Oral Problems in Advanced Cancer and Palliative Care: Prevalence, Comfort-Oriented Management, and Clinical Decision-Making

Abstract

Objective: To review the main oral problems affecting patients with advanced cancer receiving palliative care and to discuss evidence-based management strategies focused on comfort while considering symptom burden, prognosis, functional status, treatment tolerance, and individual goals of care. Methods: A narrative review was conducted using PubMed/MEDLINE and Google Scholar to identify systematic reviews, clinical studies, expert recommendations, and clinical practice statements addressing oral problems in patients with advanced cancer receiving palliative or end-of-life care. The literature was organized according to the type of oral problem, disease- or treatment-related causes, clinical impact, and management strategies. Contemporary recommendations and studies assessing oral health-related quality of life were prioritized. The literature search was updated through September 5, 2026. As this was a narrative review, no quantitative synthesis or formal risk-of-bias assessment was performed. Results: Oral problems are common among patients with advanced cancer and may involve symptoms, clinical conditions, and functional limitations. Dry mouth, taste alterations, swallowing difficulties, oral pain or discomfort, halitosis, candidiasis, dental disease, mucositis, and impaired oral hygiene may interfere with eating, hydration, communication, social interaction, and quality of life. Their causes may vary according to the malignancy, anticancer treatments, medications, dehydration, reduced oral intake, functional decline, and pre-existing oral diseases. Management should therefore begin with identification of the oral problem and potentially reversible causes, followed by assessment of discomfort, functional impact, prognosis, treatment burden, and patient preferences. Available evidence supports individualized oral care, salivary stimulation or humidification when appropriate, symptom control, treatment of clinically relevant infections, adaptation of oral hygiene practices, caregiver education, and multidisciplinary management of functional problems such as dysphagia. Recent clinical evidence also suggests that integrating dentists into palliative care teams may be associated with improvements in oral health-related quality of life and symptom burden. Conclusion: Oral problems should be recognized as an integral component of supportive and palliative care for patients with advanced cancer. Dental care should not be automatically equated with either comprehensive restorative treatment or therapeutic minimalism. Instead, care should be proportionate to the expected benefit, treatment burden, time required to achieve benefit, prognosis, tolerability, and individual goals of care. An evidence-based clinical decision-making framework is proposed to support the planning and reassessment of dental care throughout the palliative trajectory.