647 lines
No EOL
151 KiB
HTML
647 lines
No EOL
151 KiB
HTML
<?xml version="1.0" encoding="utf-8"?>
|
|
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
|
|
|
|
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
|
|
<!-- AppResources meta begin -->
|
|
<meta name="paf-app-resources" content="" />
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- AppResources meta end -->
|
|
|
|
<!-- TemplateResources meta begin -->
|
|
<meta name="paf_template" content="" />
|
|
|
|
<!-- TemplateResources meta end -->
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books" /><meta name="ncbi_pdid" content="book-part" /><meta name="ncbi_acc" content="NBK65725" /><meta name="ncbi_domain" content="pdqcis" /><meta name="ncbi_report" content="record" /><meta name="ncbi_type" content="fulltext" /><meta name="ncbi_objectid" content="" /><meta name="ncbi_pcid" content="/NBK65725.6/" /><meta name="ncbi_pagename" content="Oral Complications of Cancer Therapies (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf" /><meta name="ncbi_bookparttype" content="chapter" /><meta name="ncbi_app" content="bookshelf" />
|
|
<!-- Logger end -->
|
|
|
|
<title>Oral Complications of Cancer Therapies (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf</title>
|
|
|
|
<!-- AppResources external_resources begin -->
|
|
<link rel="stylesheet" href="/core/jig/1.15.2/css/jig.min.css" /><script type="text/javascript" src="/core/jig/1.15.2/js/jig.min.js"></script>
|
|
|
|
<!-- AppResources external_resources end -->
|
|
|
|
<!-- Page meta begin -->
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="PDQ Cancer Information Summaries [Internet]" /><meta name="citation_title" content="Oral Complications of Cancer Therapies (PDQ®)" /><meta name="citation_publisher" content="National Cancer Institute (US)" /><meta name="citation_date" content="2024/03/06" /><meta name="citation_author" content="PDQ Supportive and Palliative Care Editorial Board" /><meta name="citation_pmid" content="26389169" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK65725/" /><meta name="citation_keywords" content="oral complications of radiation therapy" /><meta name="citation_keywords" content="xerostomia" /><meta name="citation_keywords" content="bone necrosis" /><meta name="citation_keywords" content="bone necrosis" /><meta name="citation_keywords" content="oral complications of radiation therapy" /><meta name="citation_keywords" content="xerostomia" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Oral Complications of Cancer Therapies (PDQ®)" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Cancer Institute (US)" /><meta name="DC.Contributor" content="PDQ Supportive and Palliative Care Editorial Board" /><meta name="DC.Date" content="2024/03/06" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK65725/" /><meta name="description" content="Mouth and throat problems are common complications of cancer therapies. Learn about preventing and managing problems like dry mouth, taste changes, pain, and infection in this expert-reviewed summary." /><meta name="og:title" content="Oral Complications of Cancer Therapies (PDQ®)" /><meta name="og:type" content="book" /><meta name="og:description" content="Mouth and throat problems are common complications of cancer therapies. Learn about preventing and managing problems like dry mouth, taste changes, pain, and infection in this expert-reviewed summary." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK65725/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/pdqcis/CDR0000062871/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK65725/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
|
|
|
|
<!-- Page meta end -->
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico" /><meta name="ncbi_phid" content="CE8C71787C960EE100000000010F00E7.m_13" />
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3985586/3808861/4121862/3974050/3917732/251717/4216701/14534/45193/4113719/3849091/3984811/3751656/4033350/3840896/3577051/3852958/4008682/4207974/4206132/4062871/12930/3964959/3854974/36029/4128070/9685/3549676/3609192/3609193/3609213/3395586.css" /><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3411343/3882866.css" media="print" /></head>
|
|
<body class="book-part">
|
|
<div class="grid">
|
|
<div class="col twelve_col nomargin shadow">
|
|
<!-- System messages like service outage or JS required; this is handled by the TemplateResources portlet -->
|
|
<div class="sysmessages">
|
|
<noscript>
|
|
<p class="nojs">
|
|
<strong>Warning:</strong>
|
|
The NCBI web site requires JavaScript to function.
|
|
<a href="/guide/browsers/#enablejs" title="Learn how to enable JavaScript" target="_blank">more...</a>
|
|
</p>
|
|
</noscript>
|
|
</div>
|
|
<!--/.sysmessage-->
|
|
<div class="wrap">
|
|
<div class="page">
|
|
<div class="top">
|
|
<div id="universal_header">
|
|
<section class="usa-banner">
|
|
<div class="usa-accordion">
|
|
<header class="usa-banner-header">
|
|
<div class="usa-grid usa-banner-inner">
|
|
<img src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/favicons/favicon-57.png" alt="U.S. flag" />
|
|
<p>An official website of the United States government</p>
|
|
<button class="non-usa-accordion-button usa-banner-button" aria-expanded="false" aria-controls="gov-banner-top" type="button">
|
|
<span class="usa-banner-button-text">Here's how you know</span>
|
|
</button>
|
|
</div>
|
|
</header>
|
|
<div class="usa-banner-content usa-grid usa-accordion-content" id="gov-banner-top" aria-hidden="true">
|
|
<div class="usa-banner-guidance-gov usa-width-one-half">
|
|
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-dot-gov.svg" alt="Dot gov" />
|
|
<div class="usa-media_block-body">
|
|
<p>
|
|
<strong>The .gov means it's official.</strong>
|
|
<br />
|
|
Federal government websites often end in .gov or .mil. Before
|
|
sharing sensitive information, make sure you're on a federal
|
|
government site.
|
|
</p>
|
|
</div>
|
|
</div>
|
|
<div class="usa-banner-guidance-ssl usa-width-one-half">
|
|
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-https.svg" alt="Https" />
|
|
<div class="usa-media_block-body">
|
|
<p>
|
|
<strong>The site is secure.</strong>
|
|
<br />
|
|
The <strong>https://</strong> ensures that you are connecting to the
|
|
official website and that any information you provide is encrypted
|
|
and transmitted securely.
|
|
</p>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
<div class="usa-overlay"></div>
|
|
<header class="ncbi-header" role="banner" data-section="Header">
|
|
|
|
<div class="usa-grid">
|
|
<div class="usa-width-one-whole">
|
|
|
|
<div class="ncbi-header__logo">
|
|
<a href="/" class="logo" aria-label="NCBI Logo" data-ga-action="click_image" data-ga-label="NIH NLM Logo">
|
|
<img src="https://www.ncbi.nlm.nih.gov/coreutils/nwds/img/logos/AgencyLogo.svg" alt="NIH NLM Logo" />
|
|
</a>
|
|
</div>
|
|
|
|
<div class="ncbi-header__account">
|
|
<a id="account_login" href="https://account.ncbi.nlm.nih.gov" class="usa-button header-button" style="display:none" data-ga-action="open_menu" data-ga-label="account_menu">Log in</a>
|
|
<button id="account_info" class="header-button" style="display:none" aria-controls="account_popup" type="button">
|
|
<span class="fa fa-user" aria-hidden="true">
|
|
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" width="20px" height="20px">
|
|
<g style="fill: #fff">
|
|
<ellipse cx="12" cy="8" rx="5" ry="6"></ellipse>
|
|
<path d="M21.8,19.1c-0.9-1.8-2.6-3.3-4.8-4.2c-0.6-0.2-1.3-0.2-1.8,0.1c-1,0.6-2,0.9-3.2,0.9s-2.2-0.3-3.2-0.9 C8.3,14.8,7.6,14.7,7,15c-2.2,0.9-3.9,2.4-4.8,4.2C1.5,20.5,2.6,22,4.1,22h15.8C21.4,22,22.5,20.5,21.8,19.1z"></path>
|
|
</g>
|
|
</svg>
|
|
</span>
|
|
<span class="username desktop-only" aria-hidden="true" id="uname_short"></span>
|
|
<span class="sr-only">Show account info</span>
|
|
</button>
|
|
</div>
|
|
|
|
<div class="ncbi-popup-anchor">
|
|
<div class="ncbi-popup account-popup" id="account_popup" aria-hidden="true">
|
|
<div class="ncbi-popup-head">
|
|
<button class="ncbi-close-button" data-ga-action="close_menu" data-ga-label="account_menu" type="button">
|
|
<span class="fa fa-times">
|
|
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 48 48" width="24px" height="24px">
|
|
<path d="M38 12.83l-2.83-2.83-11.17 11.17-11.17-11.17-2.83 2.83 11.17 11.17-11.17 11.17 2.83 2.83 11.17-11.17 11.17 11.17 2.83-2.83-11.17-11.17z"></path>
|
|
</svg>
|
|
</span>
|
|
<span class="usa-sr-only">Close</span></button>
|
|
<h4>Account</h4>
|
|
</div>
|
|
<div class="account-user-info">
|
|
Logged in as:<br />
|
|
<b><span class="username" id="uname_long">username</span></b>
|
|
</div>
|
|
<div class="account-links">
|
|
<ul class="usa-unstyled-list">
|
|
<li><a id="account_myncbi" href="/myncbi/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_myncbi">Dashboard</a></li>
|
|
<li><a id="account_pubs" href="/myncbi/collections/bibliography/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_pubs">Publications</a></li>
|
|
<li><a id="account_settings" href="/account/settings/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_settings">Account settings</a></li>
|
|
<li><a id="account_logout" href="/account/signout/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_logout">Log out</a></li>
|
|
</ul>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
</div>
|
|
</div>
|
|
</header>
|
|
<div role="navigation" aria-label="access keys">
|
|
<a id="nws_header_accesskey_0" href="https://www.ncbi.nlm.nih.gov/guide/browsers/#ncbi_accesskeys" class="usa-sr-only" accesskey="0" tabindex="-1">Access keys</a>
|
|
<a id="nws_header_accesskey_1" href="https://www.ncbi.nlm.nih.gov" class="usa-sr-only" accesskey="1" tabindex="-1">NCBI Homepage</a>
|
|
<a id="nws_header_accesskey_2" href="/myncbi/" class="set-base-url usa-sr-only" accesskey="2" tabindex="-1">MyNCBI Homepage</a>
|
|
<a id="nws_header_accesskey_3" href="#maincontent" class="usa-sr-only" accesskey="3" tabindex="-1">Main Content</a>
|
|
<a id="nws_header_accesskey_4" href="#" class="usa-sr-only" accesskey="4" tabindex="-1">Main Navigation</a>
|
|
</div>
|
|
<section data-section="Alerts">
|
|
<div class="ncbi-alerts-placeholder"></div>
|
|
</section>
|
|
</div>
|
|
<div class="header">
|
|
<div class="res_logo"><h1 class="res_name"><a href="/books/" title="Bookshelf home">Bookshelf</a></h1><h2 class="res_tagline"></h2></div>
|
|
<div class="search"><form method="get" action="/books/"><div class="search_form"><label for="database" class="offscreen_noflow">Search database</label><select id="database"><optgroup label="Recent"><option value="books" selected="selected" data-ac_dict="bookshelf-search">Books</option><option value="nlmcatalog">NLM Catalog</option><option value="pcsubstance">PubChem Substance</option><option value="pubmed" class="last">PubMed</option></optgroup><optgroup label="All"><option value="gquery">All Databases</option><option value="assembly">Assembly</option><option value="biocollections">Biocollections</option><option value="bioproject">BioProject</option><option value="biosample">BioSample</option><option value="books" data-ac_dict="bookshelf-search">Books</option><option value="clinvar">ClinVar</option><option value="cdd">Conserved Domains</option><option value="gap">dbGaP</option><option value="dbvar">dbVar</option><option value="gene">Gene</option><option value="genome">Genome</option><option value="gds">GEO DataSets</option><option value="geoprofiles">GEO Profiles</option><option value="gtr">GTR</option><option value="ipg">Identical Protein Groups</option><option value="medgen">MedGen</option><option value="mesh">MeSH</option><option value="nlmcatalog">NLM Catalog</option><option value="nuccore">Nucleotide</option><option value="omim">OMIM</option><option value="pmc">PMC</option><option value="protein">Protein</option><option value="proteinclusters">Protein Clusters</option><option value="protfam">Protein Family Models</option><option value="pcassay">PubChem BioAssay</option><option value="pccompound">PubChem Compound</option><option value="pcsubstance">PubChem Substance</option><option value="pubmed">PubMed</option><option value="snp">SNP</option><option value="sra">SRA</option><option value="structure">Structure</option><option value="taxonomy">Taxonomy</option><option value="toolkit">ToolKit</option><option value="toolkitall">ToolKitAll</option><option value="toolkitbookgh">ToolKitBookgh</option></optgroup></select><div class="nowrap"><label for="term" class="offscreen_noflow" accesskey="/">Search term</label><div class="nowrap"><input type="text" name="term" id="term" title="Search Books. Use up and down arrows to choose an item from the autocomplete." value="" class="jig-ncbiclearbutton jig-ncbiautocomplete" data-jigconfig="dictionary:'bookshelf-search',disableUrl:'NcbiSearchBarAutoComplCtrl'" autocomplete="off" data-sbconfig="ds:'no',pjs:'no',afs:'no'" /></div><button id="search" type="submit" class="button_search nowrap" cmd="go">Search</button></div></div></form><ul class="searchlinks inline_list"><li>
|
|
<a href="/books/browse/">Browse Titles</a>
|
|
</li><li>
|
|
<a href="/books/advanced/">Advanced</a>
|
|
</li><li class="help">
|
|
<a href="/books/NBK3833/">Help</a>
|
|
</li><li class="disclaimer">
|
|
<a target="_blank" data-ga-category="literature_resources" data-ga-action="link_click" data-ga-label="disclaimer_link" href="https://www.ncbi.nlm.nih.gov/books/about/disclaimer/">Disclaimer</a>
|
|
</li></ul></div>
|
|
</div>
|
|
|
|
|
|
|
|
<!--<component id="Page" label="headcontent"/>-->
|
|
|
|
</div>
|
|
<div class="content">
|
|
<!-- site messages -->
|
|
<!-- Custom content 1 -->
|
|
<div class="col1">
|
|
|
|
</div>
|
|
|
|
<div class="container">
|
|
<div id="maincontent" class="content eight_col col">
|
|
<!-- Custom content in the left column above book nav -->
|
|
<div class="col2">
|
|
|
|
</div>
|
|
|
|
<!-- Book content -->
|
|
|
|
|
|
<!-- Custom content between navigation and content -->
|
|
<div class="col3">
|
|
|
|
</div>
|
|
|
|
<div class="document">
|
|
<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65725_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65725_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
|
|
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65725_"><span class="title" itemprop="name">Oral Complications of Cancer Therapies (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Supportive and Palliative Care Editorial Board</span>.</p><p class="small">Published online: March 6, 2024.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062871__426">This PDQ cancer information summary has current information about the causes and treatment of oral complications of cancer therapies. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000062871__427">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.</p></div><div id="CDR0000062871__3"><h2 id="_CDR0000062871__3_">General Information About Oral Complications</h2><div id="CDR0000062871__3.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062871__159">Oral complications are common in cancer patients, especially those with head and neck cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__161">Preventing and controlling oral complications can help you continue cancer treatment and have a better quality of life.
|
|
</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__279">Patients receiving treatments that affect the head and neck should have their care planned by a team of doctors and specialists.</a></div></li></ul></div><div id="CDR0000062871__159"><h3>Oral complications are common in cancer patients, especially those with head and neck cancer.</h3><p id="CDR0000062871__42"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463706/" class="def">Complications</a> are new medical problems that occur during or after a disease, procedure, or treatment and that make <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a> harder. The complications may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of the disease or treatment, or they may have other causes. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">Oral</a> complications affect the mouth. </p><p id="CDR0000062871__399"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> patients have a high risk of oral complications for a number of reasons: </p><ul id="CDR0000062871__43"><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> slow or stop the growth of new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>. </div><div class="half_rhythm"> These cancer treatments slow or stop the growth of fast growing cells, such as cancer cells. Normal cells in the lining of the mouth also grow quickly, so anticancer treatment can stop them from growing, too. This slows down the ability of oral <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> to repair itself by making new cells.
|
|
</div></li><li class="half_rhythm"><div class="half_rhythm">Radiation therapy may directly damage and break down oral tissue, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046196/" class="def">salivary glands</a>, and bone.</div></li><li class="half_rhythm"><div class="half_rhythm">Chemotherapy and radiation therapy upset the healthy balance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044123/" class="def">bacteria</a> in the mouth. </div><div class="half_rhythm"> There are many different kinds of bacteria in the mouth. Some are helpful and some are harmful. Chemotherapy and radiation therapy may cause changes in the lining of the mouth and the salivary glands, which make <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257526/" class="def">saliva</a>. This can upset the healthy balance of bacteria. These changes may lead to mouth sores, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infections</a>, and tooth decay.
|
|
</div></li></ul><p id="CDR0000062871__229">This summary is about oral complications caused by chemotherapy and radiation therapy. </p></div><div id="CDR0000062871__161"><h3>Preventing and controlling oral complications can help you continue cancer treatment and have a better quality of life.
|
|
</h3><p id="CDR0000062871__45">Sometimes treatment <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> need to be decreased or treatment stopped because of oral complications. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043981/" class="def">Preventive</a> care before cancer treatment begins and treating problems as soon as they appear may make oral complications less severe. When there are fewer complications, cancer treatment may work better and you may have a better <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</p></div><div id="CDR0000062871__279"><h3>Patients receiving treatments that affect the head and neck should have their care planned by a team of doctors and specialists.</h3><p id="CDR0000062871__281">
|
|
To manage oral complications, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046260/" class="def">oncologist</a> will work closely with your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000389460/" class="def">dentist</a> and may refer you to other health professionals with special training. These may include the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478785/" class="def">specialists</a>:</p><ul id="CDR0000062871__282"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046262/" class="def">Oncology nurse</a>.</div></li><li class="half_rhythm"><div>Dental specialists.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044661/" class="def">Dietitian</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044459/" class="def">Speech therapist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044730/" class="def">Social worker</a>.</div></li></ul><p id="CDR0000062871__334">The goals of oral and dental care are different before, during, and after cancer treatment:</p><ul id="CDR0000062871__335"><li class="half_rhythm"><div>Before cancer treatment, the goal is to prepare for cancer treatment by treating existing oral problems.</div></li><li class="half_rhythm"><div>During cancer treatment, the goals are to prevent oral complications and manage problems that occur.</div></li><li class="half_rhythm"><div>After cancer treatment, the goals are to keep teeth and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000481753/" class="def">gums</a> healthy and manage any <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000693593/" class="def">long-term side effects</a> of cancer and its treatment.</div></li></ul><p id="CDR0000062871__400">The most common oral complications from cancer treatment include the following:</p><ul id="CDR0000062871__401"><li class="half_rhythm"><div>Oral <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045789/" class="def">mucositis</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">inflamed</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257212/" class="def">mucous membranes</a> in the mouth).</div></li><li class="half_rhythm"><div>Infection.</div></li><li class="half_rhythm"><div>Salivary gland problems.</div></li><li class="half_rhythm"><div>Change in taste.</div></li><li class="half_rhythm"><div>Pain.</div></li></ul><p id="CDR0000062871__402">These complications can lead to other problems such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044659/" class="def">dehydration</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046014/" class="def">malnutrition</a>.</p></div></div><div id="CDR0000062871__5"><h2 id="_CDR0000062871__5_">Oral Complications and Their Causes</h2><div id="CDR0000062871__5.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062871__289">Cancer treatment can cause mouth and throat problems.</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062871__328">Complications of chemotherapy </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__330">Complications of radiation therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__332">Complications caused by either chemotherapy or radiation therapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062871__165">Oral complications may be caused by the treatment itself (directly) or by side effects of the treatment (indirectly).</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__167">Complications may be acute (short-term) or chronic (long-lasting).</a></div></li></ul></div><div id="CDR0000062871__289"><h3>Cancer treatment can cause mouth and throat problems.</h3><div id="CDR0000062871__328"><h4>Complications of chemotherapy </h4><p id="CDR0000062871__285"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">Oral</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463706/" class="def">complications</a> caused by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> include the following:</p><ul id="CDR0000062871__286"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">Inflammation</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulcers</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257212/" class="def">mucous membranes</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046335/" class="def">intestines</a>.</div></li><li class="half_rhythm"><div>Easy bleeding in the mouth.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373935/" class="def">Nerve</a> damage.</div></li></ul></div><div id="CDR0000062871__330"><h4>Complications of radiation therapy</h4><p id="CDR0000062871__287">Oral complications caused by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the head and neck include the following:</p><ul id="CDR0000062871__288"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045690/" class="def">Fibrosis</a> (growth of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000344349/" class="def">fibrous</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>) in the mucous membrane in the mouth.</div></li><li class="half_rhythm"><div>Tooth decay and gum disease.</div></li><li class="half_rhythm"><div>Breakdown of tissue in the area that receives <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a>.</div></li><li class="half_rhythm"><div>Breakdown of bone in the area that receives radiation.</div></li><li class="half_rhythm"><div>Fibrosis of muscle in the area that receives radiation.</div></li></ul></div><div id="CDR0000062871__332"><h4>Complications caused by either chemotherapy or radiation therapy</h4><p id="CDR0000062871__6">The most common oral complications may be caused by either chemotherapy or radiation therapy. These include the following: </p><ul id="CDR0000062871__275"><li class="half_rhythm"><div>Inflamed mucous membranes in the mouth.
|
|
</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">Infections</a> in the mouth or that travel through the bloodstream. These can reach and affect <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> all over the body.
|
|
</div></li><li class="half_rhythm"><div>Taste changes.
|
|
</div></li><li class="half_rhythm"><div>Dry mouth.
|
|
</div></li><li class="half_rhythm"><div>Pain.</div></li><li class="half_rhythm"><div>Changes in dental growth and development in children.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046014/" class="def">Malnutrition</a> (not getting enough of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044697/" class="def">nutrients</a> the body needs to be healthy) caused by being unable to eat.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044659/" class="def">Dehydration</a> (not getting the amount of water the body needs to be healthy) caused by being unable to drink.
|
|
</div></li><li class="half_rhythm"><div>Tooth decay and gum disease. </div></li></ul></div></div><div id="CDR0000062871__165"><h3>Oral complications may be caused by the treatment itself (directly) or by side effects of the treatment (indirectly).</h3><p id="CDR0000062871__230">Radiation therapy can <i>directly</i> damage oral tissue, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046196/" class="def">salivary glands</a>, and bone. Areas treated may scar or waste away.
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">Total-body radiation</a> can cause permanent damage to the salivary glands. This can change the way foods taste and cause dry mouth.</p><p id="CDR0000062871__231">Slow healing and infection are <i>indirect</i> complications of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> treatment. Both chemotherapy and radiation therapy can stop cells from dividing and slow the healing process in the mouth. Chemotherapy may decrease the number of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a> and weaken the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and cells that fight infection and disease). This makes it easier to get an infection.</p></div><div id="CDR0000062871__167"><h3>Complications may be acute (short-term) or chronic (long-lasting).</h3><p id="CDR0000062871__52"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045585/" class="def">Acute</a> complications are ones that occur during treatment and then go away. Chemotherapy usually causes acute complications that heal after treatment ends.
|
|
</p><p id="CDR0000062871__53"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045641/" class="def">Chronic</a> complications are ones that continue or appear months to years after treatment ends. Radiation can cause acute complications but may also cause permanent tissue damage that puts you at a lifelong risk of oral complications. The following chronic complications may continue after radiation therapy to the head or neck has ended:
|
|
</p><ul id="CDR0000062871__54"><li class="half_rhythm"><div>Dry mouth.</div></li><li class="half_rhythm"><div>Tooth decay.</div></li><li class="half_rhythm"><div>Infections.</div></li><li class="half_rhythm"><div>Taste changes.</div></li><li class="half_rhythm"><div>Problems in the mouth and jaw caused by loss of tissue and bone.</div></li><li class="half_rhythm"><div>Problems in the mouth and jaw caused by the growth of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046079/" class="def">benign tumors</a> in the skin and muscle.</div></li></ul><p id="CDR0000062871__55">Oral <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> or other dental work can cause problems in patients who have had radiation therapy to the head or neck. Make sure that your
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000389460/" class="def">dentist</a> knows your health history and the cancer treatments you received. </p></div></div><div id="CDR0000062871__7"><h2 id="_CDR0000062871__7_">Preventing and Treating Oral Complications Before Chemotherapy or Radiation Therapy Begins</h2><div id="CDR0000062871__7.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062871__169">Finding and treating oral problems before cancer treatment begins can prevent oral complications or make them less severe.
|
|
</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__171">Prevention of oral complications includes a healthy diet, good oral care, and dental checkups.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__173">Patients receiving high-dose chemotherapy, stem cell transplant, or radiation therapy should have an oral care plan in place before treatment begins. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__175">It is important that patients who have head or neck cancer stop smoking.</a></div></li></ul></div><div id="CDR0000062871__169"><h3>Finding and treating oral problems before cancer treatment begins can prevent oral complications or make them less severe.
|
|
</h3><p id="CDR0000062871__66">Problems such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavities</a>, broken teeth, loose crowns or fillings, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000481753/" class="def">gum</a> disease can get worse or cause problems during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> treatment. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044123/" class="def">Bacteria</a> live in the mouth and may cause an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> when the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> is not working well or when <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cell</a> counts are low. If dental problems are treated before cancer treatments begin, there may be fewer or milder <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">oral</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463706/" class="def">complications</a>.</p></div><div id="CDR0000062871__171"><h3>Prevention of oral complications includes a healthy diet, good oral care, and dental checkups.</h3><p id="CDR0000062871__67">Ways to prevent oral complications include the following:
|
|
</p><ul id="CDR0000062871__56"><li class="half_rhythm"><div class="half_rhythm">Eat a well-balanced <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044660/" class="def">diet</a>.
|
|
Healthy eating can help the body stand the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450122/" class="def">stress</a> of cancer treatment, help keep up your energy, fight infection, and rebuild <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>.</div></li><li class="half_rhythm"><div class="half_rhythm">Keep your mouth and teeth clean. This helps prevent cavities, mouth sores, and infections.
|
|
</div></li><li class="half_rhythm"><div class="half_rhythm">Have a complete oral health exam.
|
|
</div><div class="half_rhythm">Your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000389460/" class="def">dentist</a> should be part of your cancer care team. It is important to choose a dentist who has experience treating patients with oral complications of cancer treatment. A checkup of your oral health at least a month before cancer treatment begins usually allows enough time for the mouth to heal if any dental work is needed. The dentist will treat teeth that have a risk of infection or decay. This will help avoid the need for dental treatments during cancer treatment. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043981/" class="def">Preventive</a> care may help lessen dry mouth, which is a common complication of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the head or neck.</div><div class="half_rhythm">A preventive oral health exam will check for the following:<dl id="CDR0000062871__59" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Mouth sores or infections.
|
|
</p></dd><dt>-</dt><dd><p class="no_top_margin">Tooth decay.</p></dd><dt>-</dt><dd><p class="no_top_margin">Gum disease.</p></dd><dt>-</dt><dd><p class="no_top_margin">Dentures that do not fit well.</p></dd><dt>-</dt><dd><p class="no_top_margin">Problems moving the jaw.</p></dd><dt>-</dt><dd><p class="no_top_margin">Problems with the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046196/" class="def">salivary glands</a>.</p></dd></dl></div></li></ul></div><div id="CDR0000062871__173"><h3>Patients receiving high-dose chemotherapy, stem cell transplant, or radiation therapy should have an oral care plan in place before treatment begins. </h3><p id="CDR0000062871__61">The goal of the oral care plan is to find and treat oral disease that may cause complications during treatment and to continue oral care during treatment and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>. Different oral complications may occur during the different phases of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a>. Steps can be taken ahead of time to prevent or lessen how severe these <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> will be.
|
|
</p><p id="CDR0000062871__62">Oral care during radiation therapy will depend on the following:
|
|
</p><ul id="CDR0000062871__408"><li class="half_rhythm"><div>Specific needs of the patient.</div></li><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a>.</div></li><li class="half_rhythm"><div>The part of the body treated.</div></li><li class="half_rhythm"><div>How long the radiation treatment lasts.</div></li><li class="half_rhythm"><div>Specific complications that occur.</div></li></ul></div><div id="CDR0000062871__175"><h3>It is important that patients who have head or neck cancer stop smoking.</h3><p id="CDR0000062871__64">Continuing to smoke <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439432/" class="def">tobacco</a> may slow down recovery. It can also increase the risk that the head or neck cancer will <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recur</a> or that a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">second cancer</a> will form. </p></div></div><div id="CDR0000062871__9"><h2 id="_CDR0000062871__9_">Managing Oral Complications During and After Chemotherapy or Radiation Therapy</h2><div id="CDR0000062871__9.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062871__31">Regular Oral Care</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062871__177">Good dental hygiene may help prevent or decrease complications.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__179">Everyday oral care for cancer patients includes keeping the mouth clean and being gentle with the tissue lining the mouth.</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062871__32">Oral Mucositis</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062871__182">Oral mucositis is an inflammation of mucous membranes in the mouth.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__184">Care of mucositis during chemotherapy and radiation therapy includes cleaning the mouth and relieving pain.
|
|
</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062871__336">Pain</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062871__391">There can be many causes of oral pain in cancer patients.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__341">Oral pain in cancer patients may be caused by the cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__344">Oral pain may be a side effect of treatments.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__347">Certain anticancer drugs can cause oral pain.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__350">Teeth grinding may cause pain in the teeth or jaw muscles.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__359">Pain control helps improve the patient's quality of life.</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062871__33">Infection</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062871__189">Damage to the lining of the mouth and a weakened immune system make it easier for infection to occur.
|
|
</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__191">Infections may be caused by bacteria, a fungus, or a virus. </a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062871__34">Bleeding</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062871__194">Bleeding may occur when anticancer drugs make the blood less able to clot.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__196">Most patients can safely brush and floss while blood counts are low.
|
|
</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062871__35">Dry Mouth</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062871__199">Dry mouth (xerostomia) occurs when the salivary glands don't make enough saliva.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__201">Salivary glands usually return to normal after chemotherapy ends.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__203">Salivary glands may not recover completely after radiation therapy ends.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__205">Careful oral hygiene can help prevent mouth sores, gum disease, and tooth decay caused by dry mouth.
|
|
</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062871__36">Tooth Decay</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__37">Taste Changes</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__38">Fatigue</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__251">Malnutrition</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062871__253">Loss of appetite can lead to malnutrition.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__257">Nutrition support may include liquid diets and tube feeding.</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062871__40">Mouth and Jaw Stiffness</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__369">Swallowing Problems</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062871__371">Pain during swallowing and being unable to swallow (dysphagia) are common in cancer patients before, during, and after treatment. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__374">Trouble swallowing increases the risk of other complications.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__377">Whether radiation therapy will affect swallowing depends on several factors.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__380">Swallowing problems sometimes go away after treatment</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__383">Swallowing problems are managed by a team of experts. </a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062871__41">Tissue and Bone Loss</a></div></li></ul></div><div id="CDR0000062871__31"><h3>Regular Oral Care</h3><div id="CDR0000062871__177"><h4>Good dental hygiene may help prevent or decrease complications.</h4><p id="CDR0000062871__68">It is important to keep a close watch on <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">oral</a> health during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> treatment. This helps prevent, find, and treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463706/" class="def">complications</a> as soon as possible. Keeping the mouth, teeth, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000481753/" class="def">gums</a> clean during and after cancer treatment may help decrease complications such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavities</a>, mouth sores, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infections</a>.</p></div><div id="CDR0000062871__179"><h4>Everyday oral care for cancer patients includes keeping the mouth clean and being gentle with the tissue lining the mouth.</h4><p id="CDR0000062871__181">
|
|
Everyday oral care during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> includes the following:</p><h5><span class="title">Brushing teeth</span></h5><ul id="CDR0000062871__70"><li class="half_rhythm"><div>Brush teeth and gums with a soft-bristle brush 2 to 3 times a day for 2 to 3 minutes. Be sure to brush the area where the teeth meet the gums and to rinse often. </div></li><li class="half_rhythm"><div>Rinse the toothbrush in hot water every 15 to 30 seconds to soften the bristles, if needed.
|
|
</div></li><li class="half_rhythm"><div>Use a foam brush only if a soft-bristle brush cannot be used. Brush 2 to 3 times a day and use an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000462660/" class="def">antibacterial</a> rinse. Rinse often.</div></li><li class="half_rhythm"><div>Let the toothbrush air-dry between brushings.
|
|
</div></li><li class="half_rhythm"><div>Use a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044670/" class="def">fluoride</a> toothpaste with a mild taste. Flavoring may irritate the mouth, especially mint flavoring.</div></li><li class="half_rhythm"><div>If toothpaste irritates your mouth, brush with a mixture of 1/4 teaspoon of salt added to 1 cup of water.
|
|
</div></li></ul><h5><span class="title">Rinsing</span></h5><ul id="CDR0000062871__72"><li class="half_rhythm"><div>Use a rinse every 2 hours to decrease soreness in the mouth. Dissolve 1/4 teaspoon of salt and 1/4 teaspoon of baking soda in 1 quart of water.</div></li><li class="half_rhythm"><div>An antibacterial rinse may be used 2 to 4 times a day for gum disease. Rinse for 1 to 2 minutes.</div></li><li class="half_rhythm"><div>If dry mouth occurs, rinsing may not be enough to clean the teeth after a meal. Brushing and flossing may be needed.
|
|
</div></li></ul><h5><span class="title">Flossing</span></h5><ul id="CDR0000062871__74"><li class="half_rhythm"><div>Floss gently once a day.</div></li></ul><h5><span class="title">Lip care</span></h5><ul id="CDR0000062871__75"><li class="half_rhythm"><div>Use lip care products, such as cream with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000486452/" class="def">lanolin</a>, to prevent drying and cracking.</div></li></ul><h5><span class="title">Denture care</span></h5><ul id="CDR0000062871__403"><li class="half_rhythm"><div>Brush and rinse dentures every day. Use a soft-bristle toothbrush or one made for cleaning dentures.</div></li><li class="half_rhythm"><div>Clean with a denture cleaner recommended by your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000389460/" class="def">dentist</a>.</div></li><li class="half_rhythm"><div>Keep dentures moist when not being worn. Place them in water or a denture soaking solution recommended by your dentist. Do not use hot water, which can cause the denture to lose its shape.</div></li></ul><p id="CDR0000062871__295">For special oral care during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">high-dose chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>, see the <a href="#CDR0000062871__21">Managing Oral Complications of High-Dose Chemotherapy and/or Stem Cell Transplant</a> section of this summary.</p></div></div><div id="CDR0000062871__32"><h3>Oral Mucositis</h3><div id="CDR0000062871__182"><h4>Oral mucositis is an inflammation of mucous membranes in the mouth.</h4><p id="CDR0000062871__76">The terms "oral <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045789/" class="def">mucositis</a>" and "<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044733/" class="def">stomatitis</a>" are often used in place of each other, but they are different. </p><ul id="CDR0000062871__158"><li class="half_rhythm"><div>Oral mucositis is an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">inflammation</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257212/" class="def">mucous membranes</a> in the mouth. It usually appears as red, burn-like sores or as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390317/" class="def">ulcer</a>-like sores in the mouth. </div></li><li class="half_rhythm"><div>Stomatitis is an inflammation of mucous membranes and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> in the mouth. These include the gums, tongue, roof and floor of the mouth, and the inside of the lips and cheeks.</div></li></ul><p id="CDR0000062871__77">Mucositis may be caused by either radiation therapy or chemotherapy. </p><ul id="CDR0000062871__261"><li class="half_rhythm"><div>Mucositis caused by chemotherapy will heal by itself, usually in 2 to 4 weeks if there is no infection. </div></li><li class="half_rhythm"><div>Mucositis caused by radiation therapy usually lasts 6 to 8 weeks, depending on how long the treatment was. </div></li><li class="half_rhythm"><div>In patients receiving high-dose chemotherapy or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306495/" class="def">chemoradiation</a> for stem cell transplant: Mucositis usually begins 7 to 10 days after treatment begins, and lasts for about 2 weeks after treatment ends. </div></li></ul><p id="CDR0000062871__404">Swishing ice chips in the mouth for 30 minutes, beginning 5 minutes before patients receive <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046090/" class="def">fluorouracil</a>, may help prevent mucositis. Patients who receive high-dose chemotherapy and stem cell transplant may be given <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">medicine</a> to help prevent mucositis or keep it from lasting as long.</p><p id="CDR0000062871__78">Mucositis may cause the following problems: </p><ul id="CDR0000062871__79"><li class="half_rhythm"><div>Pain.</div></li><li class="half_rhythm"><div>Infection.</div></li><li class="half_rhythm"><div>Bleeding, in patients receiving chemotherapy. Patients receiving radiation therapy usually do not have bleeding.</div></li><li class="half_rhythm"><div>Trouble breathing and eating.</div></li></ul></div><div id="CDR0000062871__184"><h4>Care of mucositis during chemotherapy and radiation therapy includes cleaning the mouth and relieving pain.
|
|
</h4><p id="CDR0000062871__82">Treatment of mucositis caused by either radiation therapy or chemotherapy is about the same. Treatment depends on your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cell</a> count and how severe the mucositis is. The following are ways to treat mucositis during chemotherapy, stem cell transplant, or radiation therapy:
|
|
</p><p id="CDR0000062871__84">
|
|
<b>Cleaning the mouth</b>
|
|
</p><ul id="CDR0000062871__85"><li class="half_rhythm"><div>Clean your teeth and mouth every 4 hours and at bedtime. Do this more often if the mucositis becomes worse.
|
|
</div></li><li class="half_rhythm"><div>Use a soft-bristle toothbrush.
|
|
</div></li><li class="half_rhythm"><div>Replace your toothbrush often.</div></li><li class="half_rhythm"><div>Use lubricating jelly that is water-<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000467861/" class="def">soluble</a>, to help keep your mouth moist.
|
|
</div></li><li class="half_rhythm"><div>Use mild rinses or plain water. Frequent rinsing removes pieces of food and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044123/" class="def">bacteria</a> from the mouth, prevents crusting of sores, and moistens and soothes sore gums and the lining of the mouth.
|
|
</div></li><li class="half_rhythm"><div>If mouth sores begin to crust over, the following rinse may be used:
|
|
<dl id="CDR0000062871__87" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Three percent <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044113/" class="def">hydrogen peroxide</a> mixed with an equal amount of water or saltwater. To make a saltwater mixture, put 1/4 teaspoon of salt in 1 cup of water.</p></dd></dl>
|
|
This should not be used for more than 2 days because it will keep mucositis from healing.</div></li></ul><p id="CDR0000062871__88"><b>Relieving mucositis pain</b>
|
|
</p><ul id="CDR0000062871__89"><li class="half_rhythm"><div>Try <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045927/" class="def">topical</a> medicines for pain. Rinse your mouth before putting the medicine on the gums or lining of the mouth. Wipe mouth and teeth gently with wet gauze dipped in saltwater to remove pieces of food.
|
|
</div></li><li class="half_rhythm"><div>Painkillers may help when topical medicines do not. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044481/" class="def">Nonsteroidal anti-inflammatory drugs</a> (NSAIDS, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045176/" class="def">aspirin</a>-type painkillers) should not be used by patients receiving chemotherapy because they increase the risk of bleeding.
|
|
</div></li><li class="half_rhythm"><div>Zinc <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045916/" class="def">supplements</a> taken during radiation therapy may help treat pain caused by mucositis as well as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045667/" class="def">dermatitis</a> (inflammation of the skin).</div></li><li class="half_rhythm"><div>Povidone-<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044548/" class="def">iodine</a> mouthwash that does not contain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463134/" class="def">alcohol</a> may help delay or decrease mucositis caused by radiation therapy.</div></li></ul><p id="CDR0000062871__296">See the <a href="#CDR0000062871__336">Pain</a> section of this summary for more information on pain control.</p></div></div><div id="CDR0000062871__336"><h3>Pain</h3><div id="CDR0000062871__391"><h4>There can be many causes of oral pain in cancer patients.</h4><p id="CDR0000062871__338">A cancer patient's pain may come from the following:</p><ul id="CDR0000062871__339"><li class="half_rhythm"><div>The cancer.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">Side effects</a> of cancer treatments.</div></li><li class="half_rhythm"><div>Other medical <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a> not related to the cancer.</div></li></ul><p id="CDR0000062871__340">Because there can be many causes of oral pain, a careful <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosis</a> is important. This may include:</p><ul id="CDR0000062871__407"><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">medical history</a>.</div></li><li class="half_rhythm"><div>Physical and dental exams.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">X-rays</a> of the teeth.</div></li></ul></div><div id="CDR0000062871__341"><h4>Oral pain in cancer patients may be caused by the cancer.</h4><p id="CDR0000062871__343">Cancer can cause pain in different ways:</p><ul id="CDR0000062871__353"><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> presses on nearby areas as it grows and affects <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373935/" class="def">nerves</a> and causes inflammation.
|
|
</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">Leukemias</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045368/" class="def">lymphomas</a>, which spread through the body and may affect sensitive areas in the mouth.
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045793/" class="def">Multiple myeloma</a> can affect the teeth.
|
|
</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000387264/" class="def">Brain tumors</a> may cause headaches.
|
|
</div></li><li class="half_rhythm"><div>Cancer may spread to the head and neck from other parts of the body and cause oral pain.
|
|
</div></li><li class="half_rhythm"><div>With some cancers, pain may be felt in parts of the body not near the cancer. This is called referred pain. Tumors of the nose, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439429/" class="def">throat</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a> can cause referred pain in the mouth or jaw.</div></li></ul></div><div id="CDR0000062871__344"><h4>Oral pain may be a side effect of treatments.</h4><p id="CDR0000062871__346">Oral mucositis is the most common side effect of radiation therapy and chemotherapy. Pain in the mucous membranes often continues for a while even after the mucositis is healed.
|
|
</p><p id="CDR0000062871__355"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> may damage bone, nerves, or tissue and may cause pain. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044817/" class="def">Bisphosphonates</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> taken to treat bone pain, sometimes cause bone to break down. This is most common after a dental procedure such as having a tooth pulled. (See the <a href="#CDR0000062871__232">Oral Complications Not Related to Chemotherapy or Radiation Therapy</a> section of this summary for more information.)
|
|
</p><p id="CDR0000062871__356">Patients who have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplants</a> may develop <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045703/" class="def">graft-versus-host-disease</a> (GVHD). This can cause inflammation of the mucous membranes and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000458080/" class="def">joint</a> pain. (See the <a href="#CDR0000062871__21">Managing Oral Complications of High-Dose Chemotherapy and/or Stem Cell Transplant</a> section of this summary for more information).
|
|
</p></div><div id="CDR0000062871__347"><h4>Certain anticancer drugs can cause oral pain.</h4><p id="CDR0000062871__357">If an anticancer drug is causing pain, stopping the drug usually stops the pain. Because there may be many causes of oral pain during cancer treatment, a careful diagnosis is important. This may include a medical history, physical and dental exams, and x-rays of the teeth.
|
|
</p><p id="CDR0000062871__358">Some patients may have sensitive teeth weeks or months after chemotherapy has ended. Fluoride treatments or toothpaste for sensitive teeth may relieve the discomfort.
|
|
</p></div><div id="CDR0000062871__350"><h4>Teeth grinding may cause pain in the teeth or jaw muscles.</h4><p id="CDR0000062871__352">Pain in the teeth or jaw muscles may occur in patients who grind their teeth or clench their jaws, often because of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450122/" class="def">stress</a> or not being able to sleep. Treatment may include muscle relaxers, drugs to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430405/" class="def">anxiety</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044708/" class="def">physical therapy</a> (moist heat, massage, and stretching), and mouth guards to wear while sleeping.</p></div><div id="CDR0000062871__359"><h4>Pain control helps improve the patient's quality of life.</h4><p id="CDR0000062871__361">Oral and facial pain can affect eating, talking, and many other activities that involve the head, neck, mouth, and throat. Most patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257519/" class="def">head and neck cancers</a> have pain. The doctor may ask the patient to rate the pain using a rating system. This may be on a scale from 0 to 10, with 10 being the worst. The level of pain felt is affected by many different things. It's important for patients to talk with their doctors about pain.
|
|
</p><p id="CDR0000062871__413">Pain that is not controlled can affect all areas of the patient's life. Pain may cause feelings of anxiety and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430479/" class="def">depression</a>, and may prevent the patient from working or enjoying everyday life with friends and family. Pain may also slow the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a> from cancer or lead to new physical problems. Controlling cancer pain can help the patient enjoy normal routines and a better <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</p><p id="CDR0000062871__362">For oral mucositis pain, topical treatments are usually used. See the <a href="#CDR0000062871__32">Oral Mucositis</a> section of this summary for information on relieving oral mucositis pain.
|
|
</p><p id="CDR0000062871__363">Other pain medicines may be also be used. Sometimes, more than one pain medicine is needed. Muscle relaxers and medicines for anxiety or depression or to prevent <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045484/" class="def">seizures</a> may help some patients. For severe pain, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045054/" class="def">opioids</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044711/" class="def">prescribed</a>.</p><p id="CDR0000062871__364">Non-drug treatments may also help, including the following:
|
|
</p><ul id="CDR0000062871__365"><li class="half_rhythm"><div>Physical therapy.
|
|
</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044736/" class="def">TENS</a> (transcutaneous electrical nerve stimulation).
|
|
</div></li><li class="half_rhythm"><div>Applying cold or heat.
|
|
</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044675/" class="def">Hypnosis</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046724/" class="def">Acupuncture</a>. (See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000458088/">Acupuncture</a>.)</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044663/" class="def">Distraction</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689628/" class="def">Relaxation therapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045719/" class="def">imagery</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000650559/" class="def">Cognitive behavioral therapy</a>.
|
|
</div></li><li class="half_rhythm"><div>Music or drama <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450098/" class="def">Counseling</a>.</div></li></ul></div></div><div id="CDR0000062871__33"><h3>Infection</h3><div id="CDR0000062871__189"><h4>Damage to the lining of the mouth and a weakened immune system make it easier for infection to occur.
|
|
</h4><p id="CDR0000062871__91">Oral mucositis breaks down the lining of the mouth, which lets bacteria and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045941/" class="def">viruses</a> get into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>. When the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> is weakened by chemotherapy, even good bacteria in the mouth can cause infections. Germs picked up from the hospital or other places may also cause infections.</p><p id="CDR0000062871__262">As the white <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044648/" class="def">blood cell count</a> gets lower, infections may occur more often and become more serious. Patients who have low white blood cell counts for a long time have a higher risk of serious infections.
|
|
Dry mouth, which is common during radiation therapy to the head and neck, may also raise the risk of infections in the mouth. </p><p id="CDR0000062871__263">Dental care given before chemotherapy and radiation therapy are started can lower the risk of infections in the mouth, teeth, or gums.</p></div><div id="CDR0000062871__191"><h4>Infections may be caused by bacteria, a fungus, or a virus. </h4><p id="CDR0000062871__93">
|
|
<b>Bacterial infections</b>
|
|
</p><p id="CDR0000062871__94">
|
|
Treatment of bacterial infections in patients who have gum disease and receive high-dose chemotherapy may include the following:</p><ul id="CDR0000062871__95"><li class="half_rhythm"><div>
|
|
Using medicated and peroxide mouth rinses.
|
|
</div></li><li class="half_rhythm"><div>Brushing and flossing.
|
|
</div></li><li class="half_rhythm"><div>Wearing dentures as little as possible.
|
|
</div></li></ul><p id="CDR0000062871__97">
|
|
<b>Fungal infections</b>
|
|
</p><p id="CDR0000062871__98">
|
|
The mouth normally contains <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044571/" class="def">fungi</a> that can live on or in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000389464/" class="def">oral cavity</a> without causing any problems. However, an overgrowth (too much fungi) in the mouth can be serious and should be treated.
|
|
</p><p id="CDR0000062871__99"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045967/" class="def">Antibiotics</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046601/" class="def">steroid drugs</a> are often used when a patient receiving chemotherapy has a low white blood cell count. These drugs change the balance of bacteria in the mouth, making it easier for a fungal overgrowth to occur. Also, fungal infections are common in patients treated with radiation therapy.
|
|
Patients receiving cancer treatment may be given drugs to help prevent fungal infections from occurring.</p><p id="CDR0000062871__100"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044774/" class="def">Candidiasis</a> is a type of fungal infection that is common in patients receiving both chemotherapy and radiation therapy. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">Symptoms</a> may include a burning pain and taste changes. Treatment of fungal infections in the lining of the mouth only may include mouthwashes and lozenges that contain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046085/" class="def">antifungal</a> drugs. An antifungal rinse should be used to soak dentures and dental devices and to rinse the mouth. Drugs may be used to when rinses and lozenges do not get rid of the fungal infection. Drugs are sometimes used to prevent fungal infections.</p><p id="CDR0000062871__102">
|
|
<b>Viral infections</b>
|
|
</p><p id="CDR0000062871__103">Patients receiving chemotherapy, especially those with immune systems weakened by stem cell transplant, have an increased risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044629/" class="def">viral</a> infections. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046366/" class="def">Herpesvirus</a> infections and other viruses that are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257211/" class="def">latent</a> (present in the body but not active or causing symptoms) may flare up. Finding and treating the infections early is important. Giving <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046088/" class="def">antiviral</a> drugs before treatment starts can lower the risk of viral infections.</p></div></div><div id="CDR0000062871__34"><h3>Bleeding</h3><div id="CDR0000062871__194"><h4>Bleeding may occur when anticancer drugs make the blood less able to clot.</h4><p id="CDR0000062871__106">High-dose chemotherapy and stem cell transplants can cause a lower-than-normal number of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">platelets</a> in the blood. This can cause problems with the body's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476017/" class="def">blood clotting</a> process. Bleeding may be mild (small red spots on the lips, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000389466/" class="def">soft palate</a>, or bottom of the mouth) or severe, especially at the gum line and from ulcers in the mouth. Areas of gum disease may bleed on their own or when irritated by eating, brushing, or flossing. When platelet counts are very low, blood may ooze from the gums.</p></div><div id="CDR0000062871__196"><h4>Most patients can safely brush and floss while blood counts are low.
|
|
</h4><p id="CDR0000062871__108">Continuing regular oral care will help prevent infections that can make bleeding problems worse. Your dentist or medical doctor can explain how to treat bleeding and safely keep your mouth clean when platelet counts are low.</p><p id="CDR0000062871__109">Treatment for bleeding during chemotherapy may include the following:
|
|
</p><ul id="CDR0000062871__110"><li class="half_rhythm"><div>Medicines to reduce blood flow and help clots form.
|
|
</div></li><li class="half_rhythm"><div>Topical products that cover and seal bleeding areas.
|
|
</div></li><li class="half_rhythm"><div>Rinsing with a mixture of saltwater and 3% hydrogen peroxide. (The mixture should have 2 or 3 times the amount of saltwater than hydrogen peroxide.) To make the saltwater mixture, put 1/4 teaspoon of salt in 1 cup of water. This helps clean <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000441269/" class="def">wounds</a> in the mouth. Rinse carefully so clots are not disturbed.
|
|
</div></li></ul></div></div><div id="CDR0000062871__35"><h3>Dry Mouth</h3><div id="CDR0000062871__199"><h4>Dry mouth (xerostomia) occurs when the salivary glands don't make enough saliva.</h4><p id="CDR0000062871__112"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257526/" class="def">Saliva</a> is made by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046196/" class="def">salivary glands</a>. Saliva is needed for taste, swallowing, and speech. It helps prevent infection and tooth decay by cleaning off the teeth and gums and preventing too much <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642987/" class="def">acid</a> in the mouth. </p><p id="CDR0000062871__273">Radiation therapy can damage salivary glands and cause them to make too little saliva. Some types of chemotherapy used for stem cell transplant may also damage salivary glands. </p><p id="CDR0000062871__271">When there is not enough saliva, the mouth gets dry and uncomfortable. This condition is called dry mouth (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044537/" class="def">xerostomia</a>). The risk of tooth decay, gum disease, and infection increases, and your quality of life suffers. </p><p id="CDR0000062871__272">Symptoms of dry mouth include the following:</p><ul id="CDR0000062871__113"><li class="half_rhythm"><div>Thick, stringy saliva.
|
|
</div></li><li class="half_rhythm"><div>Increased thirst.
|
|
</div></li><li class="half_rhythm"><div>Changes in taste, swallowing, or speech.
|
|
</div></li><li class="half_rhythm"><div>A sore or burning feeling (especially on the tongue).
|
|
</div></li><li class="half_rhythm"><div>Cuts or cracks in the lips or at the corners of the mouth.
|
|
</div></li><li class="half_rhythm"><div>Changes in the surface of the tongue.
|
|
</div></li><li class="half_rhythm"><div>Problems wearing dentures.</div></li></ul></div><div id="CDR0000062871__201"><h4>Salivary glands usually return to normal after chemotherapy ends.</h4><p id="CDR0000062871__115">Dry mouth caused by chemotherapy for stem cell transplant is usually temporary. The salivary glands often recover 2 to 3 months after chemotherapy ends.
|
|
</p></div><div id="CDR0000062871__203"><h4>Salivary glands may not recover completely after radiation therapy ends.</h4><p id="CDR0000062871__117">The amount of saliva made by the salivary glands usually starts to decrease within 1 week after starting radiation therapy to the head or neck. It continues to decrease as treatment goes on. How severe the dryness is depends on the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> and the number of salivary glands that receive radiation. </p><p id="CDR0000062871__118">Salivary glands may partly recover during the first year after radiation therapy. However, recovery is usually not complete, especially if the salivary glands received direct radiation. Salivary glands that did not receive radiation may start making more saliva to make up for the loss of saliva from the damaged glands.
|
|
</p></div><div id="CDR0000062871__205"><h4>Careful oral hygiene can help prevent mouth sores, gum disease, and tooth decay caused by dry mouth.
|
|
</h4><p id="CDR0000062871__124">Care of dry mouth may include the following:
|
|
</p><ul id="CDR0000062871__121"><li class="half_rhythm"><div>Clean the mouth and teeth at least 4 times a day.
|
|
</div></li><li class="half_rhythm"><div>Floss once a day.
|
|
</div></li><li class="half_rhythm"><div>Brush with a fluoride toothpaste.
|
|
</div></li><li class="half_rhythm"><div>Apply fluoride gel once a day at bedtime, after cleaning the teeth.
|
|
</div></li><li class="half_rhythm"><div>Rinse 4 to 6 times a day with a mixture of salt and baking soda (mix ½ teaspoon salt and ½ teaspoon baking soda in 1 cup of warm water).
|
|
</div></li><li class="half_rhythm"><div>Avoid foods and liquids that have a lot of sugar in them.
|
|
</div></li><li class="half_rhythm"><div>Sip water often to relieve mouth dryness. </div></li></ul><p id="CDR0000062871__120">A dentist may give the following treatments:</p><ul id="CDR0000062871__122"><li class="half_rhythm"><div>Rinses to replace minerals in the teeth.
|
|
</div></li><li class="half_rhythm"><div>Rinses to fight infection in the mouth.
|
|
</div></li><li class="half_rhythm"><div>Saliva substitutes or medicines that help the salivary glands make more saliva.
|
|
</div></li><li class="half_rhythm"><div>Fluoride treatments to prevent tooth decay.</div></li></ul><p id="CDR0000062871__366">Acupuncture may also help relieve dry mouth.</p></div></div><div id="CDR0000062871__36"><h3>Tooth Decay</h3><p id="CDR0000062871__15">Dry mouth and changes in the balance of bacteria in the mouth increase the risk of tooth decay (cavities). Careful oral <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430486/" class="def">hygiene</a> and regular care by a dentist can help prevent cavities. See the <a href="#CDR0000062871__31">Regular Oral Care</a> section of this summary for more information. </p></div><div id="CDR0000062871__37"><h3>Taste Changes</h3><div id="CDR0000062871__209"><h4>Changes in taste (dysguesia) are common during chemotherapy and radiation therapy.</h4><p id="CDR0000062871__126">
|
|
Changes in the sense of taste is a common side effect of both chemotherapy and head or neck radiation therapy. Taste changes can be caused by damage to the taste buds, dry mouth, infection, or dental problems. Foods may seem to have no taste or may not taste the way they did before cancer treatment. Radiation may cause a change in sweet, sour, bitter, and salty tastes.
|
|
Chemotherapy drugs may cause an unpleasant taste. </p><p id="CDR0000062871__127">In most patients receiving chemotherapy and in some patients receiving radiation therapy, taste returns to normal a few months after treatment ends. However, for many radiation therapy patients, the change is permanent. In others, the taste buds may recover 6 to 8 weeks or more after radiation therapy ends. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256545/" class="def">Zinc sulfate</a> supplements may help some patients recover their sense of taste.
|
|
</p></div></div><div id="CDR0000062871__38"><h3>Fatigue</h3><p id="CDR0000062871__17">Cancer patients who are receiving high-dose chemotherapy or radiation therapy often feel <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000321374/" class="def">fatigue</a> (a lack of energy). This can be caused by either the cancer or its treatment. Some patients may have problems sleeping. Patients may feel too tired for regular oral care, which may further increase the risk for mouth ulcers, infection, and pain. For more information, see <a href="https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Fatigue</a>.</p></div><div id="CDR0000062871__251"><h3>Malnutrition</h3><div id="CDR0000062871__253"><h4>Loss of appetite can lead to malnutrition.</h4><p id="CDR0000062871__255">Patients treated for head and neck cancers have a high risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046014/" class="def">malnutrition</a>. The cancer itself, poor <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044660/" class="def">diet</a> before diagnosis, and complications from surgery, radiation therapy, and chemotherapy can lead to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044698/" class="def">nutrition</a> problems. Patients may lose the desire to eat because of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">nausea</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">vomiting</a>, trouble swallowing, sores in the mouth, or dry mouth. When eating causes discomfort or pain, the patient's quality of life and nutritional well-being suffer. The following may help patients with cancer meet their nutrition needs:</p><ul id="CDR0000062871__130"><li class="half_rhythm"><div>Serve food chopped, ground, or blended, to shorten the amount of time it needs to stay in the mouth before being swallowed.
|
|
</div></li><li class="half_rhythm"><div>Eat between-meal snacks to add <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044651/" class="def">calories</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044697/" class="def">nutrients</a>.</div></li><li class="half_rhythm"><div>Eat foods high in calories and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a>.</div></li><li class="half_rhythm"><div>Take supplements to get <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044744/" class="def">vitamins</a>, minerals, and calories.</div></li></ul><p id="CDR0000062871__256">
|
|
Meeting with a nutrition <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000688836/" class="def">counselor</a> may help during and after treatment.</p></div><div id="CDR0000062871__257"><h4>Nutrition support may include liquid diets and tube feeding.</h4><p id="CDR0000062871__259">
|
|
Many patients treated for head and neck cancers who receive radiation therapy only are able to eat soft foods. As treatment continues, most patients will add or switch to high-calorie, high-protein liquids to meet their nutrition needs. Some patients may need to receive the liquids through a tube that is inserted into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046582/" class="def">small intestine</a>. Almost all patients who receive chemotherapy and head or neck radiation therapy at the same time will need <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390298/" class="def">tube feedings</a> within 3 to 4 weeks. Studies show that patients do better if they begin these feedings at the start of treatment, before weight loss occurs.
|
|
</p><p id="CDR0000062871__260">Normal eating by mouth can begin again when treatment is finished and the area that received radiation is healed. A team that includes a speech and swallowing therapist can help the patients with the return to normal eating. Tube feedings are decreased as eating by mouth increases, and are stopped when you are able to get enough nutrients by mouth. Although most patients will once again be able to eat solid foods, many will have lasting complications such as taste changes, dry mouth, and trouble swallowing. </p></div></div><div id="CDR0000062871__40"><h3>Mouth and Jaw Stiffness</h3><p id="CDR0000062871__264">Treatment for head and neck cancers may affect the ability to move the jaws, mouth, neck, and tongue. There may be problems with swallowing. Stiffness may be caused by:</p><ul id="CDR0000062871__265"><li class="half_rhythm"><div>Oral surgery.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">Late effects</a> of radiation therapy. An overgrowth of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000344349/" class="def">fibrous</a> tissue (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045690/" class="def">fibrosis</a>) in the skin, mucous membranes, muscle, and joints of the jaw may occur after radiation therapy has ended. </div></li><li class="half_rhythm"><div>Stress caused by the cancer and its treatment.</div></li></ul><p id="CDR0000062871__367">Jaw stiffness may lead to serious health problems, including:</p><ul id="CDR0000062871__368"><li class="half_rhythm"><div>Malnutrition and weight loss from being unable to eat normally.</div></li><li class="half_rhythm"><div>Slower healing and recovery from poor nutrition.</div></li><li class="half_rhythm"><div>Dental problems from being unable to clean the teeth and gums well and have dental treatments.</div></li><li class="half_rhythm"><div>Weakened jaw muscles from not using them.</div></li><li class="half_rhythm"><div>Emotional problems from avoiding social contact with others because of trouble speaking and eating.</div></li></ul><p id="CDR0000062871__138">The risk of having jaw stiffness from radiation therapy increases with higher doses of radiation and with repeated radiation treatments. The stiffness usually begins around the time the radiation treatments end. It may get worse over time, stay the same, or get somewhat better on its own. Treatment should begin as soon as possible to keep the condition from getting worse or becoming permanent. Treatment may include the following</p><ul id="CDR0000062871__139"><li class="half_rhythm"><div>Medical devices for the mouth.</div></li><li class="half_rhythm"><div>Pain treatments.</div></li><li class="half_rhythm"><div>Medicine to relax muscles.</div></li><li class="half_rhythm"><div>Jaw exercises.</div></li><li class="half_rhythm"><div>Medicine to treat depression.</div></li></ul></div><div id="CDR0000062871__369"><h3>Swallowing Problems</h3><div id="CDR0000062871__371"><h4>Pain during swallowing and being unable to swallow (dysphagia) are common in cancer patients before, during, and after treatment. </h4><p id="CDR0000062871__373">Swallowing problems are common in patients who have head and neck cancers. Cancer treatment side effects such as oral mucositis, dry mouth, skin damage from radiation, infections, and graft-versus-host-disease (GVHD) may all cause problems with swallowing.</p></div><div id="CDR0000062871__374"><h4>Trouble swallowing increases the risk of other complications.</h4><p id="CDR0000062871__376">Other complications can develop from being unable to swallow and these can further decrease the patient's quality of life:
|
|
</p><ul id="CDR0000062871__393"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045476/" class="def">Pneumonia</a> and other respiratory problems: Patients who have trouble swallowing may <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046519/" class="def">aspirate</a> (inhale food or liquids into the lung) when trying to eat or drink. Aspiration can lead to serious conditions, including pneumonia and respiratory failure.</div></li><li class="half_rhythm"><div>Poor nutrition: Being unable to swallow normally makes it hard to eat well. Malnutrition occurs when the body doesn't get all the nutrients needed for health. Wounds heal slowly and the body is less able to fight off infections.</div></li><li class="half_rhythm"><div>Need for tube feeding: A patient who is not able to take in enough food by mouth may be fed through a tube. The healthcare team and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454994/" class="def">registered dietitian</a> can explain the benefits and risks of tube feeding for patients who have swallowing problems.</div></li><li class="half_rhythm"><div>Side effects of pain medicine: Opioids used to treat painful swallowing may cause dry mouth and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407757/" class="def">constipation</a>.</div></li><li class="half_rhythm"><div>Emotional problems: Being unable to eat, drink, and speak normally may cause depression and the desire to avoid other people.</div></li></ul></div><div id="CDR0000062871__377"><h4>Whether radiation therapy will affect swallowing depends on several factors.</h4><p id="CDR0000062871__379">The following may affect the risk of swallowing problems after radiation therapy:
|
|
</p><ul id="CDR0000062871__394"><li class="half_rhythm"><div>Total dose and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346524/" class="def">schedule</a> of radiation therapy. Higher doses over a shorter time often have more side effects.</div></li><li class="half_rhythm"><div>The way the radiation is given. Some types of radiation cause less damage to healthy tissue.</div></li><li class="half_rhythm"><div>Whether chemotherapy is given at the same time. The risk of side effects is increased if both are given.</div></li><li class="half_rhythm"><div>The patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046391/" class="def">genetic</a> makeup.</div></li><li class="half_rhythm"><div>Whether the patient is taking any food by mouth or only by tube feeding.</div></li><li class="half_rhythm"><div>Whether the patient smokes.</div></li><li class="half_rhythm"><div>How well the patient copes with problems. </div></li></ul></div><div id="CDR0000062871__380"><h4>Swallowing problems sometimes go away after treatment</h4><p id="CDR0000062871__382">Some side effects go away within 3 months after the end of treatment, and patients are able to swallow normally again. However, some treatments can cause permanent damage or late effects. Late effects are health problems that occur long after treatment has ended. Conditions that may cause permanent swallowing problems or late effects include:</p><ul id="CDR0000062871__395"><li class="half_rhythm"><div>Damaged <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a>.</div></li><li class="half_rhythm"><div>Wasting away of tissue in the treated areas.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045359/" class="def">Lymphedema</a> (buildup of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046305/" class="def">lymph</a> in the body).</div></li><li class="half_rhythm"><div>Overgrowth of fibrous tissue in head or neck areas, which may lead to jaw stiffness.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045641/" class="def">Chronic</a> dry mouth.</div></li><li class="half_rhythm"><div>Infections.</div></li></ul></div><div id="CDR0000062871__383"><h4>Swallowing problems are managed by a team of experts. </h4><p id="CDR0000062871__385">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046260/" class="def">oncologist</a> works with other health care experts who specialize in treating head and neck cancers and the oral complications of cancer treatment. These <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478785/" class="def">specialists</a> may include the following:
|
|
</p><ul id="CDR0000062871__396"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044459/" class="def">Speech therapist</a>: A speech therapist can assess how well the patient is swallowing and give the patient swallowing therapy and information to better understand the problem.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044661/" class="def">Dietitian</a>: A dietitian can help plan a safe way for the patient to receive the nutrition needed for health while swallowing is a problem.</div></li><li class="half_rhythm"><div>Dental specialist: Replace missing teeth and damaged area of the mouth with artificial devices to help swallowing.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044716/" class="def">Psychologist</a>: For patients who are having a hard time adjusting to being unable to swallow and eat normally, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454766/" class="def">psychological</a> counseling may help.</div></li></ul></div></div><div id="CDR0000062871__41"><h3>Tissue and Bone Loss</h3><p id="CDR0000062871__140">Radiation therapy can destroy very small blood vessels within the bone. This can kill bone tissue and lead to bone fractures or infection. Radiation can also kill tissue in the mouth. Ulcers may form, grow, and cause pain, loss of feeling, or infection.</p><p id="CDR0000062871__414">
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043981/" class="def">Preventive</a> care can make tissue and bone loss less severe.
|
|
</p><p id="CDR0000062871__141">
|
|
The following may help prevent and treat tissue and bone loss:</p><ul id="CDR0000062871__142"><li class="half_rhythm"><div>Eat a well-balanced diet.
|
|
</div></li><li class="half_rhythm"><div>Wear removable dentures or devices as little as possible.
|
|
</div></li><li class="half_rhythm"><div>Don't smoke.
|
|
</div></li><li class="half_rhythm"><div>Don't drink alcohol.
|
|
</div></li><li class="half_rhythm"><div>Use topical antibiotics.
|
|
</div></li><li class="half_rhythm"><div>Use painkillers as prescribed.
|
|
</div></li><li class="half_rhythm"><div>Surgery to remove dead bone or to rebuild bones of the mouth and jaw.
|
|
</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045218/" class="def">Hyperbaric oxygen</a> therapy (a method that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538149/" class="def">oxygen</a> under pressure to help wounds heal).</div></li></ul><p id="CDR0000062871__144"><div class="milestone-start" id="CDR0000062871__143"></div>See the PDQ summary on <a href="/books/n/pdqcis/CDR0000286996/">Nutrition in Cancer Care</a> for more information about managing mouth sores, dry mouth, and taste changes.<div class="milestone-end"></div></p></div></div><div id="CDR0000062871__21"><h2 id="_CDR0000062871__21_">Managing Oral Complications of High-Dose Chemotherapy and/or Stem Cell Transplant</h2><div id="CDR0000062871__21.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062871__220">Patients who receive transplants have an increased risk of graft-versus-host disease.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__222">Oral devices need special care during high-dose chemotherapy and/or stem cell transplant.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__386">Care of the teeth and gums is important during chemotherapy or stem cell transplant. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__410">Medicines and ice may be used to prevent and treat mucositis from stem cell transplant.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__224">Dental treatments may be put off until the patient's immune system returns to normal.</a></div></li></ul></div><div id="CDR0000062871__220"><h3>Patients who receive transplants have an increased risk of graft-versus-host disease.</h3><p id="CDR0000062871__146">
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045703/" class="def">Graft-versus-host disease</a> (GVHD) occurs when your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> reacts to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">stem cells</a> that come from a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a>.
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">Symptoms</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">oral</a> GVHD include the following:
|
|
</p><ul id="CDR0000062871__147"><li class="half_rhythm"><div>Sores that are red and have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269469/" class="def">ulcers</a>, which appear in the mouth 2 to 3 weeks after the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">transplant</a>.
|
|
</div></li><li class="half_rhythm"><div>Dry mouth.
|
|
</div></li><li class="half_rhythm"><div>Pain from spices, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463134/" class="def">alcohol</a>, or flavoring (such as mint in toothpaste).</div></li><li class="half_rhythm"><div>Swallowing problems.</div></li><li class="half_rhythm"><div>A feeling of tightness in the skin or in the lining of the mouth.</div></li><li class="half_rhythm"><div>Taste changes.</div></li></ul><p id="CDR0000062871__148">
|
|
It's important to have these symptoms treated because they can lead to weight loss or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046014/" class="def">malnutrition</a>. Treatment of oral GVHD may include the following:</p><ul id="CDR0000062871__149"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045927/" class="def">Topical</a> rinses, gels, creams, or powders.
|
|
</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046085/" class="def">Antifungal</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injection</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439423/" class="def">Psoralen and ultraviolet A (PUVA) therapy</a>.
|
|
</div></li><li class="half_rhythm"><div>Drugs that help the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046196/" class="def">salivary glands</a> make more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257526/" class="def">saliva</a>.
|
|
</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044670/" class="def">Fluoride</a> treatments.
|
|
</div></li><li class="half_rhythm"><div>Treatments to replace minerals lost from teeth by acids in the mouth.</div></li></ul></div><div id="CDR0000062871__222"><h3>Oral devices need special care during high-dose chemotherapy and/or stem cell transplant.</h3><p id="CDR0000062871__151">
|
|
The following can help in the care and use of dentures, braces, and other oral devices during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">high-dose chemotherapy</a> or stem cell transplant:
|
|
</p><ul id="CDR0000062871__152"><li class="half_rhythm"><div>Have brackets, wires, and retainers removed before high-dose chemotherapy begins.
|
|
</div></li><li class="half_rhythm"><div>Wear dentures only when eating during the first 3 to 4 weeks after the transplant.
|
|
</div></li><li class="half_rhythm"><div>Brush dentures twice a day and rinsing them well.
|
|
</div></li><li class="half_rhythm"><div>Soak dentures in an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000462660/" class="def">antibacterial</a> solution when they are not being worn.
|
|
</div></li><li class="half_rhythm"><div>Clean denture soaking cups and changing denture soaking solution every day.
|
|
</div></li><li class="half_rhythm"><div>Remove dentures or other oral devices when cleaning your mouth.
|
|
</div></li><li class="half_rhythm"><div>Continue your regular oral care 3 or 4 times a day with dentures or other devices out of the mouth.</div></li><li class="half_rhythm"><div>If you have mouth sores, avoid using removable oral devices until the sores have healed.</div></li></ul></div><div id="CDR0000062871__386"><h3>Care of the teeth and gums is important during chemotherapy or stem cell transplant. </h3><p id="CDR0000062871__388">Talk to your medical doctor or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000389460/" class="def">dentist</a> about the best way to take care of your mouth during high-dose chemotherapy and stem cell transplant. Careful brushing and flossing may help prevent <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> of oral tissues. The following may help prevent infection and relieve discomfort of oral in tissues:
|
|
</p><ul id="CDR0000062871__397"><li class="half_rhythm"><div>Brush teeth with a soft-bristle brush 2 to 3 times a day. Be sure to brush the area where the teeth meet the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000481753/" class="def">gums</a>.</div></li><li class="half_rhythm"><div>Rinse the toothbrush in hot water every 15 to 30 seconds to keep the bristles soft.</div></li><li class="half_rhythm"><div>Rinse your mouth 3 or 4 times while brushing.</div></li><li class="half_rhythm"><div>Avoid rinses that have alcohol in them. </div></li><li class="half_rhythm"><div>Use a mild-tasting toothpaste.</div></li><li class="half_rhythm"><div>Let the toothbrush air-dry between uses.</div></li><li class="half_rhythm"><div>Floss according to your medical doctor's or dentist's directions.</div></li><li class="half_rhythm"><div>Clean the mouth after meals.</div></li><li class="half_rhythm"><div>Use foam swabs to clean the tongue and roof of the mouth.</div></li><li class="half_rhythm"><div>Avoid the following:<ul id="CDR0000062871__409"><li class="half_rhythm"><div>Foods that are spicy or acidic.</div></li><li class="half_rhythm"><div>"Hard" foods that could irritate or break the skin in your mouth, such as chips.</div></li><li class="half_rhythm"><div>Hot foods and drinks.</div></li></ul></div></li></ul></div><div id="CDR0000062871__410"><h3>Medicines and ice may be used to prevent and treat mucositis from stem cell transplant.</h3><p id="CDR0000062871__412"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">Medicines</a> may be given to help prevent mouth sores or help the mouth heal faster if it is damaged by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>. Also, holding ice chips in the mouth during high-dose chemotherapy, may help prevent mouth sores.</p></div><div id="CDR0000062871__224"><h3>Dental treatments may be put off until the patient's immune system returns to normal.</h3><p id="CDR0000062871__154">Regular dental treatments, including cleaning and polishing, should wait until the transplant patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> returns to normal.
|
|
The immune system can take 6 to 12 months to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recover</a> after high-dose chemotherapy and stem cell transplant. During this time, the risk of oral <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463706/" class="def">complications</a> is high. If dental treatments are needed, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045967/" class="def">antibiotics</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046609/" class="def">supportive care</a> are given. </p><p id="CDR0000062871__267">Supportive care before oral procedures may include giving antibiotics or immunoglobulin G, adjusting steroid <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a>, and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">platelet</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046001/" class="def">transfusion</a>.</p></div></div><div id="CDR0000062871__25"><h2 id="_CDR0000062871__25_">Oral Complications in Second Cancers</h2><p id="CDR0000062871__26"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a> who received <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a> or who underwent <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> are at risk of developing a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">second cancer</a> later in life. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">Oral</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046595/" class="def">squamous cell cancer</a> is the most common second <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445073/" class="def">oral cancer</a> in transplant patients. The lips and tongue are the areas that are affected most often. </p><p id="CDR0000062871__389">Second cancers are more common in patients treated for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045368/" class="def">lymphoma</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045793/" class="def">Multiple myeloma</a> patients who received a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a> using their own <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">stem cells</a> sometimes develop an oral <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046231/" class="def">plasmacytoma</a>.</p><p id="CDR0000062871__390">Patients who received a transplant should see a doctor if they have swollen <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> or lumps in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045882/" class="def">soft tissue</a> areas. This could be a sign of a second cancer.</p></div><div id="CDR0000062871__232"><h2 id="_CDR0000062871__232_">Oral Complications Not Related to Chemotherapy or Radiation Therapy</h2><div id="CDR0000062871__232.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062871__236">Certain drugs used to treat cancer and other bone problems are linked to bone loss in the mouth.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062871__243">Treatment of ONJ usually includes treating the infection and good dental hygiene.</a></div></li></ul></div><div id="CDR0000062871__236"><h3>Certain drugs used to treat cancer and other bone problems are linked to bone loss in the mouth.</h3><p id="CDR0000062871__421"> Some <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> break down bone <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> in the mouth. This is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000723852/" class="def">osteonecrosis</a> of the jaw (ONJ). ONJ can also cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">Symptoms</a> include pain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">inflamed</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046324/" class="def">lesions</a> in the mouth, where areas of damaged bone may show. </p><p id="CDR0000062871__422">Drugs that may cause ONJ include the following:</p><ul id="CDR0000062871__423"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044817/" class="def">Bisphosphonates</a>: Drugs given to some patients whose <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to the bones. They are used to decrease pain and the risk of broken bones. Bisphosphonates are also used to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045363/" class="def">hypercalcemia</a> (too much <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045632/" class="def">calcium</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>). Bisphosphonates commonly used include <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000487470/" class="def">zoledronic acid</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045175/" class="def">pamidronate</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045355/" class="def">alendronate</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000514443/" class="def">Denosumab</a>: A drug used to prevent or treat certain bone problems. Denosumab is a type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">monoclonal antibody</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046739/" class="def">Angiogenesis inhibitors</a>: Drugs or substances that keep new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> from forming. In cancer treatment, angiogenesis inhibitors may prevent the growth of new blood vessels that <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> need to grow. Some of the angiogenesis inhibitors that may cause ONJ are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046115/" class="def">bevacizumab</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000468779/" class="def">sunitinib</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000509041/" class="def">sorafenib</a>.</div></li></ul><p id="CDR0000062871__424"> It's important for the health care team to know if a patient has been treated with these drugs. Cancer that has spread to the jawbone can look like ONJ. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> may be needed to find out the cause of the ONJ.</p><p id="CDR0000062871__415">ONJ is not a common <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a>. It occurs more often in patients who receive bisphosphonates or denosumab by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injection</a> than in patients who take them by mouth. Taking bisphosphonates, denosumab, or angiogenesis inhibitors increases the risk of ONJ. The risk of ONJ is much greater when angiogenesis inhibitors and bisphosphonates are used together.</p><p id="CDR0000062871__405">The following may also increase the risk of ONJ: </p><ul id="CDR0000062871__406"><li class="half_rhythm"><div>Having teeth removed.</div></li><li class="half_rhythm"><div>Wearing dentures that do not fit well.</div></li><li class="half_rhythm"><div>Having <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045793/" class="def">multiple myeloma</a>.</div></li></ul><p id="CDR0000062871__425">Patients with bone <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastases</a> may decrease their risk of ONJ by getting screened and treated for dental problems before bisphosphonate or denosumab <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> is started. </p></div><div id="CDR0000062871__243"><h3>Treatment of ONJ usually includes treating the infection and good dental hygiene.</h3><p id="CDR0000062871__245">Treatment of ONJ may include the following:
|
|
</p><ul id="CDR0000062871__246"><li class="half_rhythm"><div>Removing the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infected</a> tissue, which may include bone. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322858/" class="def">Laser surgery</a> may be used.</div></li><li class="half_rhythm"><div>Smoothing sharp edges of exposed bone.</div></li><li class="half_rhythm"><div>Using <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045967/" class="def">antibiotics</a> to fight infection.</div></li><li class="half_rhythm"><div>Using medicated mouth rinses.</div></li><li class="half_rhythm"><div>Using pain medicine.</div></li></ul><p id="CDR0000062871__247">During treatment for ONJ, you should continue to brush and floss after meals to keep your mouth very clean. It is best to avoid <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439432/" class="def">tobacco</a> use while ONJ is healing. </p><p id="CDR0000062871__248">You and your doctor can decide whether you should stop using medicines that cause ONJ, based on the effect it would have on your general health.
|
|
</p></div></div><div id="CDR0000062871__23"><h2 id="_CDR0000062871__23_">Oral Complications and Social Problems</h2><p id="CDR0000062871__155">The social problems related to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">oral</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463706/" class="def">complications</a> can be the hardest problems for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> patients to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454700/" class="def">cope</a> with. Oral complications affect eating and speaking and may make you unable or unwilling to take part in mealtimes or to dine out. Patients may become frustrated, withdrawn, or depressed, and they may avoid other people. Some <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> that are used to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430479/" class="def">depression</a> cannot be used because they can make oral complications worse. See the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summaries for more information:</p><ul id="CDR0000062871__398"><li class="half_rhythm"><div>
|
|
<a href="/books/n/pdqcis/CDR0000269124/">Adjustment to Cancer: Anxiety and Distress</a>
|
|
</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/pdqcis/CDR0000062806/">Depression</a>
|
|
</div></li></ul><p id="CDR0000062871__156">
|
|
Education, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046609/" class="def">supportive care</a>, and the treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> are important for patients who have mouth problems that are related to cancer treatment. Patients are watched closely for pain, ability to cope, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">response</a> to treatment. Supportive care from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000650566/" class="def">health care providers</a> and family can help the patient cope with cancer and its complications.
|
|
</p></div><div id="CDR0000062871__27"><h2 id="_CDR0000062871__27_">Oral Complications of Chemotherapy and Radiation Therapy in Children</h2><p id="CDR0000062871__28">Children who received <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">high-dose chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the head and neck may not have normal dental growth and development. New teeth may appear late or not at all, and tooth size may be smaller than normal. The head and face may not develop fully. The changes
|
|
are usually the same on both sides of the head and are not always noticeable.</p><p id="CDR0000062871__268">Orthodontic treatment for patients with these dental growth and development <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> is being studied. </p></div><div id="CDR0000062871__29"><h2 id="_CDR0000062871__29_">Changes to This Summary (03/06/2024)</h2><p id="CDR0000062871__30">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
|
|
</p><p id="CDR0000062871__157">The title of this summary was changed to match the health professional version and the metadata was updated.</p></div><div id="CDR0000062871__AboutThis_1"><h2 id="_CDR0000062871__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062871__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000062871__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000062871__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000062871__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000062871__AboutThis_6">This PDQ cancer information summary has current information about the causes and treatment of oral complications of cancer therapies. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000062871__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000062871__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
|
|
</p><p id="CDR0000062871__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/supportive-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Supportive and Palliative Care Editorial Board</a>.
|
|
</p></div><div id="CDR0000062871__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000062871__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
|
|
</p><p id="CDR0000062871__AboutThis_12">Clinical trials can be found online at <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
|
|
</p></div><div id="CDR0000062871__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000062871__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
|
|
</p><p id="CDR0000062871__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000062871__AboutThis_21">PDQ® Supportive and Palliative Care Editorial Board. PDQ Oral Complications of Cancer Therapies. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389169]</p><p id="CDR0000062871__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 scientific images.
|
|
</p></div><div id="CDR0000062871__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062871__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062871__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000062871__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
|
|
<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65725</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389169" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389169</a></span></div></div></div>
|
|
|
|
</div>
|
|
|
|
<!-- Custom content below content -->
|
|
<div class="col4">
|
|
|
|
</div>
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<!-- Custom contetnt below bottom nav -->
|
|
<div class="col5">
|
|
|
|
</div>
|
|
</div>
|
|
|
|
<div id="rightcolumn" class="four_col col last">
|
|
<!-- Custom content above discovery portlets -->
|
|
<div class="col6">
|
|
<div id="ncbi_share_book"><a href="#" class="ncbi_share" data-ncbi_share_config="popup:false,shorten:true" ref="id=NBK65725&db=books">Share</a></div>
|
|
|
|
</div>
|
|
<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65725.6/?report=reader">PubReader</a></li><li><a href="/books/NBK65725.6/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65725" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65725" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Supportive and Palliative Care Editorial Board. Oral Complications of Cancer Therapies (PDQ®): Patient Version. 2024 Mar 6. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65725.8/">NBK65725.8</a></span> October 15, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65725.7/">NBK65725.7</a></span> June 6, 2024</li><li><span class="bk_col_itm">NBK65725.6</span> March 6, 2024 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65725.5/">NBK65725.5</a></span> December 6, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65725.4/">NBK65725.4</a></span> April 26, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65725.3/">NBK65725.3</a></span> December 16, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65725.2/">NBK65725.2</a></span> January 22, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65725.1/">NBK65725.1</a></span> April 24, 2014</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062871__3" ref="log$=inpage&link_id=inpage">General Information About Oral Complications</a></li><li><a href="#CDR0000062871__5" ref="log$=inpage&link_id=inpage">Oral Complications and Their Causes</a></li><li><a href="#CDR0000062871__7" ref="log$=inpage&link_id=inpage">Preventing and Treating Oral Complications Before Chemotherapy or Radiation Therapy Begins</a></li><li><a href="#CDR0000062871__9" ref="log$=inpage&link_id=inpage">Managing Oral Complications During and After Chemotherapy or Radiation Therapy</a></li><li><a href="#CDR0000062871__21" ref="log$=inpage&link_id=inpage">Managing Oral Complications of High-Dose Chemotherapy and/or Stem Cell Transplant</a></li><li><a href="#CDR0000062871__25" ref="log$=inpage&link_id=inpage">Oral Complications in Second Cancers</a></li><li><a href="#CDR0000062871__232" ref="log$=inpage&link_id=inpage">Oral Complications Not Related to Chemotherapy or Radiation Therapy</a></li><li><a href="#CDR0000062871__23" ref="log$=inpage&link_id=inpage">Oral Complications and Social Problems</a></li><li><a href="#CDR0000062871__27" ref="log$=inpage&link_id=inpage">Oral Complications of Chemotherapy and Radiation Therapy in Children</a></li><li><a href="#CDR0000062871__29" ref="log$=inpage&link_id=inpage">Changes to This Summary (03/06/2024)</a></li><li><a href="#CDR0000062871__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65881/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389165" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Delirium (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Delirium (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Supportive and Palliative Care Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389398" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Pruritus (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Pruritus (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Supportive and Palliative Care Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389249" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Sleep Disorders (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Sleep Disorders (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Supportive and Palliative Care Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389474" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Depression (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Depression (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Supportive and Palliative Care Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389372" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Informal Caregivers in Cancer (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Informal Caregivers in Cancer (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Supportive and Palliative Care Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=26389169" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=26389169" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67c96e85f4a390645e03ff14">Oral Complications of Cancer Therapies (PDQ®) - PDQ Cancer Information Summaries</a><div class="ralinkpop offscreen_noflow">Oral Complications of Cancer Therapies (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67c96e01ab82281a8009412f">Childhood Thyroid Cancer Treatment (PDQ®) - PDQ Cancer Information Summaries</a><div class="ralinkpop offscreen_noflow">Childhood Thyroid Cancer Treatment (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67c96df1f4a390645eff3601">Childhood Thyroid Cancer (PDQ®) - PDQ Cancer Information Summaries</a><div class="ralinkpop offscreen_noflow">Childhood Thyroid Cancer (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67c96d99a68b6b5afc38b7c0">Last Days of Life (PDQ®) - PDQ Cancer Information Summaries</a><div class="ralinkpop offscreen_noflow">Last Days of Life (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
|
|
|
|
<!-- Custom content below discovery portlets -->
|
|
<div class="col7">
|
|
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
<!-- Custom content after all -->
|
|
<div class="col8">
|
|
|
|
</div>
|
|
<div class="col9">
|
|
|
|
</div>
|
|
|
|
<script type="text/javascript" src="/corehtml/pmc/js/jquery.scrollTo-1.4.2.js"></script>
|
|
<script type="text/javascript">
|
|
(function($){
|
|
$('.skiplink').each(function(i, item){
|
|
var href = $($(item).attr('href'));
|
|
href.attr('tabindex', '-1').addClass('skiptarget'); // ensure the target can receive focus
|
|
$(item).on('click', function(event){
|
|
event.preventDefault();
|
|
$.scrollTo(href, 0, {
|
|
onAfter: function(){
|
|
href.focus();
|
|
}
|
|
});
|
|
});
|
|
});
|
|
})(jQuery);
|
|
</script>
|
|
</div>
|
|
<div class="bottom">
|
|
|
|
<div id="NCBIFooter_dynamic">
|
|
<!--<component id="Breadcrumbs" label="breadcrumbs"/>
|
|
<component id="Breadcrumbs" label="helpdesk"/>-->
|
|
|
|
</div>
|
|
|
|
<div class="footer" id="footer">
|
|
<section class="icon-section">
|
|
<div id="icon-section-header" class="icon-section_header">Follow NCBI</div>
|
|
<div class="grid-container container">
|
|
<div class="icon-section_container">
|
|
<a class="footer-icon" id="footer_twitter" href="https://twitter.com/ncbi" aria-label="Twitter"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<defs>
|
|
<style>
|
|
.cls-11 {
|
|
fill: #737373;
|
|
}
|
|
</style>
|
|
</defs>
|
|
<title>Twitter</title>
|
|
<path class="cls-11" d="M250.11,105.48c-7,3.14-13,3.25-19.27.14,8.12-4.86,8.49-8.27,11.43-17.46a78.8,78.8,0,0,1-25,9.55,39.35,39.35,0,0,0-67,35.85,111.6,111.6,0,0,1-81-41.08A39.37,39.37,0,0,0,81.47,145a39.08,39.08,0,0,1-17.8-4.92c0,.17,0,.33,0,.5a39.32,39.32,0,0,0,31.53,38.54,39.26,39.26,0,0,1-17.75.68,39.37,39.37,0,0,0,36.72,27.3A79.07,79.07,0,0,1,56,223.34,111.31,111.31,0,0,0,116.22,241c72.3,0,111.83-59.9,111.83-111.84,0-1.71,0-3.4-.1-5.09C235.62,118.54,244.84,113.37,250.11,105.48Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_facebook" href="https://www.facebook.com/ncbi.nlm" aria-label="Facebook"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<title>Facebook</title>
|
|
<path class="cls-11" d="M210.5,115.12H171.74V97.82c0-8.14,5.39-10,9.19-10h27.14V52l-39.32-.12c-35.66,0-42.42,26.68-42.42,43.77v19.48H99.09v36.32h27.24v109h45.41v-109h35Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_linkedin" href="https://www.linkedin.com/company/ncbinlm" aria-label="LinkedIn"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<title>LinkedIn</title>
|
|
<path class="cls-11" d="M101.64,243.37H57.79v-114h43.85Zm-22-131.54h-.26c-13.25,0-21.82-10.36-21.82-21.76,0-11.65,8.84-21.15,22.33-21.15S101.7,78.72,102,90.38C102,101.77,93.4,111.83,79.63,111.83Zm100.93,52.61A17.54,17.54,0,0,0,163,182v61.39H119.18s.51-105.23,0-114H163v13a54.33,54.33,0,0,1,34.54-12.66c26,0,44.39,18.8,44.39,55.29v58.35H198.1V182A17.54,17.54,0,0,0,180.56,164.44Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_github" href="https://github.com/ncbi" aria-label="GitHub"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<defs>
|
|
<style>
|
|
.cls-11,
|
|
.cls-12 {
|
|
fill: #737373;
|
|
}
|
|
|
|
.cls-11 {
|
|
fill-rule: evenodd;
|
|
}
|
|
</style>
|
|
</defs>
|
|
<title>GitHub</title>
|
|
<path class="cls-11" d="M151.36,47.28a105.76,105.76,0,0,0-33.43,206.1c5.28,1,7.22-2.3,7.22-5.09,0-2.52-.09-10.85-.14-19.69-29.42,6.4-35.63-12.48-35.63-12.48-4.81-12.22-11.74-15.47-11.74-15.47-9.59-6.56.73-6.43.73-6.43,10.61.75,16.21,10.9,16.21,10.9,9.43,16.17,24.73,11.49,30.77,8.79,1-6.83,3.69-11.5,6.71-14.14C108.57,197.1,83.88,188,83.88,147.51a40.92,40.92,0,0,1,10.9-28.39c-1.1-2.66-4.72-13.42,1-28,0,0,8.88-2.84,29.09,10.84a100.26,100.26,0,0,1,53,0C198,88.3,206.9,91.14,206.9,91.14c5.76,14.56,2.14,25.32,1,28a40.87,40.87,0,0,1,10.89,28.39c0,40.62-24.74,49.56-48.29,52.18,3.79,3.28,7.17,9.71,7.17,19.58,0,14.15-.12,25.54-.12,29,0,2.82,1.9,6.11,7.26,5.07A105.76,105.76,0,0,0,151.36,47.28Z">
|
|
</path>
|
|
<path class="cls-12" d="M85.66,199.12c-.23.52-1.06.68-1.81.32s-1.2-1.06-.95-1.59,1.06-.69,1.82-.33,1.21,1.07.94,1.6Zm-1.3-1">
|
|
</path>
|
|
<path class="cls-12" d="M90,203.89c-.51.47-1.49.25-2.16-.49a1.61,1.61,0,0,1-.31-2.19c.52-.47,1.47-.25,2.17.49s.82,1.72.3,2.19Zm-1-1.08">
|
|
</path>
|
|
<path class="cls-12" d="M94.12,210c-.65.46-1.71,0-2.37-.91s-.64-2.07,0-2.52,1.7,0,2.36.89.65,2.08,0,2.54Zm0,0"></path>
|
|
<path class="cls-12" d="M99.83,215.87c-.58.64-1.82.47-2.72-.41s-1.18-2.06-.6-2.7,1.83-.46,2.74.41,1.2,2.07.58,2.7Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M107.71,219.29c-.26.82-1.45,1.2-2.64.85s-2-1.34-1.74-2.17,1.44-1.23,2.65-.85,2,1.32,1.73,2.17Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M116.36,219.92c0,.87-1,1.59-2.24,1.61s-2.29-.68-2.3-1.54,1-1.59,2.26-1.61,2.28.67,2.28,1.54Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M124.42,218.55c.15.85-.73,1.72-2,1.95s-2.37-.3-2.52-1.14.73-1.75,2-2,2.37.29,2.53,1.16Zm0,0"></path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_blog" href="https://ncbiinsights.ncbi.nlm.nih.gov/" aria-label="Blog">
|
|
<svg xmlns="http://www.w3.org/2000/svg" id="Layer_1" data-name="Layer 1" viewBox="0 0 40 40">
|
|
<defs><style>.cls-1{fill:#737373;}</style></defs>
|
|
<title>NCBI Insights Blog</title>
|
|
<path class="cls-1" d="M14,30a4,4,0,1,1-4-4,4,4,0,0,1,4,4Zm11,3A19,19,0,0,0,7.05,15a1,1,0,0,0-1,1v3a1,1,0,0,0,.93,1A14,14,0,0,1,20,33.07,1,1,0,0,0,21,34h3a1,1,0,0,0,1-1Zm9,0A28,28,0,0,0,7,6,1,1,0,0,0,6,7v3a1,1,0,0,0,1,1A23,23,0,0,1,29,33a1,1,0,0,0,1,1h3A1,1,0,0,0,34,33Z"></path>
|
|
</svg>
|
|
</a>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
|
|
<section class="container-fluid bg-primary">
|
|
<div class="container pt-5">
|
|
<div class="row mt-3">
|
|
<div class="col-lg-3 col-12">
|
|
<p><a class="text-white" href="https://www.nlm.nih.gov/socialmedia/index.html">Connect with NLM</a></p>
|
|
<ul class="list-inline social_media">
|
|
<li class="list-inline-item"><a href="https://twitter.com/NLM_NIH" aria-label="Twitter" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<style type="text/css">
|
|
.st20 {
|
|
fill: #FFFFFF;
|
|
}
|
|
|
|
.st30 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
</style>
|
|
<title>Twitter</title>
|
|
<g>
|
|
<g>
|
|
<g>
|
|
<path class="st20" d="M192.9,88.1c-5,2.2-9.2,2.3-13.6,0.1c5.7-3.4,6-5.8,8.1-12.3c-5.4,3.2-11.4,5.5-17.6,6.7 c-10.5-11.2-28.1-11.7-39.2-1.2c-7.2,6.8-10.2,16.9-8,26.5c-22.3-1.1-43.1-11.7-57.2-29C58,91.6,61.8,107.9,74,116 c-4.4-0.1-8.7-1.3-12.6-3.4c0,0.1,0,0.2,0,0.4c0,13.2,9.3,24.6,22.3,27.2c-4.1,1.1-8.4,1.3-12.5,0.5c3.6,11.3,14,19,25.9,19.3 c-11.6,9.1-26.4,13.2-41.1,11.5c12.7,8.1,27.4,12.5,42.5,12.5c51,0,78.9-42.2,78.9-78.9c0-1.2,0-2.4-0.1-3.6 C182.7,97.4,189.2,93.7,192.9,88.1z"></path>
|
|
</g>
|
|
</g>
|
|
<circle class="st30" cx="124.4" cy="128.8" r="108.2"></circle>
|
|
</g>
|
|
</svg></a></li>
|
|
<li class="list-inline-item"><a href="https://www.facebook.com/nationallibraryofmedicine" aria-label="Facebook" rel="noopener noreferrer" target="_blank">
|
|
<svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<style type="text/css">
|
|
.st10 {
|
|
fill: #FFFFFF;
|
|
}
|
|
|
|
.st110 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
</style>
|
|
<title>Facebook</title>
|
|
<g>
|
|
<g>
|
|
<path class="st10" d="M159,99.1h-24V88.4c0-5,3.3-6.2,5.7-6.2h16.8V60l-24.4-0.1c-22.1,0-26.2,16.5-26.2,27.1v12.1H90v22.5h16.9 v67.5H135v-67.5h21.7L159,99.1z"></path>
|
|
</g>
|
|
</g>
|
|
<circle class="st110" cx="123.6" cy="123.2" r="108.2"></circle>
|
|
</svg>
|
|
</a></li>
|
|
<li class="list-inline-item"><a href="https://www.youtube.com/user/NLMNIH" aria-label="Youtube" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<title>Youtube</title>
|
|
<style type="text/css">
|
|
.st4 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
|
|
.st5 {
|
|
fill: #FFFFFF;
|
|
}
|
|
</style>
|
|
<circle class="st4" cx="124.2" cy="123.4" r="108.2"></circle>
|
|
<g transform="translate(0,-952.36218)">
|
|
<path class="st5" d="M88.4,1037.4c-10.4,0-18.7,8.3-18.7,18.7v40.1c0,10.4,8.3,18.7,18.7,18.7h72.1c10.4,0,18.7-8.3,18.7-18.7 v-40.1c0-10.4-8.3-18.7-18.7-18.7H88.4z M115.2,1058.8l29.4,17.4l-29.4,17.4V1058.8z"></path>
|
|
</g>
|
|
</svg></a></li>
|
|
</ul>
|
|
</div>
|
|
<div class="col-lg-3 col-12">
|
|
<p class="address_footer text-white">National Library of Medicine<br />
|
|
<a href="https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/@38.9959508,-77.101021,17z/data=!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb:0x19156f88b27635b8!8m2!3d38.9959508!4d-77.0988323" class="text-white" target="_blank" rel="noopener noreferrer">8600 Rockville Pike<br />
|
|
Bethesda, MD 20894</a></p>
|
|
</div>
|
|
<div class="col-lg-3 col-12 centered-lg">
|
|
<p><a href="https://www.nlm.nih.gov/web_policies.html" class="text-white">Web Policies</a><br />
|
|
<a href="https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office" class="text-white">FOIA</a><br />
|
|
<a href="https://www.hhs.gov/vulnerability-disclosure-policy/index.html" class="text-white" id="vdp">HHS Vulnerability Disclosure</a></p>
|
|
</div>
|
|
<div class="col-lg-3 col-12 centered-lg">
|
|
<p><a class="supportLink text-white" href="https://support.nlm.nih.gov/">Help</a><br />
|
|
<a href="https://www.nlm.nih.gov/accessibility.html" class="text-white">Accessibility</a><br />
|
|
<a href="https://www.nlm.nih.gov/careers/careers.html" class="text-white">Careers</a></p>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="col-lg-12 centered-lg">
|
|
<nav class="bottom-links">
|
|
<ul class="mt-3">
|
|
<li>
|
|
<a class="text-white" href="//www.nlm.nih.gov/">NLM</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.nih.gov/">NIH</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.hhs.gov/">HHS</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.usa.gov/">USA.gov</a>
|
|
</li>
|
|
</ul>
|
|
</nav>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentOmnitureBaseJS/InstrumentNCBIConfigJS/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js?v=1"> </script>
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/static/js/hfjs2.js"> </script>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<!--/.page-->
|
|
</div>
|
|
<!--/.wrap-->
|
|
</div><!-- /.twelve_col -->
|
|
</div>
|
|
<!-- /.grid -->
|
|
|
|
<span class="PAFAppResources"></span>
|
|
|
|
<!-- BESelector tab -->
|
|
|
|
|
|
|
|
<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK65725&ncbi_domain=pdqcis&ncbi_report=record&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK65725.6/&ncbi_pagename=Oral Complications of Cancer Therapies (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf&ncbi_bookparttype=chapter&ncbi_app=bookshelf" /></noscript>
|
|
|
|
|
|
<!-- usually for JS scripts at page bottom -->
|
|
<!--<component id="PageFixtures" label="styles"></component>-->
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal105 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/4062932/4209313/4212053/4076480/3921943/3400083/3426610.js" snapshot="books"></script></body>
|
|
</html> |