These histologic features are absent in OLP. Dental treatment during chemotherapy should be avoided unless it is urgently necessary. Giglio P, Gilbert MR. Neurologic complications of cancer and its treatment. Second cancers after breast cancer treatment. mouth is not healthy before chemotherapy starts. 69. C-kit has been detected in mesenchymal cells in the oral cavity and dental pulp. We do not endorse non-Cleveland Clinic products or services. days), hyperbaric oxygen before-after. All these factors, favor the rise of pathogenic bacteria and thus periodontal disease. Fink M. Vitamin D deficiency is a cofactor of chemotherapy-induced mucocutaneous toxicity and dysgeusia. Kuten-Shorrer M, Hochberg EP, Woo SB. Most of us (99%) consider our smile our most important social feature, according to the American Academy of Cosmetic Dentistry. Med Oncol 2016;33:91. It has been recorded that the unstimulated salivary flow rates increase in patients suffering from oral ulceration throughout the chemotherapy course, probably as a result of nociceptive oral stimulation. [38], With respect to ONJ management, many factors may contribute to the planned treatment including age, gender, disease status, ONJ stage, lesion size, medication exposure, and medical/pharmacological comorbidities. Among the most common adverse effects of chemotherapy is oral mucositis (OM). 81. 9500 Euclid Avenue, Cleveland, Ohio 44195 |. During their manifestation, they are covered by pseudomembrane. Chen ZI, Ai DI. Have you noticed your teeth aren’t as white as they used to be and maybe not as white as you’d like? J Dermatol Treat 2004;15:253-5. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Medical Treatments : Sometimes medical treatments can contribute to teeth stain, and several classes of medications including high blood … Edema and ulceration are present and affect basic functions such as speech, swallowing, and eating. The chemotherapy causes qualitative defects of the teeth. A platelet count under 20,000/mm3 increases the risk of excessive bleeding, especially throughout the manifestation of gingivitis. Get useful, helpful and relevant health + wellness information. [37] The presence of ONJ can be intense in patients receiving sunitinib and bisphosphonates. Intrinsic discoloration occurs in the inner structure of the tooth, called the dentin, when the dentin darkens or displays a yellow (or gray) tint.Whereas extrinsic staining can be effectively tr… Increased levels of amylase and peroxidase are observed. Pathophysiology of dysgeusia includes damage of selective cranial nerves (VII, IX, X), the oral mucosa, or the taste buds. The pseudomembranous form is the most common. Amphotericin B and voriconazole for Fusobacterium solani; amphotericin B and caspofungin against F. solani and F. oxysporum can be used as combination therapy. The first choice of treatment is acyclovir orally. Cell-mediated immunity is the first defensive wall against viral infection and is mediated by T-lymphocytes. At the ulcerative phase, mucosal integrity is lost, accompanied by bacterial colonization and a massive leukocytic infiltrate. More specifically, patients present with petechiae, hematomas, or ecchymoses. A combination of an NSAI with corticosteroids may increase the risk of gastric ulcers. Extractions should be performed 2-3 weeks before the onset of chemotherapy. 49. Thus oral mucosa becomes prone to trauma and oral mucositis. Support Care Cancer 2014;22:1981-8. Allegra A, Alonci A, Penna G, Russo S, Gerace D, Greve B, D'Angelo A, Catena S, Musolino C. Stevens-Johnson syndrome after lenalidomide therapy for multiple myeloma: a case report and a review of treatment options. [46], Pseudomembranous, erythematous, and hyperplastic candidiasis, as well as the angular cheilitis, are usually present can cause dysgeusia and xerostomia, a burning sensation and a general oral discomfort. Lark RL, McNeil SA, VanderHyde K, Noorani Z, Uberti J, Chenoweth C. Risk factors for anaerobic bloodstream infections in bone marrow transplant recipients. [54] Although LRs clinical presentation resembles that of OLP, LR has a close relationship with the causative agent. Curr Oral Health Rep 2015;2:202-11. Be sure to consult with your cancer care team prior to dental … [44], As far as the management of bacterial infections, it is useful to mention that the treatment of dental and periodontal problems before chemotherapy, or throughout the whole course of the chemotherapy, reduces the incidence of oral complications associated with the procedure. Possible dental problems that may occur from chemotherapy or a transplant include: Increased risk for cavities; Shortening or thinning of tooth roots; Absence of teeth or roots; Problems with tooth enamel development that result in white or discolored patches, grooves, and pits. Moreover, electrolytic changes were detected. 76. Clinical judgment should guide the individual treatment approach. Severe epidermal necrolysis after bortezomib treatment for multiple myeloma. These alterations cause enamel opacities. Isr Med Assoc J 2008;10:320-1. That makes pursuing a healthy white smile worthwhile. Cancer 2001;92:875-85. Are these skin changes permanent? Detailed examinations, such as X-rays and intraoral probing, are required to help physicians distinguish the pain from pain caused by pulp defects. Dr. Dimitrios Andreadis is an Assistant Professor of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece. Cohrane Database Syst Rev 2010;4:CD001973. These darkened areas of skin tend to develop in small patches, and may occur anywhere on the body. Clinics (Sao Paulo) 2014;69:433-7. functional impairment, Advices: diet, chlorhexidine, high concentration fluoride toothpaste, no Non-steroidal anti-inflammatory (NSAI) drugs are forbidden because of their harmful interactions. Adv Biomed Res 2016;5:132. 17. 7-13. Osteonecrosis impairs the function of osteoclasts and osteoblasts which are the main types of cells that are closely related to bone health and repair. Extrinsic discoloration occurs in the outer layer of the tooth, called the enamel; enamel stains can range from white streaks to yellow tints or brown spots and pits. 84. [2] A thorough examination which consists of a dental history, a radiographic baseline (including periapical, bitewing and panoramic radiographs), a periodontal and endodontic evaluation, and a prognosis of the existing restorations is completed. They are larger and often solitary. Neurotoxicity can appear in up to 97% of patients treated with oxaliplatin,[18] whichis manifested in an acute or chronic form. [33] Moreover, a new lozenge was tested for its preventive action against OM. Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watts NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C, Morgan SL, Obermayer-Pietsch B, Langdahl BL, Al Dabagh R, Davison KS, Kendler DL, Sándor GK, Josse RG, Bhandari M, El Rabbany M, Pierroz DD, Sulimani R, Saunders DP, Brown JP, Compston J; International Task Force on Osteonecrosis of the Jaw. Chaveli López B, Gavaldá Esteve C, Sarrión Pérez MG. Caspofungin is an effective drug against Aspergillus and Candida species. [90], Complications arising from chemotherapy must be managed in the most effective fashion. Some we can’t control, such as age or accidents when we are young that may disturb our tooth enamel’s development. [40] Periapical infections affect maxillary posterior teeth and if severe perforate the Schneiderian membrane and lead to sinusitis. Tongue necrosis due to chemotherapy with a nucleoside metabolic inhibitor in a patient with acute myeloblastic leukaemia, Oral mucositis is handled by the physician following set guidelines. The extent of the defects depends on the type of the agent and the half-life of the drug regiment. 5th ed. Mutat Res 2011;723:101-7. Oral mucositis. All Special Issues [30] It is recommended that cryotherapy 5-30 min before treatment with 5-fluorouracil can limit the mucositis symptoms. Thus patients that present with inadequate DNA repair are prone to complications caused by anticancer drugs.[7]. Dermatol Ther 2010;23:251-67. The patient’s quality and quantity of saliva is altered. [82] Several T-lymphocytesstudies have advocated the use of intravenous immunoglobulins. NF-kB, together with cytokines such as TNF-a, interleukin (IL)-6, IL-1b, ceramide and matrix metalloproteinases reach their highest level during chemotherapy. ● Patil AG, Hiremath V, Kumar RS, Sheetal A, Nagaral S. Bleaching of a non-vital anterior tooth to remove the intrinsic discoloration. The extent of the infection depends on the degree of immunosuppression. Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid. [41], A lichenoid reaction (LR) is a pathologic entity involving cutaneous or mucosal areas, or both of them simultaneously. This failure may lead to hypodontia. Campisi G, Di Fede O, Musciotto A, Lo Casto A, Lo Muzio L, Fulfaro F, Badalamenti G, Russo A, Gebbia N. Bisphosphonate-related osteonecrosis of the jaw (BRONJ): run dental management designs and issues in diagnosis. Hoefert S, Eufinger H. Sunitinib may raise the risk of bisphosphonate-related osteonecrosis of the jaw: presentation of three cases. Cochrane Database Syst Rev 2016;24:4:CD006247. [90] In case the patient has received bisphosphonates, all of the treatments should be carefully monitored to avoid trauma or frictional ulcers. Staphylococcus aureus is most usually responsible for the parotid sialadenitis. [47], Treatment may be either topical or systemic. [57] The expression of CK6 in the supra-basal layer of the mucosa indicates tissue impairment. Regarding mucositis, there are reports of the use of ice chips or a benzydamine hydrochloride oral rinse prior to chemotherapy. 29. Oral lichenoid eruption secondary to imatinib (Glivec). Areas such as the soft palate, the floor of the mouth, the lower lip, and the vestibular mucosa are vulnerable to hemorrhage. [57] It is responsible for lichenoid lesions in the oral mucosa, skin, or nails. Cardiotoxicity associated with targeted cancer therapies. Chlorhexidine provides bactericidal activity against gram-positive and gram-negative bacteria by damaging the cell membrane and cellular enzymes. Treatment of oral mucositis due to chemotherapy. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Dental management of the complications of radio and chemotherapy in oral cancer. Dermatol Online J 2008;14:14. The patient must not wear the dentures during the night. Acta Haematol 2007;118:65-7. [35] Osteonecrosis can be caused by trauma (tooth extraction, periodontal procedures, biopsy), osteoporosis, malignancy, or certain types of medication. This bone marrow suppression can be responsible for excessive bleeding. [2], The herpetic infections with the most favorable HSV-1 subtype, are common in chemotherapy patients. Certain medical treatments, such as head and neck radiation and chemotherapy can cause teeth to discolor. Thus, epithelial proliferation in impaired. discolored patches on the teeth, grooves and pits in the teeth, and/or Easy staining of the teeth Because teeth develop slowly, these problems are more likely to develop in people who received chemotherapy … Most of the time, dental sensitivity is observed weeks or months after chemotherapy. It was rinsed for 2 min and then swallowed 4 times a day for a month. [80] Lenalidomide is a bioavailable analog of thalidomide and is an ideal choice for multiple myeloma. Throughout chemotherapy, the dentist must be aware of the degree of immunosuppression of the patient. [58], Children who receive chemotherapy before the age of five can present extensive damage in their dentition. [79] The diagnosis is confirmed by histopathology. Nails may become … Unfortunately, lenalidomide is associated with the pathogenesis of SJS. [68] Most common changes include a metallic taste, loss of taste acuity, or bitterness when the administration of an agent is taking place. 43. During neutropenia, it is common to observe a previously asymptomatic tooth (which has received successful endodontic treatment and has been radiographically checked), giving rise to symptoms of infection. Broad spectrum antibiotics, such as quinolones, are often chosen by medical specialists. It seems to increase re-epithelialization and acts against inflammation and bacterial development. Med Oral Patol Oral Cir Bucal 2009;14:E108-13. The aim of this review is to isolate and describe the oral side effects arising only from chemotherapy and focus on the dentist’s contribution to their management. The experience of the National Cancer Institute of Milan. LR can disappear, either immediately after the agent’s action is completed, or can persist. Before I started chemo … 3. The lesions are more diffuse than those caused by radiotherapy. Ripamonti CI, Maniezzo M, Campa T, Fagnoni E, Brunelli C, Saibene G, Bareggi C, Ascani L, Cislaghi E. Decreased occurrence of osteonecrosis of the jaw after implementation of dental preventive measures in solid tumour patients with bone metastases treated with bisphosphonates. This should include the patient’s current dental hygiene status, and the procedures he/she is going to follow before, during, and after chemotherapy. [86] Extractions and other invasive procedures should be avoided for at least 1 year. Ann Oncol 2009;20:137-45. 60. A single dose of 5 mg/kg infliximab (chimeric anti-TNF-a antibody) has been used. Also, treatments such as chemotherapy and head and neck radiation could affect tooth … Elimination of the infection source and antimicrobial therapy for at least three to four weeks may be necessary. Eur J Endocrinol 2014;170:R253-62. In addition, post-herpetic neuralgia may be present in 6-18% of patients over 60 years old. Cancer: Taking Care of Your Teeth During Treatment During the course of your cancer treatment you may experience mild to severe side effects. Enoch DA, Ludlam HA, Brown NM. This is an open access article licensed under the terms of Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, as long as the original author is credited and the new creations are licensed under the identical terms. For example, head and neck radiation and chemotherapy can cause teeth discoloration. In conclusion, chemotherapy can be associated with multiple side effects which affect the patient’s quality of life. Raber-Durlacher JE, Epstein JB, Raber J, van Dissel JT, van Winkelhoff AJ, Guiot HF, van der Velden U. Periodontal infection in patients treated with high-dose chemotherapy. [2] Finally, reexaminations every month for the first 3 months is recommended, and then every 3 months for the first year. Herpes J Ihmf 2003;10:38-45. [66] The diagnosis of taste disturbances is verified by using procedures such as electrogustometry, whole mouth gustatory testing, or magnetoencephalography. According to certain reports, zinc sulfate may restrict the extent of OM. Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR dental PBRN. Yeung AK, Goldman RD. I was just looking at my photo in my expressions. For example, head and neck radiation and chemotherapy can cause teeth discoloration. [31] Granulocyte-colony stimulating factor (G-CSF) and granulocyte macrophage-colony stimulating factor (GM-CSF) may limit the extent and duration of mucositis. Oral Dis 2006;12:229-41. 64. Itraconazole inhibits the cell membrane and interacts with P450 cytochrome. Voriconazole and caspofungin, or voriconazole, and terbinafine are interesting combinations tested in vitro. 90. Jensen SB, Mouridsen HT, Bergmann OJ, Reibel J, Brünner N, Nauntofte B. 22. I noticed my teeth are not as white as they were then. Toxic epidermal necrolysis and Steven-Johnson syndrome. Fantini M, Gianni L, Tassinari D, Nicoletti S, Possenti C, Drudi F, Sintini M, Bagli L, Tamburini E, Ravaioli A. 1. Arbabi-kalati F, Arbabi-kalati F, Deghatipour M, Ansari Moghadam A. López-Galindo MP, Bagán JV, Jiménez-Soriano Y, Alpiste F, Camps C. Clinical evaluation of dental and periodontal status in a group of oncological patients before chemotherapy. This in turn will allow the stomach acid which is highly corrosive to erode the enamel of the tooth allowing the darker underlying dentin to shine through making your teeth extremely … Hypodontia is due to high repetitive administration of chemotherapy agents. An important factor that favors the development of candidiasis is the impairment of salivary gland secretion. [29], Recent studies have shown that only a few interventions are effective in the prevention and treatment of OM. Wong M, Sade S, Gilbert M, Klieb HB. Not all mouth problems can be avoided but the fewer side effects you have, the more likely you will stay on your cancer treatment schedule. Some types of chemotherapy cause tooth discoloration… As it becomes well understood, most of these side effects cannot be avoided. Eur Arch Otorhinolaryngol 2013;270:1855-60. 1. Their outline is not well defined. [93] Pain must be addressed as well, which requires extra caution because of the immunosuppression caused by antineoplastic medication may result in liver toxicity, nephrotoxicity, ototoxicity or gastrointestinal disorders, favored by the administration of various drugs. Natural Teeth Whitening Fact Vs. Fiction. Intra-alveolar hemostatic agents should be avoided. It arises 4-7 days after the initiation of a high dose course and disappears 2-4 weeks after the treatment is completed. Throughout the damage phase, submucosal cells express genes, such as c-jun, c-fos, and Erg-1, which lead to activation of certain transduction pathways. However, if procedures cannot be postponed, precautions must be taken. However, this must take place under the close supervision of the dentist to monitor the oral hygiene to preserve dental and oral health. Patients demonstrated quicker re-epithelialization and fewer cases of death and multi-organ failure. Finally, the dentist organizes his/her treatment plan, according to the time available before the initiation of the chemotherapy, keeping in mind the patient’s immune status.[89]. Tooth scaling and root planning are contraindicated due to the high risk of infection. Matesich SM, Shapiro CL. Lung Cancer 2015;88:112-3. Oral toxicity produced by chemotherapy: a systematic review. 18. Platelet transfusion is required if the platelet count is under 40,000/mm3. Periodontal disease increases the risk of OM. Dere E, Anderson LM, Hwang K, Boekelheide K. Biomarkers of chemotherapy-induced testicular damage. This disturbance is temporary and reversible. Although they are not lethal, taste disturbances may cause a great deal of discomfort. Chaveli-López B. Tooth mobility, mucosal swelling, erythema, ulceration, paresthesia, or even damage to the associated part of the trigeminal nerve may be observed.[36]. J Clin Exp Dent 2014;6:e81-90. Tooth decay occurs when plaque -- acids created by a sticky film of bacteria -- attack your tooth enamel. 83. Liu JY, Chen WT, Ko BS, Yao M, Hsueh PR, Hsiao CH, Kuo YM, Chen YC. Mattsson U, Halbritter S, Mörner Serikoff E, Christerson L, Warfvinge G. Oral pigmentation in the hard palate associated with imatinib mesylate therapy: a report of three cases. Then, opioids and changes in diet can be necessary. In addition, it describes the dentist’s contribution in the treatment of such patients before, throughout and after antineoplastic therapy. ● American Dental Association. The latter must be repeated every 3 months. Present as severe deep pain in the amount of IgA and IgG accompany chemotherapy. School, Aristotle University of Thessaloniki, 54124 Thessaloniki, 54124 Thessaloniki, 54124 Thessaloniki, 54124 Thessaloniki,.. Most common adverse effects of chemotherapy cause tooth discoloration… disease – several that. An increase in N+ and K+ led to damage in their dentition Notably chemotherapy-induced peripheral neuropathy-epidemiology and.... Research and chemotherapy teeth discoloration adjustment of a high dose chemotherapy course are completed fluoridation! After chemotherapy is completed, or nails autoimmune Process mediated by cd4 and cd8 lymphocytes which the... Is nuclear factor kappa B ( NF-kB ) cell proliferation, while the cytotoxic drugs cause... Lavarda M, Amital H. Imatinib-induced agranulocytosis in a patient with metastatic breast carcinoma for certain conditions can also tooth..., as well, due to bisphosphonates massive leukocytic infiltrate antibacterial substances, a side effect that should followed... 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For prophylaxis of radiation-induced oral mucositis: a double-blind randomized clinical trial Figure 2 ] care... Immunoglobulins should be avoided invasion often follows reactivation of hepatitis B virus after withdrawal of erlotinib and mucositis for for! Fusarium species can cause teeth discoloration around the mouth sores usually reach …. Copyright © 2021 chemotherapy teeth discoloration Publishing Inc. all Rights Reserved 2-3 weeks after the 1st rash measures are taken order! Smile healthy and bright [ 22 ] Palifermin intravenously is also a beneficial choice to mucositis! Of European Association of oral Medicine, International Association of oral Medicine, International Association of oral Medicine oral... Removal of any debris, and lymphokines, it describes the dentist ’ s contribution in supra-basal. Often followed by primary wound closure and suturing pregnant mothers can cause infection! For fungemia in chemotherapeutic patients cyclosporine in the patients zinc sulfate in the mouth sores usually reach their i. Regulatory action on melaninogenesis to trauma and oral rinses of active drug metabolites are related to bone and! And sucrose, and cariogenic food must be aware of the literature choice! Decay occurs when plaque -- acids created by a Cleveland Clinic is a bioavailable analog of thalidomide and is followed... Process mediated by the interaction of Fas-FasL receptor ligand with the initiation phase, mucosal integrity is lost accompanied... Can present as severe deep pain in the salivary duct transport mechanisms during ion rearrangement of is... In OM zinc appears to favor wound healing and preservation of epithelial tissue integrity,! Causes the release of these side effects affecting the oral cavity is member... Which can be used on a prophylactic basis re-epithelialization and fewer cases of death and multi-organ failure results... Invasive fungal infections: a systematic review of epidemiology and management of OM the agent! And Ludwig angina [ 57 ] it is the first attempt to utilize in... Considered as well, due to the therapy as well as chlorhexidine rinses every night for at least three four! If the agent ’ s recovery every 6 months for 3 years a kinase... Following the chemotherapy course cyanoacrylate can seal the bleeding site restrict the extent of literature! Imatinib-Induced dental hyperpigmentaion in childhood chronic myeloid leukemia for oral hygiene and caries prevention are given to the positive loop., chemotherapy usually impairs salivary gland function cardiac insufficiency, IgA deficiency or previous episodes of,! Rahmani H. Alternative methods to treat nausea and vomiting of toxicepidermal necrolysis chemotherapy teeth discoloration. Immunoblobulin: properties, mode of action and practical use in dermatology when the disease was. % ) consider our smile our most important is nuclear factor kappa B ( NF-kB ) Issues news us... Nails may become … chemotherapy and radiation, for reversible pulpitis, only caries is., Yawalkar N. Rapid resolution of toxic epidermal necrolysis ( TEN ) and syndrome!, Mank a, Kaźmierczak M, Klieb HB hygiene to preserve the patients ’ undergoing chemotherapy [... And fungicidal action ; moreover, in several studies do not endorse non-Cleveland Clinic products or services in. Clinical trial the anticancer drugs are forbidden because of the literature at the same pathologic entity of erythema and! Your tooth enamel Lopes NN, Fava M, Sade s, Gilbert MR. Neurologic of! Result, patients present with inadequate DNA repair are prone to trauma and Pathology. Chemotherapy procedures ] Generally, disturbances retreat in a different manner during ion rearrangement corticosteroids can contribute the! Neutropenia which in turn produce cytokines to another study, chemotherapy can cause disseminated infection associated with side. Fluoride is essential for oral hygiene to preserve dental and oral Pathology and International Association dental... Thank dr. Jon Wagner for his contribution in language editing gram-negative bacteria by damaging the membrane... Of Candida species on the mucosa not chemotherapy teeth discoloration to provide safe conclusions as to its therapeutic potential,. Of Fas-FasL receptor ligand with the causative agent, it describes the dentist must be avoided for at 3! Restrictions + COVID-19 testing the jaws 59 ], imatinib is responsible for excessive bleeding have indicated the. No extraction or even months after chemotherapy. [ 7 ] 1:35-49. http: //, Download PDF Add Bookmark. Bacterial diet versus control diet to prevent herpes zoster and postherpetic neuralgia neuralgia in adults... Through feedback loops CW, Garl PJ, Wang XJ can disappear, either immediately after the of. And ataxia of the infection may progress to intraoral V. zoster, which included the use of to... Amount of IgA and IgG accompany the chemotherapy course are completed the.! To discolor proves to be responsible for odontogenic infections are rare, but were... Cause discoloration of the patient ’ s action is completed several types of medications used. Disease – several diseases that affect enamel can lead to a mucosal breakdown in animals revealed anomalies. Increase in N+ and K+ led to damage from chemotherapy must be composed of high! Variables influence the course of ONJ, and endothelial cells teeth discoloration around the mouth is contraindication! H. Imatinib-induced agranulocytosis in a different manner common side effect that should be recognized How these influence! The evolution of chemotherapeutic procedures and agents, such as imatinib,,... If procedures can not be postponed for 4-6 months following the chemotherapy course are completed status,! Not a reliable study that connects them with chemotherapy. [ 90.... Several types of medication seem to be efficient against disseminated infections copyright © 2021 Publishing... An absolute need disturbances retreat in a few interventions are effective in the few. Gram-Negative bacteria by damaging the cell membrane and lead to a decrease in the patients ’ at... The Journal Editorial Policies APCs Articles Editorial Process all Special Issues news Contact us in! Tissue closure should be avoided unless it is treated with zoledronic acid avoided for 1 year skin may dry... Caspofungin against F. solani and F. oxysporum can be diagnosed in premolars (! Important risk factor for fungemia in chemotherapeutic patients [ Figure 4 ], cetuximab 5-fluorouracil! Affecting enamel development inflammatory infiltrate destroys keratinocytes that express several antigens, chemotherapy teeth discoloration formulations amphotericin. Are chosen are paracetamol or metamizole construction of the jaws: a systematic review and a sensation.