Treatments for head and neck cancer can affect the health of the teeth, gums, lining of the mouth and salivary glands. Ideally, people with head and neck cancer should see a dentist, working with their health care team, at least two weeks before starting any treatment. The goal is to prevent or reduce treatment side effects in the mouth.
A number of steps can be taken to maintain oral health before, during and after treatment:
Pre-radiation fluoride treatment. Radiation directed at the salivary glands can affect these organs, which in turn may cause tooth decay (cavities) over time. People about to undergo radiation treatment of the mouth can be given high doses of fluoride to reduce damage to the teeth and gums.
Denture check. Dentures should be evaluated for proper fit before cancer treatment. Adjustments can then be made to reduce the risk of injury to the gums and mouth tissues during treatment.
Mouth care. Head and neck radiation can cause tooth decay, gum disease, mouth sores, dry mouth, taste changes and jawbone stiffness. To help manage these side effects, it’s important to keep the mouth moist and clean while receiving radiation.
Rinse your mouth several times a day with one-quarter teaspoon of baking soda and one eighth teaspoon of salt dissolved in one cup of warm water. It also helps to rinse frequently with plain water. To keep your mouth healthy, avoid spicy or crunchy foods, tobacco and alcohol (including mouthwashes that contain alcohol).
Post-treatment plan. Even after you finish treatment, especially radiation, it’s important to see your dentist regularly. If you notice soreness or an area of the gum that isn’t healing or any other oral health care issue, report it to your health care team, including your dentist, doctor and nurse as soon as possible.
In this section, we discuss some of the specific side effects you may experience and ways to manage them.
Mucositis (Mouth Sores)
Radiation treatments for head and neck cancer and some types of chemotherapy can cause sores inside the mouth and on the lining of the throat and digestive tract. These sores can be a serious problem because they can cause pain and lead to infections, making it difficult to eat, drink and swallow. Once treatment ends, mouth sores do disappear within a few weeks. If you experience any changes in your mouth, be sure to report them to your doctor or nurse.
There are a number of things you can do to ease mouth sores and pain:
Choose a soft-bristle toothbrush for brushing your teeth.
If toothpaste irritates your mouth, use a mixture of a half teaspoon of salt with four cups of water.
Drink plenty of fluids.
Tell your doctor if you are experiencing mouth pain. It’s important to manage this symptom because it can affect your quality of life and even slow progress toward better health. When your pain is controlled, you will be better able to eat and drink fluids. There are several ways to soothe mouth pain, but before you begin any of these treatments, ask your doctor about the best ones for you. Some require a prescription:
• Ice chips or Popsicles
• Ibuprofen (such as Motrin) or acetaminophen (such as Tylenol) for mild pain
• Over-the-counter oral anesthetics, such as Anbesol, Xylocaine or Orajel. Let your doctor know if you are using them, especially if he or she prescribes a mouthwash containing lidocaine.
• Gelclair is an oral gel designed to coat and soothe mouth sores by forming a protective barrier in the mouth. This product is available by prescription only.
• “Magic mouthwash” is another prescription product. It contains Maalox to coat the mouth, lidocaine to relieve the pain and an antihistamine to soothe the mouth sores. Some pharmacies that specialize in cancer care offer their own version of magic mouthwash.
• Opiates, a class of drugs that includes morphine, also may be prescribed to help you cope with mouth pain. A fast-acting opiate called fentanyl citrate (Actiq and others) is available in a berry-flavored lozenge on a stick. Like a cough drop, the lozenge dissolves in the mouth, and the drug is delivered quickly into the bloodstream.
This condition is mainly caused by radiation that affects the salivary glands. For some people with head and neck cancer, this side effect may last long after treatment has ended, making it challenging to taste, chew, swallow or speak.
There are a number of things you can do to keep your mouth moist during and after radiation treatment and help relieve dry mouth:
Sip water or sugarless drinks. Soups that are not salty, milk shakes, smoothies or ice cream can help as well, as can sucking on ice chips.
Avoid caffeine and alcohol. Coffee and other caffeine-containing beverages and drinks containing alcohol can lead to dehydration (loss of too much water from the body).
Eat foods that are moist, such as fruits and vegetables. Use gravies and sauces, in moderation, to help moisten foods.
Avoid bread and foods that are breaded. These foods tend to absorb moisture from the mouth.
Damage to the Lower Jaw
A rare condition called osteoradionecrosis sometimes occurs in patients who have had high-dose radiation to the lower jaw. Over time, the ability of the lower jaw to fight infection is reduced by the radiation, and this may lead to bone complications. Talk to your doctor about your risk for this side effect and make sure your dentist is aware of radiation treatments that might affect your jawbone health in the long term.