Antineoplastic Drugs and Their Effects on Soft Tissue and Bone Remodeling in the Oral Cavity

Antineoplastic drugs, commonly employed in cancer treatment, have notable adverse effects on soft tissues and bone, often resulting in serious complications. These agents, which include those targeting DNA synthesis, mitotic inhibitors, and DNA-interactive compounds, disrupt tumor growth as well as normal cellular functions. A significant consequence is damage to the oral cavity, particularly affecting soft tissues and bone remodeling. One prevalent adverse effect on soft tissues is oral mucositis, an inflammatory condition characterized by painful ulcerations, erythema, and an increased risk of secondary infections. Oral mucositis typically develops within days of chemotherapy initiation, peaks around 7–10 days and resolves after treatment cessation. Additionally, chemotherapy-induced xerostomia arises from impaired salivary gland function, resulting in decreased saliva production, which complicates mastication and swallowing and heightens the risk of infections. Some antineoplastic drugs, such as Imatinib, may induce melanosis, an alteration in pigmentation due to heightened melanogenesis. Additionally, osteonecrosis of the jaw is a severe complication linked to bisphosphonates, which are used to manage bone metastases and malignant hypercalcemia. Osteonecrosis of the jaw results from suppressed osteoclast and osteoblast activity, leading to impaired bone remodeling, reduced vascular supply, and eventual necrosis. Factors such as dental extractions, trauma, and invasive procedures can exacerbate osteonecrosis of the jaw, underscoring the necessity for preventive dental care in patients undergoing chemotherapy. Despite the therapeutic importance of antineoplastic agents, their adverse effects on oral soft tissues and bone present significant clinical challenges. Further research is essential to clarify the underlying mechanisms and develop strategies to mitigate these complications, ultimately enhancing the quality of life for cancer patients.