Recent years have provided both better treatment options and faster, improved detection of cancer – leading to a significant increase in cancer survival rates. This has contributed to a greater chance of long-term health and improved quality of life post-treatment.
However, though a patient’s oncological care might be complete, the consequences for their oral health continues. Studies show an increased risk of caries, periodontal disease, and denture use for patients who have survived cancer.[i]
Acute oral risks and complications of both radiotherapy and chemotherapy are well understood, allowing for effective management techniques. Unfortunately, the long-term oral health consequences for cancer survivors are not as well recognised, researched, and addressed within routine dental care. As the rates of survival increase, dental professionals are in a unique position to monitor and support patients in managing the long-term issues.
Oral health changes after treatment
Cancer survivors often experience a continuum of oral health changes long after treatment is complete. Firstly, xerostomia is a common long-term issue associated for cancer survivors, particularly those patients who have received radiotherapy for head and neck cancers which often leads to permanently damaged salivary glands. Research shows that up to 90% of head and neck cancer patients who were treated with radiotherapy develop this irreversible damage that impacts everything from mastication and altered taste to speaking and sleeping.[ii]
The reduced buffering capacity and transformation of saliva composition means that even if it partially recovers, the protective function can still be compromised. These alterations increase the build-up of plaque, worsen gingival inflammation, and ultimately increase the risk of caries.[iii] The consequences are bidirectional too, when these oral symptoms arise, gingival sensitivity becomes greater, making patients hesitant and unmotivated when it comes to oral hygiene, leading to a reduced level of plaque control through inconsistent and inadequate hygiene routines. With prompt intervention, dental professionals have the ability to manage the disease and reduce its progression further.
Beyond the changes in saliva composition, the lasting impact of cancer treatment can have further effects on the oral environment itself. The balance of bacteria in the mouth changes significantly, which increases patients’ vulnerability to infection and chronic inflammation.[iv] Furthermore, the body’s ability to naturally heal can become compromised, meaning that even the most minor oral complications can be difficult to resolve if left unaddressed.
Certain medications prescribed during treatment – such as for pain management,[v] inflammation, or bone health – can have secondary effects on oral tissues.[vi] These changes include increased sensitivity,[vii] delayed healing,[viii] or changes in the supporting structures of the teeth,[ix] which all contribute to increased vulnerability of oral health. These subtle changes are not always recognisable to patients, making professional intervention vital – taking a proactive role in the ongoing oral health of patients.
Behavioural and compliance challenges
As well as biological risks, behavioural influences contribute to the oral health consequences of cancer survival. Amongst the continued effects of cancer are increased fatigue,[x] reduced manual dexterity,[xi] altered sensory perception,[xii] and health-related discomfort which each share a role in a patient’s reduced ability to maintain healthy oral hygiene routines.
Interdental cleaning is important for all patients, making it vital for those post-cancer-treatment. With the additional challenges, interdental cleaning can often become neglected, ultimately causing the deterioration of oral health. This emphasises a major challenge in survivorship care – ensuring that preventive advice is both clinically appropriate and realistically achievable long-term.
Supporting interdental cleaning
Though patient compliance can pose a challenge in attaining and maintaining interdental cleaning, it is vital that dentists encourage it, particularly for patients who have experienced lifechanging health events. Achieving consistent and effective interdental cleaning requires the right tools for the job – that balance efficiency and oral hygiene success.
One such product is the range of FLEXI interdental brushes from TANDEX, designed for a thorough clean and a gentle delivery. Clinicians can work with the patient to recommend the right size with the FLEXI interdental brushes designed to support controlled, gentle cleaning between the teeth – reducing the risk of trauma. The brushes are also extendable by using the cap included – making them perfect for those with limited dexterity. For cancer survivors experiencing sensitivity or fatigue, this approach can support better long-term compliance than many other oral hygiene methods.
The role of dentistry in holistic survivorship care
As cancer survival increases, so do the post-treatment challenges, particularly regarding oral care. Dental professionals have the ability to support patients in managing and navigating something they have never experienced before. By recognising these challenges, encouraging preventive strategies, and recommending the right tools for the job, patients can gain both confidence and satisfaction in their oral hygiene routines – working towards a brighter future for both their smile and systemic health.
For more information on Tandex’s range of products, visit https://tandex.dk/
Our products are also available from DHB Oral Healthcare https://dhb.co.uk/
Author: Jacob Watwood on behalf of Tandex – Rodericks Dental Partners Associate dentist at Fieldside Dental Practice
[i] An R, Wu Z, Liu M, Zhao Y, Chen W. Oral health behavior and oral health service utilization among cancer patients in China: A multicenter cross-sectional study. Front Oncol. 2023 Apr 5;13:1027835. doi: 10.3389/fonc.2023.1027835. PMID: 37152038; PMCID: PMC10155684.
[ii] Fedele S (2009). Diagnostic aids in the screening of oral cancer. Head & Neck Oncology 1(5), 1-6. ISSN: 1758-3284
[iii] Anne Marie Lynge Pedersen, Daniel Belstrøm, The role of natural salivary defences in maintaining a healthy oral microbiota, Journal of Dentistry, Volume 80, Supplement 1, 2019, Pages S3-S12, ISSN 0300-5712, https://doi.org/10.1016/j.jdent.2018.08.010.
[iv] Boksa FA, Leinbach LI, Mody DP, Ganesan SM, Mays JW. Oral microbiome alterations after cancer treatment: a scoping review and analysis. Med Oncol. 2025 Aug 19;42(10):432. doi: 10.1007/s12032-025-02998-6. PMID: 40828300; PMCID: PMC12364993.
[v] Kharat A, Baidya OP, Choudhari SH, Shakeela NV, Nasim R, Hathi K. Impact of Systemic Medications on Oral Health: A Cross-Sectional Study Among Geriatric Patients. Cureus. 2025 Jul 29;17(7):e88964. doi: 10.7759/cureus.88964. PMID: 40896019; PMCID: PMC12392364.
[vi] PDQ Supportive and Palliative Care Editorial Board. Oral Complications of Cancer Therapies (PDQ®): Patient Version. 2024 Oct 15. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK65725
[vii] Calik, J., Calik, K., Sauer, N., Zdzisław, B., Giedziun, P., Mackiewicz, J., Murawski, M., & Dzięgiel, P. (2024). Impact of Bisphosphonate Therapy on Oral Health in Patients with Breast and Prostate Cancer and Bone Metastases: A Comprehensive Study. Cancers, 16(6), 1124. https://doi.org/10.3390/cancers16061124
[viii] Landesberg R, Cozin M, Cremers S, Woo V, Kousteni S, Sinha S, Garrett-Sinha L, Raghavan S. Inhibition of oral mucosal cell wound healing by bisphosphonates. J Oral Maxillofac Surg. 2008 May;66(5):839-47. doi: 10.1016/j.joms.2008.01.026. PMID: 18423269; PMCID: PMC2426967.
[ix] Romano F, Franco F, Mognetti B, Berta GN. Impact of Endocrine Therapy for Cancer on Periodontal Health: A Systematic Review. Cancers (Basel). 2025 Sep 19;17(18):3066. doi: 10.3390/cancers17183066. PMID: 41008909; PMCID: PMC12468678.
[x]Al Maqbali M, Al Sinani M, Al Naamani Z, Al Badi K, Tanash MI. Prevalence of Fatigue in Patients With Cancer: A Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2021 Jan;61(1):167-189.e14. doi: 10.1016/j.jpainsymman.2020.07.037. Epub 2020 Aug 5. PMID: 32768552..
[xi] Nair AH, Patel T, Nair AR, Krishnan NA, Balasubramanian D, Iyer S, Thankappan K. Oral Management of Patients Undergoing Head and Neck Cancer Treatment. J Maxillofac Oral Surg. 2024 Aug;23(4):783-792. doi: 10.1007/s12663-023-01911-w. Epub 2023 Apr 20. PMID: 39118922; PMCID: PMC11303626.
[xii] Riantiningtyas RR, Dougkas A, Bredie WLP, Kwiecien C, Bruyas A, Philouze P, Giboreau A, Carrouel F. Investigating oral somatosensory perception and oral symptoms of head and neck cancer patients: insights on eating behaviour. Support Care Cancer. 2024 May 1;32(5):320. doi: 10.1007/s00520-024-08512-4. PMID: 38691143; PMCID: PMC11062985.
