Oral manifestations of systemic chemotherapy and their management.

Many antineoplastic drugs in use now have cytotoxic side effects that also manifest in the oral cavity or influence dental management. Chemotherapeutic agents that have a high potential for precipitating oral mucosal damage and bone marrow depression are methotrexate, cyclophosphamide, daunorubicin, doxorubicin hydrochloride, 5-fluorouracil, bleomycin, nitrogen mustard, cytosine-arabinoside, 6-mercaptopurine, busulfan, and L-phenylalanine mustard. Mucositis may lead to neglected oral hygiene, which in turn may cause a chain reaction of local infections, bleeding, and septicemia in myelosuppressed patients. Preventive oral care before chemotherapy and active oral care during therapy are necessary for compromised patients. A protocol for oral care is described.