Oral Medicine · Oncology patients
Chemotherapy, head and neck radiation and targeted therapies directly affect the mouth, teeth and jaw bones. The right dental assessment and care, before, during and after cancer treatment, reduces infections, pain and treatment delays, and helps you keep eating and speaking comfortably. Dr. Andra Rettman, a specialist in Oral Medicine, treats oncology patients in close coordination with their medical team, and helps them use their Kupat Holim (health fund) entitlement.
Cancer treatments target rapidly dividing cells, including the lining of the mouth, the salivary glands and immune cells. Many patients therefore develop painful mouth sores, dry mouth, taste changes, infections and rapid tooth decay. A "silent" dental infection can flare up precisely when the immune system is suppressed, leading to fever, hospital admission or a delay in treatment.
Bottom line: the most effective way to reduce oral complications is an assessment by a dentist specialized in Oral Medicine before chemotherapy or radiation begins, followed by close monitoring. This is also what international guidelines recommend (MASCC/ISOO, NIDCR).
Head and neck radiation carries a particularly high risk: radiation reduces blood supply to the jaw bone and damages the salivary glands, often long-term. Extracting a tooth from irradiated bone may lead to bone necrosis (osteoradionecrosis), which is why key decisions are made in advance.
Come in as early as possible after diagnosis, ideally at least two to three weeks before head and neck radiation starts. This window allows necessary treatment and extractions to be completed and the tissues to heal before radiation.
The goal is not to "fix everything" before treatment, but to deal with what could put you at risk in the coming months, while preserving your teeth for the long term.
During chemotherapy or radiation the aim is to prevent infection, relieve pain and help you keep eating and drinking. Invasive dental procedures are planned according to blood counts (neutrophils and platelets) and in coordination with the oncology team.
The most common complication. Gentle hygiene, suitable rinses and pain management, as directed by your doctor, make a real difference.
Makes chewing, swallowing and speaking harder and increases decay. Saliva substitutes, frequent sips of water and fluoride help protect the teeth.
Common when immunity is low. Early diagnosis by an Oral Medicine specialist allows prompt treatment.
Usually temporary. Keep up adequate nutrition and report reduced eating to your team.
The mouth remains sensitive after treatment ends. After head and neck radiation, long-term dry mouth, rapid decay at the gumline and limited mouth opening (trismus) are common. Many patients also continue to receive bone-protecting drugs such as Zometa (zoledronic acid) or Xgeva (denosumab), which raise the risk of jaw osteonecrosis after extractions or oral surgery.
Important: if you received radiation to the jaw area or drugs such as Zometa/Xgeva, do not have an extraction or oral surgery without prior planning by a dentist who knows your medical history.
| Side effect | When it appears | What to do |
|---|---|---|
| Mucosal sores and pain | During chemotherapy and radiation | Gentle hygiene, tailored rinses, treating pain and infection |
| Dry mouth | During and after radiation | Saliva substitutes, hydration, fluoride, monitoring for decay |
| Rapid tooth decay | Months to years after radiation | Daily fluoride, frequent check-ups, early restoration |
| Limited mouth opening | After radiation to the jaw area | Stretching exercises and referral for supportive therapy |
| Jaw bone necrosis | After radiation or bone drugs, mainly following extraction | Prevention, advance planning, specialist care |
Israeli residents with cancer who are receiving, or are about to receive, chemotherapy or radiation are entitled to health-fund participation (Clalit, Maccabi, Meuhedet and Leumit) in dental care under the national health basket:
The entitlement can also be used at a private clinic, subject to the fund's prior approval. You submit a hospital summons letter, a medical letter with the diagnosis, confirmation of the treatment end date, a dental treatment plan and a price quote. For reimbursement you submit a signed summary detailing treatments and costs, plus original receipts and tax invoices.
How we help: we prepare a detailed treatment plan and quote in the format your health fund requires, and explain the order of steps. Actual reimbursement follows the fund's tariff, so it is worth confirming the amount with your fund in advance.
Oral Medicine is a recognized dental specialty focused on diagnosing and treating diseases of the oral mucosa and jaws, and on dental care for medically complex patients. Dr. Andra Rettman graduated from the Hebrew University, Hadassah School of Dental Medicine, completed the Oral Medicine residency, and serves as a senior physician in the Department of Oral Medicine, Sedation and Maxillofacial Imaging at Hadassah Ein Kerem, where she also teaches residents.
What this means for you: familiarity with cancer therapies and medications, direct communication with your medical team, and a treatment plan that considers your overall health, not only your teeth. Treatment is provided in English and Hebrew.
Right after diagnosis, ideally at least two to three weeks before head and neck radiation starts, so infections can be treated and healing can occur first. If treatment has already started, it is still worth coming in; care will be adapted.
Yes, with proper planning. Simple and preventive treatment is usually possible; invasive procedures are timed according to blood counts and coordinated with your oncologist, typically when immunity recovers between cycles.
Yes. Under the health basket, funds cover 50% of conservative and restorative treatment before chemotherapy or radiation, and full coverage after treatment (with a referral within 24 months of completion), according to the fund's tariff.
Yes, subject to the fund's prior approval. You submit medical documents, a treatment plan and a quote; the fund should respond within about a week. We prepare the plan and quote for you.
Extraction in irradiated bone raises the risk of bone necrosis, so it is done only after specialist assessment and planning, and sometimes alternatives allow it to be avoided. There is no single "safe" waiting period; the decision depends on radiation dose and tooth location.
Gentle hygiene, frequent sips of water, saliva substitutes, tailored rinses and treatment of infection and pain. Sores that do not heal should be examined, as some are infectious and need specific treatment.
Yes, with planning. These drugs raise the risk of jaw osteonecrosis, mainly after extractions and surgery. Most conservative treatment (fillings, root canals, cleanings) is possible, while invasive procedures are carefully planned with your oncologist.
Yes. Consultations and treatment are available in English and Hebrew, and we can help you understand Israeli health-fund procedures.
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