What Is the Impact of Cancer Treatment on Oral Cavity?
Chemotherapy and radiation therapy, are true, gold standards for treating cancers, They help treat and also improve the patient's compliance and general systemic quality of life to a great extent. However, they are also equally associated with several side effects or adverse reactions more so upon the oral mucosa or the oral mucous membrane.
Introduction
People facing the dual burden of oral mucositis and cancer endure significant challenges that profoundly affect their physical and emotional well-being. Moreover, the distressing impact on quality of life, the psychological toll of coping with cancer and its treatment, and the uncertainty of recovery create a formidable and emotionally taxing experience for individuals dealing with oral mucositis and cancer. Addressing these struggles requires comprehensive care and support, as well as research to develop more effective management strategies to alleviate the physical and emotional burdens faced by these courageous individuals.
What Is Oral Mucositis?
Mucositis or Oral mucositis is a common and distressing condition characterized by inflammation and ulceration of the mucous membranes lining the mouth and throat. It often occurs as a side effect of cancer treatments, such as radiation therapy and chemotherapy, but can also be triggered by other factors like certain medications or medical conditions. The condition arises due to the damaging effects of these treatments on rapidly dividing cells in the oral mucosa, leading to painful sores and lesions. Oral mucositis can range from mild discomfort to severe pain, impacting a patient's ability to eat, speak, and maintain proper oral hygiene. Early detection and appropriate management are crucial in preventing complications and improving the overall quality of life for affected individuals.
What Are the Oral Complications Post Cancer Treatment?
Oral complications that arise because of either chemotherapy or radiation therapy include:
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Mucositis or stomatitis.
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Xerostomia or dry mouth.
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Bacterial, fungal, or viral infections of the oral cavity (more specifically in patients suffering from low neutrophil count or neutropenia).
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Increased risk of dental caries or sudden carious lesions due to increased fracture rate of enamel.
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Loss or disturbances in the sensation of taste.
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Osteoradionecrosis.
What Is the Pathophysiology of Oral Mucositis in Cancer Therapies?
It is mainly attributed to the drugs that affect DNA (deoxyribonucleic acid) synthesis, for example, mainly S-phase specific agents such as Fluorouracil, Methotrexate, and Cytarabine as they are cell-cycle specific agents. Generalized mucositis of the whole body limits the patient's potential for tolerance toward chemotherapy or radiation therapy. This also in turn jeopardizes their nutritional status that compromises their general systemic health. In those patients receiving radiation therapy specifically as adjuvant therapy for head and neck cancers, the risk of developing mucositis is approximately around 30 % to 60 %. Though the exact pathophysiology of development is not elucidated in dental or medical literature, studies have indicated that chemotherapy and radiation therapy interferes with the cell cycle resulting in an abrupt turnover of the epithelial cells. This leads to cell death thus resulting in the injury of the mucosa or mucosal membrane or tissue. Subsequently, in patients with poor oral hygiene or in immunocompromised patients with systemic disorders, further risk exists for indirect invasion of the mucosa by gram-negative bacteria or fungal species. As most cancer drugs may cause fluctuations in the blood count, the probability of developing mucositis is dependent upon the extension and phases of treatment. Approximately it is estimated that nearly 40% of patients treated with standard chemotherapy drugs indeed develop mucositis.
What Are the Phases of Drug or Radiation-Induced Trauma on Oral Cavity?
The risk of drug-induced trauma or mucosal injury increases usually with the number of chemotherapy cycles and is also linked to any previous episodes of chemotherapy-induced mucositis.
Phase I: It is the inflammatory or vascular phase. In this phase of inflammation initially, the exposed cells, mainly the superficial epithelial cells or even the endothelial, and connective tissue cells within the buccal mucosal region release free radicals, proteins, and inflammatory mediators like cytokines, interleukins (IL-1B), prostaglandins, and tumor necrosis factor (TNF).
Phase II: It is the epithelial phase. In this phase, chemotherapy and radiation interfere with or prevent normal cell division in the oral mucosal epithelium, leading to decreased epithelial turnover thereby resulting in an epithelial breakdown.
Phase III: It is the ulcerative or bacteriological phase, also known as the pseudomembranous phase. The epithelial breakdown that occurs in the previous phase turns into an ulcerative phase, usually within one week of treatment or chemotherapy. This would result in the formation of pseudomembranes and ulcers in the oral mucosa. Concomitantly bacterial colonization may also occur along the ulcerated mucosa.
Phase IV: It is the healing phase. The duration of this phase is the final phase lasting from 12 to 16 days. This depends upon the epithelial proliferation rate and hematopoietic recovery of the affected patient.
How is Oral Mucositis Managed in Patients With Cancer?
People with cancer who undergo chemotherapy and radiotherapy treatment should be always referred to the dentist for a comprehensive oral and dental examination. A prophylactic examination may be more helpful in identifying potential complications before therapy is initiated. The dental surgeon can hence identify any potential infections that may require prompt antibiotic therapy after seeking physician consent. Patients are also motivated to maintain professional dental care with regular follow-ups to manage the functional efficiency of the oral cavity throughout cancer therapy.
In case of a potential opportunistic infection, the dentist may recommend antibiotic lozenges to the affected patients. These lozenges mainly contain Polymyxin E and Tobramycin, and Amphotericin B. They have been successfully shown to eliminate microbial flora especially and are particularly effective in treating chemotherapeutic or radiation-induced oral mucositis. Patients should refrain from acidic foods such as citric fruits or fruit juices. Tobacco or alcohol consumption should be strictly prohibited. The dental surgeon may also aim to prevent the risk of oral infections in these patients by prescribing appropriate antioxidant therapies for minimizing the systemic spread of oral cavity infections.
Conclusion
Oral mucositis is a known and distressing adverse effect of antineoplastic therapy. Patients may experience pain, dysphagia (difficulty in swallowing), dysgeusia (altered taste), the subsequent effect of dehydration, and potential affliction to malnutrition. Hence it is vital that these patients receive appropriate dental care, regular checkups, and timely treatment. Prophylactic dental care can not only treat the symptoms of oral mucositis but also reduce the risk of its occurrence thereby improving the quality of life drastically.
