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Oral Complications of Chemotherapy and Head/Neck Radiation

Oral Complications Not Related to Chemotherapy or Radiation Therapy

Bisphosphonates are drugs taken by some cancer patients to treat bone-related side effects.

Bisphosphonates are drugs given to some patients whose cancer has spread to the bones. They are used to reduce pain and decrease the risk of broken bones. (See the PDQ summary on Pain for more information.) Bisphosphonates are also used to treat hypercalcemia (too much calcium in the blood). Some cancer cells secrete substances that cause calcium to be absorbed into the bloodstream from bones. (See the PDQ summary on Hypercalcemia for more information.)

Certain bisphosphonates are linked to a risk of bone loss.

It's important for the health care team to know if a patient at risk for oral complications has been treated with bisphosphonates. Certain bisphosphonates are linked to the breakdown of bone in the mouth, usually the jaw. This is called bisphosphonate-associated osteonecrosis (BON). It occurs more often in patients taking intravenous bisphosphonates, but it sometimes develops in patients taking them by mouth. Symptoms include pain and inflamed lesions in the mouth, where areas of damaged bone may be seen. There are many patients who take bisphosphonates, but the number who develop BON is small. The risk of BON in patients with bone tumors may be decreased if dental problems are found and treated before beginning bisphosphonate therapy.

Treatment of BON usually includes treating the infection and good dental hygiene.

Treatment of BON may include the following:

During treatment for BON, the patient should continue to brush and floss the teeth after meals to keep the mouth very clean. Avoiding tobacco use while BON is healing may be advised.

Stopping the use of the bisphosphonate is a decision to be made by the patient and doctor, based on the effect it would have on the patient's general health.

New types of bisphosphonates are being studied in clinical trials. The use of hyperbaric oxygen therapy (HBO) combined with stopping the use of bisphosphonates is under study for the treatment of BON. It is not known if tobacco use increases the risk of developing BON.