Navigating Stomatologic Complications Secondary to Antineoplastic Agents-A Comprehensive Review

Abstract

This review systematically examines the oral complications associated with conventional and novel anti-cancer therapies. It highlights that while molecularly targeted agents including monoclonal antibodies targeting the vascular endothelial growth factor and its receptor, the epidermal growth factor receptor, tyrosine kinase inhibitors, and immune checkpoint inhibitors tend to exhibit a lower overall toxicity profile compared to traditional cytotoxic chemotherapeutics, they are nonetheless linked to significant oral adverse events. These complications encompass inflammatory mucosal reactions known as mucositis, salivary gland dysfunction leading to a sensation of dryness in the mouth, taste alterations referred to as dysgeusia, and, critically, medication-related osteonecrosis of the jaw. In particular, bone-modifying agents such as bisphosphonates and denosumab disrupt bone remodeling and the formation of new blood vessels, thereby increasing the susceptibility to osteonecrosis of the jaw, especially following invasive dental procedures. The review delineates the multifactorial pathogenesis underlying these toxicities, which involves direct cell toxicity, impaired wound healing, and secondary infections. Furthermore, it emphasizes the importance of pre-treatment dental evaluation and preventive strategies including patient education, prophylactic dental care, and the integration of adjunctive therapies such as laser therapy and autologous platelet concentrates to mitigate these adverse effects. The analysis advocates for interdisciplinary collaboration between oncologists and dental professionals to optimize management protocols, enhance treatment adherence, and ultimately improve the quality of life for oncology patients undergoing anti-cancer therapy.

Keywords: bone remodeling; dysgeusia; interdisciplinary management; mucositis; oncologic therapy; oral toxicity; osteonecrosis; preventive dentistry; targeted agents; xerostomia.

Figure 1

Bone sequestrum ((a)—left image) secondary to 15 months of Denosumab use in a 54 yo man with metastatic renal cell carcinoma treated in parallel with Nivolumab plus ipilimumab and ((b)—right image) secondary to 38 months of treatment with bevacizumab and 5-fluorouracil for a metastatic colon cancer in a 68 yo woman (personal archive).

Figure 2

Radiological aspect of bone sequestrum (personal archive).

Figure 3

Gingival swelling (personal archive).

Figure 4

Oro-antral communication (personal archive).