Taking Care of Yourself
While Living With Cancer
Dental Health and
Osteonecrosis of the Jaw
©2004 Novartis
Printed in U.S.A.
September 2004
ONC-8155
Dental health during
cancer treatment
Cancer treatments can affect your entire body,
Regular dental hygiene is not that different for
including your teeth and gums.1 Side effects of
people with cancer than it is for people who
treatment may include inflammation of the
don't have cancer, but because cancer treatments
mucous membranes in the mouth (mucositis),
can affect the teeth and gums, it can be even
infections, taste changes, dry mouth, pain, tooth
more important.1
decay, gum disease, and sores inside your mouth.
If you have cancer, your routine dental hygiene
Therefore, good dental health practices are
should include1:
especially important for people living with
cancer. Good communication is important, too.
· Brushing your teeth and tongue after every
Your dentist should know that you are being
meal and at bedtime, using a soft toothbrush
treated for cancer, and your oncologist should be
and gentle stroke
aware of your dental history.
· Gentle flossing once a day to remove plaque
As a patient living with cancer, you should:
(if your gums bleed or hurt, the area that is
sore should be avoided, but the other teeth
· Schedule a dental exam and cleaning before
still should be flossed)
cancer treatment begins and periodically
during the course of your treatment
· Keeping your mouth moist by rinsing often
with water (many medicines cause "dry
· Discuss dental procedures, such as the
mouth," which can lead to decay and other
pulling of teeth or insertion of dental
dental problems)
implants, with your oncologist before you
start your cancer treatment
· Avoiding use of mouthwash that contains
alcohol
· Have your dentist check and adjust removable
dentures, if you have them
Use a mirror to check your teeth and gums daily
for any changes, such as sores or bleeding gums.
· Tell your physician about any bleeding of the
If you notice a problem or a change, or experience
gums, pain, or unusual feeling in your teeth or
pain in your mouth, teeth, or jaws, report it to
gums, or any dental infections
your dentist or oncologist immediately.
Osteonecrosis of the jaw
Osteonecrosis (pronounced OSS-tee-oh-ne-KRO-sis)
· Radiation therapy to the head or neck
of the jaw is a rare conditon that involves the
· Chemotherapy
loss, or breakdown, of the jaw bone.2 It can be a
· Steroid therapy (for example, cortisone)
serious condition. Symptoms include, but are not
limited to:
· Underlying cancer
· Anemia (low blood count) and other blood-
· Pain, swelling, or infection of the gums
related disorders
· Loosening of teeth
· Infection
· Poor healing of the gums
· A history of poor dental health
· Numbness or the feeling of heaviness in the jaw
· Gum disease or dental surgery (such as pulled teeth)
If you experience any of these or other dental
· Alcohol abuse or cigarette smoking
symptoms, tell both your oncologist and your
· Poor nutrition
dentist immediately and follow your oncologist's
· Poor blood circulation or clotting problems2
recommendations regarding continuation of your
cancer treatment. Your oncologist may refer you
Once your cancer treatment has started, if you
to an oral surgeon or dental oncologist with
experience pain in your mouth, teeth, or jaw--
experience in osteonecrosis.
or any other symptom of possible dental
problems--tell both your oncologist and
To diagnose osteonecrosis of the jaw, doctors
dentist immediately.
may use X rays or tests for infection (microbial
cultures). Treatments for osteonecrosis of the
Dental care is an important element of your
jaw may include antibiotics, oral rinses, and
overall cancer care. Beginning as soon as
removable mouth appliances.2,3 Minor dental
possible after your cancer diagnosis, your
work may be necessary to remove injured tissue
treatment team should involve your regular
and reduce sharp edges of the bone.2,3 Surgery
dentist or a dental oncologist (a dentist who is
is typically avoided because it may make the
specially trained to treat people with cancer).
condition worse.2,3
· Be sure to tell your regular dentist that you
Scientists do not know exactly what causes
are being treated for cancer
osteonecrosis of the jaw or how often it occurs.
· Update your medical history record with your
This disease has occurred in some cancer
dentist to include your cancer diagnosis and
patients receiving bisphosphonates. However, it
treatments
is not known what role if any these medications
· Provide your dentist and your oncologist with
play in its development. Some possible factors
each other's name and telephone number for
that may increase the risk of osteonecrosis include:
consultation
If you wish, use the form below to record information to give to
your dentist and oncologist.
Dental Consultation Form
Dentist's Name: ______________________ Phone No:___________
Oncologist's Name: ___________________ Phone No:___________
About My Cancer Treatment
Diagnosis (Disease & Stage): ________________________________
__________________________________________________________
Date of Diagnosis: _________________________
Past and Planned Treatments (Date): _________________________
__________________________________________________________
__________________________________________________________
Surgery (Site:___________________________________________)
Radiation Therapy (Site:_________________________________)
Chemotherapy
Drugs:
Immunotherapy or Other Biological Therapy
(Treatments:____________________________________________)
Steroids
Bisphosphonates
Other Cancer Treatments (Please List)
__________________________________________________________
__________________________________________________________
__________________________________________________________
About My Dental Procedures
Date of Last Complete Dental Exam: _________________________
Current and Planned Treatments (Date):
__________________________________________________________
__________________________________________________________
Wisdom Teeth Extraction or Other Dental Surgery
Periodontics or Other Gum Surgery
Braces or Other Orthodontics
References: 1. For the dental patient: oral care for cancer patients.
Root Canal Therapy
Sealants
Am Dent Assoc. 2002 133(7):1014. 2. National Cancer Institute.
Dental Implants
Fillings
Oral complications of chemotherapy and head/neck radiation
(PDQ). 2004. 3. Durie BG. Aredia/Zometa and osteonecrosis of
Dentures
Bridges
the jaws. International Myeloma Foundation. 2004.
Caps, Bonding, Veneers
Tooth Contouring or Shaping
This document is for informational purposes and is not intended
Crowns
Bleaching
as a substitute for medical professional help or advice, nor is it
Other Dental Procedures (Please List)
intended as a recommendation for any particular treatment
plan. A medical professional should always be consulted for
_______________________________________________________
any health problem or medical condition.
_______________________________________________________