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After treatment and remission

Mouth and teeth

Chemotherapy and transplant affect the lining of the mouth, saliva and teeth. This topic explains how to restore and protect mouth health after treatment.

Last updated: ~2 min read
Healthy teeth need regular care
Figure 1.Healthy teeth need regular care.

01Short answer

Leukaemia treatment can cause several changes in the mouth: inflammation of the lining (mucositis), dry mouth, taste changes, fungal infections, sensitive gums and a higher risk of tooth decay. Mucositis usually heals 2–4 weeks after chemotherapy. Dry mouth, especially after head and neck radiation or a transplant, can last a long time; with less saliva, teeth become more prone to decay. The NIDCR and NCI recommend brushing twice a day with a soft brush, fluoride toothpaste, flossing (when blood counts allow), drinking water, fewer sugary snacks and regular dental check-ups. In people treated as children, tooth development is checked too.

02Simple explanation

Treatment affects the mouth and teeth.

Mucositis usually clears within weeks.

Dry mouth raises the risk of decay.

Soft brush and fluoride, twice a day.

Regular dental check-ups.

03Scientific explanation

Mucositis: according to the NCI, mucositis after chemotherapy usually heals in 2–4 weeks.

Saliva: saliva neutralises acids and protects teeth; less saliva raises the risk of decay and infection (NIDCR).

Oral GVHD: after an allogeneic transplant, white patches, pain and dryness in the mouth can be signs of graft-versus-host disease.

Children: the COG guidelines recommend dental check-ups at least twice a year for people who had chemotherapy or head radiation in childhood, because of effects on tooth development.

04What happens in the body?

What changes in the mouth?

Chemotherapy affects the fast-renewing cells of the mouth. The lining thins, sores may form and saliva decreases.

Small glowing droplets on a smooth surface.
Figure 3.Saliva protects the mouth.

When to see the dentist

After treatment, once blood counts have recovered, a dental check-up is advised. Then usually every 6 months.

Daily care

A soft brush and fluoride toothpaste, twice a day. Restart flossing when your blood counts allow. Avoid alcohol-based mouthwashes.

A soft toothbrush in a gentle beam of light.
Figure 2.A soft brush, twice a day.

Dry mouth

Sip water often; sugar-free gum or saliva substitutes may help. Cut down on sugary drinks and acidic snacks.

What to watch for

Sores that do not heal, white patches, swollen or painful gums, or jaw pain — show them to your doctor or dentist.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05Toward a healthy mouth

Mouth care steps.

Check-up — A dental check-up.1Check-upA dental check-up.
Brushing — Twice daily, soft brush.2BrushingTwice daily, soft brush.
Moisture — Sip water, keep the mouth moist.3MoistureSip water, keep the mouth moist.
Protection — Fluoride toothpaste, less sugar.4ProtectionFluoride toothpaste, less sugar.
TeethProtected from decay.
MoistureThe mouth is comfortable.
ProtectionFewer infections.

06Mouth problems and general care (simplified)

ProblemGeneral careWho to see
MucositisGentle care, salt-water rinsesDoctor
Dry mouthWater, sugar-free gumDoctor, dentist
Decay riskFluoride, less sugarDentist
White patches—Doctor (fungus, GVHD)
Bleeding gumsSoft brushDoctor (platelets)

* People treated as children are advised to have special dental follow-up.

07Key terms

Mucositis
Inflammation of the lining of the mouth.
Xerostomia
Dry mouth.
Fluoride
A mineral that strengthens enamel.
Candidiasis
A fungal infection of the mouth.
Tooth decay
Damage to a tooth by bacteria.
Oral GVHD
The mouth form of graft-versus-host disease.

08Key points

  • Treatment affects the mouth.
  • Mucositis clears within weeks.
  • Dry mouth raises decay risk.
  • Soft brush and fluoride.
  • See the dentist regularly.
  • Show changes to your doctor.

09Frequently asked questions

When can I have dental treatment?

Planned treatment after blood counts recover, agreed with your haematologist.

Can I use an electric toothbrush?

Yes, with a soft head.

Should I use mouthwash?

Alcohol-free products or salt water; your doctor may prescribe a special one.

My teeth hurt and are sensitive. What can I do?

A sensitive-teeth toothpaste may help; if pain continues, see your dentist.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. When can I have dental treatment?

  2. Can I use an electric toothbrush?

  3. Should I use mouthwash?

  4. My teeth hurt and are sensitive. What can I do?

  5. Does this information replace medical advice?

My questions

12Sources

  1. National Cancer Institute (NCI). Mouth and Throat Problems during Cancer Treatment
  2. National Cancer Institute (NCI). Oral Complications of Cancer Therapies (PDQ®)–Patient Version
  3. NHS. How to keep your teeth clean
  4. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers
  5. National Cancer Institute (NCI). Follow-Up Medical Care
  6. National Cancer Institute (NCI). Cancer Survivorship
  7. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  8. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
  9. National Cancer Institute. Facing Forward: Life After Cancer Treatment
  10. American Cancer Society. Chemo Brain
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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