Dental Care Before Cancer Treatment: Chemotherapy, Radiotherapy and Your Teeth (2026 UK Guide)

Last updated: October 2026. Sources: NHS England, NHS.uk, the NHS Business Services Authority (NHSBSA), GOV.UK, NHS inform, GOV.WALES, the HSC Business Services Organisation (Northern Ireland), the Faculty of Dental Surgery at the Royal College of Surgeons of England, the British Dental Association and NHS hospital trust patient information. All figures, rules and eligibility details verified on 26 October 2026.

TL;DR If you are about to start chemotherapy, head and neck radiotherapy or a stem cell transplant, ask your cancer team about a dental check now. UK guidance says it should ideally happen about a month before treatment, with any extractions at least 10 days before. A cancer medical exemption certificate does not make NHS dental treatment free.

Being told you have cancer brings a long list of appointments, and a trip to the dentist may feel like the least of your worries. But many people are told by their cancer team to "see a dentist first", and there is a good reason for it. Cancer treatment can affect your mouth even when the cancer is nowhere near your head, and a dental problem that flares up mid-treatment can delay the treatment itself.

This guide explains why the dental check matters, who arranges it, what happens at the appointment, how to look after your mouth during treatment, what changes after head and neck radiotherapy, and what you will pay. It is based on the February 2026 national guideline from the Faculty of Dental Surgery at the Royal College of Surgeons of England (RCS England), NHS England guidance, and patient leaflets from NHS (National Health Service) hospitals. Your own cancer and dental teams know your treatment plan, so their advice always comes first.

Why your dentist matters before cancer treatment

Mouth problems are a common side effect of cancer treatment. The RCS England patient leaflet puts it plainly: "Although your treatment may not be anywhere near the head, some of the treatment side effects can still affect your mouth." [3]

The aim of a check before treatment is to find and deal with anything that could cause trouble later, such as decay, a loose or infected tooth, or gum disease. RCS England explains that "The aim is for your mouth to be as fit as possible for the upcoming cancer treatment to avoid any unscheduled interruptions or delays." [3]

There is a safety reason too. Some treatments lower the white blood cells that fight infection. NHS England warns that "Dental infections can lead to sepsis, and this risk is increased with unmanaged tooth decay during episodes of low neutrophil counts in patients receiving cancer therapy." [4] Neutrophils are a type of white blood cell.

Which cancer treatments can affect your mouth

NHS England says the following groups should be offered an oral health check as part of their cancer care [4]:

• people with a diagnosis of head and neck cancer
• people having radiotherapy to the jaws, including some people treated for lymphoma and skin cancers
• people who will have chemotherapy or immunotherapy for any type of cancer
• people who will have a bone marrow (stem cell) transplant
• people receiving bone-strengthening drugs called denosumab or bisphosphonates

Chemotherapy and transplants mainly cause short-term problems such as a sore mouth and a higher risk of infection. Radiotherapy to the head and neck can cause lasting changes to the jaw bone and the salivary glands, which is why the planning for that group is especially careful.

If you are being given zoledronic acid or denosumab as part of your cancer treatment, tell your dentist. These drugs carry a small risk of a jaw bone problem called medication-related osteonecrosis of the jaw (MRONJ), and the Scottish Dental Clinical Effectiveness Programme (SDCEP) publishes dental advice for people prescribed them for cancer [24]. The MHRA (Medicines and Healthcare products Regulatory Agency) introduced patient reminder cards for these medicines in 2015 [25], so keep yours handy for dental visits.

When to have the dental check

As early as you can. The RCS England guideline says "A comprehensive oral evaluation should be undertaken as soon as possible following cancer diagnosis." [2]

For timing, the guideline gives these targets:

These are ideals, not legal deadlines. Cancer treatment sometimes needs to start quickly, and your cancer team will not delay urgent treatment for a dental appointment. East Kent Hospitals, for example, tells head and neck patients that the dental assessment may sometimes happen after chemotherapy has begun so that cancer treatment is not delayed [26]. The key message is to raise the subject on the day you are diagnosed, not the week before treatment.

Who arranges the dental check

This depends on your cancer and where you are treated.

Head and neck cancer. NHS England says patients with head and neck cancer "should be assessed by a consultant in restorative dentistry who works with the surgeon in the multidisciplinary team" [4]. In practice, the hospital usually arranges this for you. Restorative dentistry is the specialty that plans and repairs teeth and replaces missing ones.

Other cancers. For most people having chemotherapy, NHS England says the team managing your cancer should advise you "to have a comprehensive oral assessment with their dentist" [4]. That usually means your own dental practice. NHS England adds that "Patients do not need to change their current dental provision to a specific team if they have access prior to the start of therapy; all dentists (NHS or independent) can support their care" [4]. Some cancer centres have their own hospital dental team and some do not, so ask your cancer nurse what happens locally.

Children and teenagers. The RCS England guideline says "Referral to a specialist paediatric dental team at diagnosis is the gold standard." [2]

Whoever does the check, your own dentist should be kept informed. University Hospitals of North Midlands, for example, tells patients that "routine check-ups with your own general dental practitioner should be maintained" and that your dentist "will be kept informed of your treatment throughout" [15].

What happens at the appointment

The check is similar to a thorough routine examination, with a few extras:

1. Examination and X-rays. Your dentist checks your teeth, gums and any fillings, crowns or dentures. Before head and neck radiotherapy, Cambridge University Hospitals explains that the assessment "will include a dental x-ray known as an orthopantomogram (an OPG)", which shows all your teeth and jaws in one picture [14].
2. A plan for any problem teeth. Decayed teeth are filled or stabilised. Teeth with a poor outlook may be removed before treatment starts. RCS England recommends a tiered approach, where teeth with a poor prognosis or infection risk are removed and teeth with a guarded prognosis may be kept after an informed discussion about future risks [2].
3. Prevention. You may have fluoride varnish painted on your teeth [2] and be given a prescription for a high-strength fluoride toothpaste [15] [16].
4. Fluoride trays (some head and neck patients). These are thin, clear plastic moulds that hold fluoride gel against your teeth. University Hospitals of North Midlands describes two visits, one for impressions and one for fitting, with the trays usually worn overnight [16].
5. Advice. You should be told which side effects to expect and how to look after your mouth.

Being told you need teeth removed before cancer treatment can be upsetting, especially if they do not hurt. The guideline itself recognises this distress [1]. Ask your dentist to explain why each tooth is a risk, and whether any could safely be kept.

Looking after your mouth during treatment

RCS England's patient leaflet and guidance set out a simple routine [2] [3]:

• Brush gently twice a day, including last thing at night, with a soft or child-sized toothbrush.
• Use a fluoride toothpaste, and a high-strength one if it has been prescribed. Toothpastes above 1,500 ppm (parts per million) fluoride are "available on prescription from a dentist" [13].
• Spit, don't rinse after brushing, so the fluoride stays on your teeth longer [3].
• Use an alcohol-free fluoride mouthwash at a different time from brushing [2]. Our guide to choosing an alcohol-free fluoride mouthwash explains the options.
• Choose a mild toothpaste if your mouth is sore. RCS England suggests a toothpaste free of sodium lauryl sulphate (SLS) with mild or no flavour, as long as it still contains fluoride [2].
• Avoid foam sponge sticks, which work poorly and can be a choking risk [2].
• Check with your team before flossing if your platelet count is low [3].
• Cut down on sugary snacks and drinks between meals, especially if your mouth is dry [3].

You may be surprised that chlorhexidine mouthwash (sold as Corsodyl) is not on the list. RCS England says "Chlorhexidine is not recommended for preventing caries, periodontal disease, or mucositis in head and neck cancer patients." [2] Its patient leaflet adds that it "can be quite irritating" [3]. Some hospitals still suggest it in particular situations, so follow your own team's advice.

If you wear dentures, RCS England advises taking them out at night and cleaning them carefully, and stopping wearing them if they become painful [2].

Common mouth side effects and when to call your team

The NHS lists "a sore mouth and throat (mucositis)" among the common side effects of chemotherapy, along with a weakened immune system that makes infections more likely [17]. Mucositis is inflammation of the lining of the mouth. It can also happen with radiotherapy to the head and neck [1].

Other mouth effects can include [1] [2] [3]:

• mouth ulcers, which can become infected (our guide to mouth ulcers that won't heal covers ulcers in general)
• oral thrush, a fungal infection that can look like white patches
• cold sores and other viral infections
• taste changes
• dry mouth, which raises the risk of tooth decay because saliva normally protects your teeth

RCS England advises checking your mouth every day and telling your medical team urgently if you notice white spots, a white coated tongue, blisters or ulcers, bleeding or crusting of the lips, red areas or bleeding gums [3]. Its headline advice is: "If you develop tooth pain or infection, contact the cancer team urgently" [3].

Can you have dental treatment during chemotherapy

Routine dental work is usually paused. RCS England says "Elective dental treatment should generally be avoided during active cancer therapy, with care focused on prevention and management of acute problems." [2] Its patient leaflet explains that you can stay in touch with your local dental team, but non-urgent treatment should stop during active cancer treatment [3].

Urgent problems can still be treated. If you need something like an extraction, your dentist will speak to your cancer team first. The guideline says blood tests may be needed "within 24 to 48 hours" beforehand, including at least a full blood count, so the teams can check whether it is safe to go ahead and whether you need extra support such as antibiotics or a platelet transfusion [2]. This is why it matters that your dentist knows about your cancer treatment.

After head and neck radiotherapy: osteoradionecrosis and lifelong care

Radiotherapy to the head and neck can permanently change the jaw. Cambridge University Hospitals explains that it "permanently weakens the jaw bones (including teeth) and can affect the blood supply in this area", and that saliva production "is usually permanently reduced" [14].

The most serious dental complication is osteoradionecrosis (ORN), where an area of jaw bone that has had radiotherapy dies and fails to heal [1]. It is often triggered by a tooth extraction or other injury in the treated area [1] [2]. One 2021 study described "The overall lifelong risk of mandibular Osteoradionecrosis (MORN) in head and neck (HN) radiotherapy (RT) is 4-8%" [20]. RCS England says "There is no definitive treatment for ORN, which can significantly impair quality of life." [2]

That is why the guideline advises avoiding extractions in treated areas where possible after radiotherapy, and considering alternatives such as root canal treatment [2]. If you do need a tooth out, RCS England advises seeing a specialist dentist or surgeon who can plan treatment to reduce the risk [3].

Other long-term changes can include a dry mouth, a higher risk of decay, and stiffness that limits how wide you can open your mouth (trismus) [2]. RCS England says "Lifelong dental follow-up is required, usually by a general dental practitioner in liaison with specialist services, and individualised review intervals." [2] Many people need more frequent check-ups than before [1]. Our guide to how often you should see a dentist explains how recall intervals are normally set.

If you have had treatment for mouth cancer, regular dental visits also mean someone is checking your mouth for changes. Our guide to the signs of mouth cancer explains what to look out for.

Do cancer patients get free NHS dental treatment

Many people assume they do, because people having treatment for cancer can get free prescriptions in England. But the two are separate.

NHSBSA says you are entitled to a medical exemption certificate if you are having treatment for cancer, the effects of cancer or the effects of cancer treatment [6]. It then makes clear: "A medical exemption certificate does not exempt you from other NHS charges including dental treatment or glasses." [5]

What you pay in England depends on who treats you:

• Treatment from a hospital dentist is free. NHS.uk lists people "getting treatment in an NHS hospital from a hospital dentist (but you may still need to pay for dentures or bridges)" among those who get free NHS dental treatment [8]. Many head and neck patients are treated this way.
• Treatment at an NHS dental practice is charged at the normal band rates, unless you qualify for free care for another reason.

You pay one band charge for a whole course of treatment, at the level of the highest band you need [7]. Our NHS dental charges guide explains the bands in detail.

You still get free NHS dental treatment in England if, for example, you are under 18 (or under 19 in full-time education), pregnant or had a baby in the last 12 months, or you or your partner get certain benefits, such as income-related Employment and Support Allowance, Pension Credit Guarantee Credit or Universal Credit below an income limit [8]. If money is tight, the NHS Low Income Scheme can give full help (an HC2 certificate) or partial help (HC3) [8] [9]. Cancer often affects income, so it may be worth applying. Our guide to who qualifies for free NHS dental treatment covers every category.

There is one narrow rule for people who have had surgery for mouth or jaw tumours: the NHS dental charges regulations say no charge is made for certain dental appliances supplied outside general dental practice to someone who has had surgery affecting the jaws or soft tissues of the mouth as part of treatment for invasive tumours [23]. Ask your hospital team whether this applies to you.

Scotland, Wales and Northern Ireland

None of the official free dental treatment lists in the four UK nations includes cancer as a category [8] [10] [11] [12].

Is this likely to change

Not soon. A 2023 YouGov survey for the British Dental Association (BDA) found "82% saying exemptions should cover cancer patients, whose treatments can cause severe dental problems" [21], and MPs debated access to dentistry for cancer patients in Westminster Hall on 17 April 2024 [22]. But responding to a parliamentary petition on 5 March 2026, the UK Government said: "There are no current plans to extend free care to cancer patients, although those struggling with NHS dental costs can apply for help." [19]

Children and teenagers having cancer treatment

NHS dental treatment is free for children in every UK nation [8] [10] [11] [12], so cost should not be a barrier to a child's dental care.

RCS England recommends that every child or young person has a dental assessment at diagnosis, ideally with a specialist children's dental team [2]. Because children are at high risk of tooth decay during treatment, the guideline says they "should undergo dental examinations every three months during active therapy" [2]. Planning is often more cautious than for adults: teeth with a poor outlook are more likely to be removed early, partly to avoid repeat general anaesthetics [2].

The guideline also recommends lifelong dental follow-up for all children and young people treated for cancer, because of late effects on developing teeth and a higher lifetime risk of mouth cancer [2]. If your child has braces, the orthodontic team should be asked whether they need to come off before treatment [2].

If you cannot find an NHS dentist before treatment starts

NHS England admits this is a real problem. Its guidance notes reports that some patients cannot access dental care once diagnosed if they are not already known to a dental practice, and says "Data to quantify this problem is not available." [4] We know how frustrating this can be when the clock is ticking. These steps can help:

1. Tell your cancer team straight away. NHS England has asked integrated care boards (ICBs), the NHS bodies that commission dental services, to "review and ensure prioritised access for appropriate oral health assessment, prevention (advice and interventions), and treatment for patients diagnosed with cancer who cannot access a dentist prior to their intended start date for cancer therapy" [4]. Arrangements vary by area, so your cancer nurse is the best person to ask.
2. Contact your local ICB. NHS.uk advises that if you cannot find an NHS dentist, "you can contact your local integrated care board (ICB)" [18].
3. Search more widely. Some practices offer both NHS and private appointments [18], and any dentist, NHS or private, can provide the check [4]. Our guide to finding an NHS dentist accepting new patients has practical tips.
4. For urgent problems, if you are mid-treatment contact your cancer team's helpline first [3]. Otherwise, NHS 111 can direct you to urgent dental care [27]. Our emergency dentist guide explains when to call 111 and when to go to A&E.

Frequently asked questions

Should I see a dentist before chemotherapy?

Yes, ideally. NHS England says people starting chemotherapy should be advised to have a full oral assessment with their dentist [4], and RCS England recommends a check as soon as possible after diagnosis, ideally about a month before treatment [2]. It lets your dentist treat any problem teeth before your immune system is lowered.

How long before radiotherapy should I have a dental check?

RCS England says the dental assessment should ideally take place at least one month before head and neck radiotherapy, and any teeth at risk should ideally be removed 10 to 21 days before treatment starts [2]. If you have been diagnosed with head and neck cancer, your hospital team usually arranges this check for you.

Can I go to the dentist while having chemotherapy?

Yes, but routine work is usually paused. RCS England advises avoiding non-urgent dental treatment during active cancer treatment [2]. Urgent problems can be treated after your dentist speaks to your cancer team, and you may need a blood test 24 to 48 hours beforehand [2]. Always tell the cancer team about tooth pain or swelling [3].

Do cancer patients get free dental treatment on the NHS?

Not automatically. No UK nation lists cancer as a reason for free NHS dental treatment [8] [10] [11] [12]. In England, treatment from an NHS hospital dentist is free, apart from dentures or bridges [8]. At a dental practice you pay normal charges unless you qualify another way, such as through benefits or the NHS Low Income Scheme [8].

Does my medical exemption certificate cover dental treatment?

No. In England, the medical exemption certificate for cancer gives you free NHS prescriptions only. NHSBSA states: "A medical exemption certificate does not exempt you from other NHS charges including dental treatment or glasses." [5] You may still qualify for free or cheaper dental care through age, benefits or an HC2 or HC3 certificate [8].

Can I have a tooth taken out after radiotherapy?

Sometimes, but it needs careful planning. After head and neck radiotherapy, RCS England advises avoiding extractions in the treated area where possible because of the risk of osteoradionecrosis, a jaw bone complication, and considering alternatives such as root canal treatment [2]. If an extraction is needed, a specialist dentist or surgeon should plan it [3].

Why do I need high-fluoride toothpaste after radiotherapy?

Radiotherapy to the head and neck often reduces saliva for good, and saliva normally protects teeth from decay [14] [3]. High-strength fluoride toothpaste, available on prescription from a dentist [13], helps strengthen teeth against this higher risk. Hospital teams often advise using it long term after head and neck radiotherapy [14].

What if I can't find an NHS dentist before my cancer treatment starts?

Tell your cancer team as soon as possible. NHS England has asked local NHS bodies to arrange priority dental access for people diagnosed with cancer who cannot find a dentist before treatment [4]. You can also contact your local integrated care board [18]. For urgent problems during treatment, contact your cancer team first [3].

Find a dentist before your treatment starts

If you already have a dentist, call them as soon as you know your treatment plan and tell them what kind of treatment you are having and when it starts. If you do not, your cancer team and your local ICB are your first ports of call, and any dentist, NHS or private, can carry out the check [4].

When you are ready, search for a dentist near you on Dentists Closeby to compare NHS and private practices in your area. We know finding an appointment quickly is not always easy, so it is worth asking each practice whether they can see you before your cancer treatment begins.

Sources

1. The Oral & Dental Management of Patients Before, During and After Cancer Therapy (full guideline) -- Faculty of Dental Surgery, Royal College of Surgeons of England, February 2026, accessed 2026-10-26
2. The Oral & Dental Management of Patients Before, During and After Cancer Therapy: Guidance in brief -- Faculty of Dental Surgery, Royal College of Surgeons of England, February 2026, accessed 2026-10-26
3. Oral health care for patients having cancer treatment -- Faculty of Dental Surgery, Royal College of Surgeons of England, patient leaflet, accessed 2026-10-26
4. Oral healthcare provision for cancer pathways -- NHS England, published 2 December 2024, last updated 16 December 2024, accessed 2026-10-26
5. Does my medical condition entitle me to help with my NHS health costs? -- NHS Business Services Authority, accessed 2026-10-26
6. Medical exemption certificates -- NHS Business Services Authority, accessed 2026-10-26
7. How much NHS dental treatment costs -- NHS.uk, last reviewed 13 March 2025, accessed 2026-10-26
8. Who can get free NHS dental treatment or help with dental costs -- NHS.uk, last reviewed 11 February 2025, accessed 2026-10-26
9. Free NHS dental treatment -- NHS Business Services Authority, accessed 2026-10-26
10. Receiving NHS dental treatment in Scotland -- NHS inform, last updated 27 July 2026, accessed 2026-10-26
11. NHS dental charges and exemptions -- Welsh Government (GOV.WALES), last updated 27 July 2026, accessed 2026-10-26
12. Dental Charges and Fees -- HSC Business Services Organisation (Northern Ireland), accessed 2026-10-26
13. Delivering better oral health, Chapter 9: fluoride -- Office for Health Improvement and Disparities, GOV.UK, last updated 10 September 2025, accessed 2026-10-26
14. Dental assessment for patients having radiotherapy for head and neck cancer -- Cambridge University Hospitals NHS Foundation Trust, approved 14 January 2025, accessed 2026-10-26
15. Restorative Dental Assessment -- University Hospitals of North Midlands NHS Trust, reapproved October 2025, accessed 2026-10-26
16. Duraphat Toothpaste -- University Hospitals of North Midlands NHS Trust, reapproved October 2025, accessed 2026-10-26
17. Chemotherapy -- NHS.uk, last reviewed 14 February 2025, accessed 2026-10-26
18. How to find an NHS dentist -- NHS.uk, last reviewed 6 February 2025, accessed 2026-10-26
19. Fund free dental care for head and neck cancer patients: Government response -- UK Government response to a UK Parliament petition, 5 March 2026, accessed 2026-10-26
20. The Prediction of Mandibular Osteoradionecrosis (ORN) in Head and Neck Radiotherapy Using CT-Derived Radiomic Features -- International Journal of Radiation Oncology, Biology, Physics, November 2021, accessed 2026-10-26
21. Ministers must rethink outrageous charge hikes -- British Dental Association, 24 April 2023, accessed 2026-10-26
22. Dentistry: Access for Cancer Patients -- Hansard, House of Commons, Westminster Hall debate, 17 April 2024, accessed 2026-10-26
23. The National Health Service (Dental Charges) Regulations 2005, regulation 3 -- legislation.gov.uk, accessed 2026-10-26
24. Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw -- Scottish Dental Clinical Effectiveness Programme, published March 2017, reviewed March 2024, accessed 2026-10-26
25. Denosumab (Xgeva, Prolia); intravenous bisphosphonates: osteonecrosis of the jaw - further measures to minimise risk -- MHRA Drug Safety Update, GOV.UK, 20 July 2015, accessed 2026-10-26
26. Dental advice for patients having radiotherapy and chemotherapy for head and neck cancer -- East Kent Hospitals University NHS Foundation Trust, last reviewed May 2025, accessed 2026-10-26
27. How to find an emergency or urgent NHS dentist appointment -- NHS.uk, last reviewed 14 May 2025, accessed 2026-10-26