High-dose chemotherapy and stem cell transplants can cause a lower-than-normal number of platelets in the blood. This can cause problems with the body's blood clotting process. Bleeding may be mild small red spots on the lips, soft palate , or bottom of the mouth or severe, especially at the gum line and from ulcers in the mouth.
Areas of gum disease may bleed on their own or when irritated by eating, brushing, or flossing. When platelet counts are very low, blood may ooze from the gums. Continuing regular oral care will help prevent infections that can make bleeding problems worse.
Your dentist or medical doctor can explain how to treat bleeding and safely keep your mouth clean when platelet counts are low. Saliva is made by salivary glands. Saliva is needed for taste, swallowing, and speech. It helps prevent infection and tooth decay by cleaning off the teeth and gums and preventing too much acid in the mouth.
Radiation therapy can damage salivary glands and cause them to make too little saliva. Some types of chemotherapy used for stem cell transplant may also damage salivary glands. When there is not enough saliva, the mouth gets dry and uncomfortable. This condition is called dry mouth xerostomia.
The risk of tooth decay, gum disease, and infection increases, and your quality of life suffers. Dry mouth caused by chemotherapy for stem cell transplant is usually temporary. The salivary glands often recover 2 to 3 months after chemotherapy ends. The amount of saliva made by the salivary glands usually starts to decrease within 1 week after starting radiation therapy to the head or neck.
It continues to decrease as treatment goes on. How severe the dryness is depends on the dose of radiation and the number of salivary glands that receive radiation. Salivary glands may partly recover during the first year after radiation therapy.
However, recovery is usually not complete, especially if the salivary glands received direct radiation. Salivary glands that did not receive radiation may start making more saliva to make up for the loss of saliva from the damaged glands.
Dry mouth and changes in the balance of bacteria in the mouth increase the risk of tooth decay cavities. Careful oral hygiene and regular care by a dentist can help prevent cavities. See the Regular Oral Care section of this summary for more information.
Changes in the sense of taste is a common side effect of both chemotherapy and head or neck radiation therapy. Taste changes can be caused by damage to the taste buds, dry mouth, infection, or dental problems. Foods may seem to have no taste or may not taste the way they did before cancer treatment.
Radiation may cause a change in sweet, sour, bitter, and salty tastes. Chemotherapy drugs may cause an unpleasant taste. In most patients receiving chemotherapy and in some patients receiving radiation therapy, taste returns to normal a few months after treatment ends. However, for many radiation therapy patients, the change is permanent. In others, the taste buds may recover 6 to 8 weeks or more after radiation therapy ends. Zinc sulfate supplements may help some patients recover their sense of taste.
Cancer patients who are receiving high-dose chemotherapy or radiation therapy often feel fatigue a lack of energy. This can be caused by either the cancer or its treatment. Some patients may have problems sleeping.
Patients may feel too tired for regular oral care, which may further increase the risk for mouth ulcers, infection, and pain. See the PDQ summary on Fatigue for more information. Patients treated for head and neck cancers have a high risk of malnutrition.
The cancer itself, poor diet before diagnosis, and complications from surgery, radiation therapy, and chemotherapy can lead to nutrition problems.
Patients may lose the desire to eat because of nausea , vomiting , trouble swallowing, sores in the mouth, or dry mouth. When eating causes discomfort or pain, the patient's quality of life and nutritional well-being suffer. The following may help patients with cancer meet their nutrition needs:.
Meeting with a nutrition counselor may help during and after treatment. Many patients treated for head and neck cancers who receive radiation therapy only are able to eat soft foods.
As treatment continues, most patients will add or switch to high-calorie, high-protein liquids to meet their nutrition needs. Some patients may need to receive the liquids through a tube that is inserted into the stomach or small intestine. Almost all patients who receive chemotherapy and head or neck radiation therapy at the same time will need tube feedings within 3 to 4 weeks. Studies show that patients do better if they begin these feedings at the start of treatment, before weight loss occurs.
Normal eating by mouth can begin again when treatment is finished and the area that received radiation is healed. A team that includes a speech and swallowing therapist can help the patients with the return to normal eating. Tube feedings are decreased as eating by mouth increases, and are stopped when you are able to get enough nutrients by mouth.
Although most patients will once again be able to eat solid foods, many will have lasting complications such as taste changes, dry mouth, and trouble swallowing.
Treatment for head and neck cancers may affect the ability to move the jaws, mouth, neck, and tongue. There may be problems with swallowing. Stiffness may be caused by:. The risk of having jaw stiffness from radiation therapy increases with higher doses of radiation and with repeated radiation treatments. The stiffness usually begins around the time the radiation treatments end. It may get worse over time, stay the same, or get somewhat better on its own. Treatment should begin as soon as possible to keep the condition from getting worse or becoming permanent.
Treatment may include the following. Swallowing problems are common in patients who have head and neck cancers.
Cancer treatment side effects such as oral mucositis, dry mouth, skin damage from radiation, infections, and graft-versus-host-disease GVHD may all cause problems with swallowing. Other complications can develop from being unable to swallow and these can further decrease the patient's quality of life:.
Some side effects go away within 3 months after the end of treatment, and patients are able to swallow normally again. However, some treatments can cause permanent damage or late effects.
Late effects are health problems that occur long after treatment has ended. Conditions that may cause permanent swallowing problems or late effects include:. The oncologist works with other health care experts who specialize in treating head and neck cancers and the oral complications of cancer treatment.
These specialists may include the following:. Radiation therapy can destroy very small blood vessels within the bone. This can kill bone tissue and lead to bone fractures or infection. Radiation can also kill tissue in the mouth. Ulcers may form, grow, and cause pain, loss of feeling, or infection.
Preventive care can make tissue and bone loss less severe. See the PDQ summary on Nutrition in Cancer Care for more information about managing mouth sores, dry mouth, and taste changes. Graft-versus-host disease GVHD occurs when your tissue reacts to bone marrow or stem cells that come from a donor. Symptoms of oral GVHD include the following:. It's important to have these symptoms treated because they can lead to weight loss or malnutrition. Treatment of oral GVHD may include the following:.
The following can help in the care and use of dentures, braces, and other oral devices during high-dose chemotherapy or stem cell transplant:. Talk to your medical doctor or dentist about the best way to take care of your mouth during high-dose chemotherapy and stem cell transplant. Careful brushing and flossing may help prevent infection of oral tissues. The following may help prevent infection and relieve discomfort of oral in tissues:.
Medicines may be given to help prevent mouth sores or help the mouth heal faster if it is damaged by chemotherapy or radiation therapy. Also, holding ice chips in the mouth during high-dose chemotherapy, may help prevent mouth sores. Regular dental treatments, including cleaning and polishing, should wait until the transplant patient's immune system returns to normal.
The immune system can take 6 to 12 months to recover after high-dose chemotherapy and stem cell transplant. During this time, the risk of oral complications is high. If dental treatments are needed, antibiotics and supportive care are given. Cancer survivors who received chemotherapy or a transplant or who underwent radiation therapy are at risk of developing a second cancer later in life.
Oral squamous cell cancer is the most common second oral cancer in transplant patients. The lips and tongue are the areas that are affected most often. Second cancers are more common in patients treated for leukemia or lymphoma , Multiple myeloma patients who received a stem cell transplant using their own stem cells sometimes develop an oral plasmacytoma.
Medically reviewed by Sanjai Sinha, MD. Last updated on Jan 14, Xyzal levocetirizine is an antihistamine that reduces the effects of natural chemical histamine in the body. Histamine can produce symptoms such as a runny nose or hives. Xyzal is used to treat symptoms of year-round perennial allergies in children who are at least 6 months old. Xyzal is also used to treat itching and swelling caused by chronic urticaria hives in adults and children who are at least 6 months old.
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