By Rachel Nguyen.
For many cancer patients, ringing the bell at the end of treatment is a sign of victory combined witha sigh of relief. But what comes next is rarely discussed: the lasting damage cancer therapy can leave behind, especially in the mouth.
Similar to firefighters extinguishing a house fire: once you step inside, the floors are soaked, walls are charred, and the foundation is weakened. Cancer treatment works the same way. It can be a powerful lifesaving tool in eliminating cancer, but it leaves behind a damaged mouth needing careful restoration similar to a crumbling home.
Salivary glands may stop working properly. Teeth become brittle and decay rapidly. Eating can
become a cumbersome task. Oral infections become more frequent. In severe cases, the jawbone
can slowly deteriorate and die.
The truth of the matter is, it’s not a matter of if oral complications arise but rather it becomes a
matter of inevitability. Cancer treatment is often the last ray of hope in a patient’s long list of
decisions. Being fully informed of the potential side effects helps prepare patients to deal with the after effects specifically the less spoken oral complications.
Before cancer treatment, patients must receive “dental clearance” – a standard of care that
oncologists are required to refer patients to a dentist. This practice eliminates existing infection,
instable teeth, or other dental problems that may contribute to decreased quality of life posttreatment. It can be described as checking your brakes before driving down a mountain. You wouldn’t want to wait halfway down the hill to discover they do not work as intended.
As a dental student from Charlotte working with newly diagnosed cancer patients through theAlbert Schweitzer Fellowship, I have witnessed how uneven this system can be in Eastern NC. Financially stable or well-insured patients often secure appointments quickly. But for many others, particularly low-income, Medicaid recipients, rural residents – obtaining dental clearance can feel like trying to drive through rush-hour traffic.
Data from the U.S. Census Bureau showed higher rates of uninsured individuals and residents living at or below 138% of the federal poverty level across many counties in the region indicating the existence of healthcare disparities.
I had the privilege of working with a patient with a history of breast and thymus cancer after she had completed chemotherapy months earlier. When she presented to the clinic, she was diagnosed with Burning Mouth Syndrome. She described her pain as similar to eating a Carolina Reaper pepper with every meal. She didn’t have dental insurance and was already stretched thin managing bills and transportation. Dental care had been postponed until the pain became unmanageable. By the time we saw her, she was also facing severely decayed teeth – a stark reminder of how easily oral complications is overlooked when access to care is out of reach.
Delays in dental clearance can postpone the initiation of cancer treatment, which may contribute
to cancer progression, while also increasing the risk of serious oral complications. The same thing could be said post-cancer treatment to cause permanent dry mouth, allowing cavities to spread quickly and silently. A minor issue can escalate into multiple tooth extractions and serious infections. These are not simply side eIects, but symptoms of a fragmented system. When oral health is separated from cancer care, survivors fall through the cracks along with quality of life and everyday activities.
My partner and I are working locally to improve education for newly diagnosed cancer patients to help them understand long-term oral risks and the importance of preventative care. Education alone is not enough. Systemic changes are needed including expanded dental coverage, improved
referral pathways, and better integration between medical and dental care. When undergoing the
grueling process of cancer treatment, it is our job to fix the hidden pain which has an immeasurable value. Survivors deserve more than remission. They deserve comfort, dignity, and the ability to eat, speak, and smile without pain.
Rachel Nguyen
ECU School of Dental Medicine
2025-2026 ECU Health Schweitzer Fellow
Opinions expressed are the author’s own.