Skip to content

Cancer Health Center

Font Size

Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®): Supportive care - Health Professional Information [NCI] - Infection

continued...

Pulpal/periapical infections of dental origin can cause complications for the chemotherapy patient.[14] Such lesions should be eliminated before chemotherapy begins. Prechemotherapy endodontic therapy should be completed at least 10 days before chemotherapy begins. Teeth with poor prognoses should be extracted, using the 10-day window as a guide. Specific management guidelines are delineated in the NIH Consensus Conference statement.[14,15]

Ill-fitting, removable prosthetic appliances can traumatize oral mucosa and increase the risk of microbial invasion into deeper tissues. Denture-soaking cups can readily become colonized with a variety of pathogens, including P. aeruginosa, E. coli, Enterobacter species, Staphylococcus aureus, Klebsiella species, and Candida albicans. Dentures should be evaluated before chemotherapy begins and adjusted as necessary to reduce risk of trauma. Denture-cleansing solutions should be changed daily. In general, dentures should not be worn when the patient has ulcerative mucositis and is neutropenic (i.e., absolute neutrophil count <500 cells/mm3).

Fungal Infection

Candidiasis

Candidiasis is typically caused by opportunistic overgrowth of C. albicans, a normal inhabitant of the oral cavity in a large proportion of individuals. Several variables contribute to its clinical expression, including drug- or disease-induced immunosuppression, mucosal injury, and salivary compromise. In addition, use of antibiotics may alter the oral flora, thereby creating a favorable environment for fungal overgrowth.[18]

A systematic review indicated that the weighted mean prevalence of clinical oral fungal infection during chemotherapy is 38%.[19] The most common forms of intraoral candidiasis reported in oncology patients are pseudomembranous and erythematous candidiasis.[20,21] Pseudomembranous candidiasis can usually be diagnosed on the basis of its characteristic clinical appearance and may be accompanied by burning pain and taste changes. The appearance of erythematous candidiasis is relatively nonspecific, and laboratory testing may be needed to confirm the diagnosis. It may be accompanied by a burning sensation of the affected tissues.

Topical oral antifungal agents such as nystatin rinse and clotrimazole troches are often used but appear to have variable efficacy in preventing or treating fungal infection in neutropenic patients.[22,23] Patients who wear removable dental prostheses (e.g., partial or full denture) should remove them before the oral antifungal agents are used. Dentures can also be treated by soaking them overnight in the antifungal solution.

1|2|3|4|5|6|7
Next Article:

Today on WebMD

Colorectal cancer cells
A common one in both men and women.
Lung cancer xray
See it in pictures, plus read the facts.
 
sauteed cherry tomatoes
Fight cancer one plate at a time.
Ovarian cancer illustration
Do you know the symptoms?
 
Jennifer Goodman Linn self-portrait
Blog
what is your cancer risk
HEALTH CHECK
 
colorectal cancer treatment advances
Video
breast cancer overview slideshow
SLIDESHOW
 
prostate cancer overview
SLIDESHOW
lung cancer overview slideshow
SLIDESHOW
 
ovarian cancer overview slideshow
SLIDESHOW
Actor Michael Douglas
Article