| | Complication | Patients at risk | Considerations |
| Acute | Oral infection (viral, bacterial and fungal) | - Intensive high-dose chemotherapy regimens
- Head and neck radiation
| - Odontogenic infections may present with pain/fever but without cardinal signs of erythema and purulence
- Intraoral HSV recrudescence may affect keratinized and non-keratinized mucosal sites
|
| Oral mucositis | - Intensive high-dose chemotherapy regimens
- Head and neck radiation
- mTOR inhibitor therapy
| - Starts 7 to 10 days after chemotherapy, resolves within three weeks
- Peaks after third week of radiation, resolves weeks after completion of therapy
- mTOR inhibitor stomatitis appears aphthous-like, develops within first week of therapy
|
| Salivary dysfunction | | - Oral burning common
- Increased risk of candidiasis
|
| Oral hemorrhage | - Thrombocytopenia secondary to chemotherapy
| - Appears in the oral cavity as areas of active bleeding, petechiae, or ecchymosis
|
| Late | Chronic GVHD | - Patients who received allogeneic hematopoietic cell transplantation
| - Typically appears after day +100
- Reticulation, erythema and/or ulcerations, primarily affecting the tongue and buccal mucosa
- Superficial mucoceles of the palate
|
| Jaw osteonecrosis | - Anti-resorptive therapy
- Head and neck radiation
| - Characterized by exposed necrotic bone in the oral cavity
- Symptoms usually due to secondary soft tissue infection
|
| Taste dysfunction | - Head and neck radiation
- Chemotherapy
- Chronic GVHD
| - Typically recovers after several months
|
| Trismus | - Head and neck surgery
- Head and neck radiation
- Chronic GVHD
| - Develops gradually over time
- Maintaining oral hygiene and providing dental care can be challenging
- Requires long-term physical therapy
|
| Impairment of craniofacial development in children | - Chemotherapy or head and neck radiation at a young age
| - Dental abnormalities include delayed eruption of teeth, microdontia, and tooth agenesis
- Bone abnormalities include deficient head and neck skeletal growth
|
| Salivary dysfunction | - Head and neck radiation
- Chronic GVHD
| - Oral burning common
- Increased risk of candidiasis and dental caries
- Prescription and non-prescription management
|
| Oral squamous cell carcinoma | - History of head and neck cancer
- Recipients of allogeneic hematopoietic cell transplantation
| - Field cancerization changes increase risk of new primary lesions
- Well-defined, abnormal mucosal lesions, require biopsy for diagnosis
|
