentist can prescribe medicines that may increase saliva flow. Another option is artificial saliva. Your remaining natural saliva may become thicker and stickier. Saliva helps clean your mouth and protect your teeth from decay. A loss of saliva flow will increase the risk of decay and yeast infection. It also may affect periodontal (gum) disease. This is why it's important to see a dentist regularly if your salivary glands are affected.
- Oral sores and muscle stiffness — Radiation can cause sores in your mouth. It also can stiffen the muscles in your face and jaw. This muscle stiffness (called fibrosis) can make it more difficult to open your mouth, to chew and to clean your teeth.
- A permanent decrease in blood flow — Radiation decreases blood flow. This means that sores will take longer to heal and you will be at higher risk of infection. If you need teeth extracted after radiation therapy, you may receive very high levels of oxygen before and after the procedure. This treatment is called hyperbaric oxygen therapy. It may help to prevent bone cells from dying because of a lack of oxygen. You may also receive antibiotics to help prevent infection. Decreased blood flow is another reason to remove teeth that might pose a problem before radiation treatment begins.
- Tissue inflammation — If you have neck cancer, the radiation can cause sores in your throat and make it difficult to swallow.
Unlike radiation therapy, taking cancer drugs (chemotherapy) affects your entire body. However, the effects in the mouth usually are not permanent.
The oral effects of chemotherapy include:
- New outbreak of herpes infections
- Fungus infections
- Sores in the mouth
- Dry mouth
- Change in taste
- Increased risk of infection
- Increased risk of bleeding
- Loss of appetite, or pain with eating
Because cancer drugs do not affect blood flow permanently, your dentist can be more conservative about which teeth need to be extracted before therapy begins.
How dry your mouth gets will depend on:
- Which cancer drugs you receive
- What other drugs you take
- How well your salivary glands work before cancer treatment
Once you stop chemotherapy, your saliva flow tends to gradually increase.
The goal of surgery for head and neck cancer is to remove the cancer. This often involves the removal of bone and soft tissue. The tissue loss may affect the function of your mouth and jaw. For example, some people have problems with chewing, swallowing and/or speaking after treatment. The amount of disability will be related to the following:
- Where the cancer is located
- The type of surgery you need
- Whether or not you receive radiation or chemotherapy
Your surgeon may try to reconstruct the area using bone and soft tissue from other parts of your body. For many people, this occurs at the time of the cancer surgery. The goal is to restore the function of your mouth and jaw and provide an acceptable appearance. You and your family should discuss this with your surgeon before surgery.