RadiationTreatment andYour Mouth

RadiationTreatment andYour Mouth

Oral Health, Cancer Care, and You

Fitting the Pieces Together

Oral Health, Cancer Care, and You is anawareness campaign sponsored by theNational Institute of Dental andCraniofacial Research (NIDCR) throughits National Oral Health InformationClearinghouse (NOHIC). Thiscampaign is being conducted inpartnership with the National CancerInstitute, the National Institute ofNursing Research, the Centers forDisease Control and Prevention, andthe Friends of the NIDCR. For moreinformation about the campaign,please contact NOHIC. Campaignpublications are also available online athttp://www.aerie.com/nohicweb.

National Oral HealthInformation ClearinghouseAttn: OCCT1 NOHIC WayBethesda, MD 20892–3500Phone: 1–877–216–1019 (Toll-free)Fax: 301–907–8830E-mail: nidr@aerie.com

Oral Health, Cancer Care, and You

Fitting the Pieces Together

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Are You Being TreatedWith Radiation for Cancerin Your Head or Neck?If so, this booklet can help you. Whileradiation helps treat cancer, it can alsocause other things to happen in yourmouth called side effects. Some ofthese problems could cause you todelay or stop treatment.

This booklet will tell you ways to helpprevent mouth problems so you’ll getthe most from your cancer treatment.

To help prevent serious problems, seea dentist at least 2 weeks beforestarting radiation.

A dentist can help prevent mouthproblems.

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How Does RadiationAffect the Mouth?Doctors use radiation to treat cancerbecause it kills cancer cells. But radia-tion to the head and neck can harmnormal cells, including cells in themouth. Side effects include problemswith your teeth and gums; the soft,moist lining of your mouth; glands thatmake saliva (spit); and jaw bones.

It’s important to know that sideeffects in the mouth can be serious.

• The side effects can hurt and makeit hard to eat, talk, and swallow.

• You are more likely to get an infec-tion, which can be dangerous whenyou are receiving cancer treatment.

• If the side effects are bad, you maynot be able to keep up with yourcancer treatment. Your doctor mayneed to cut back on your cancertreatment or may even stop it.

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What Mouth ProblemsDoes Radiation Cause?You may have certain side effects inyour mouth from radiation. Anotherperson may have different problems.Some problems go away after treat-ment. Others last a long time, whilesome may never go away.

• Dry mouth.

• A lot of cavities.

• Loss of taste.

• Sore mouth and gums.

• Infections.

• Jaw stiffness.

• Jaw bone changes.

You can see or feel most of these problems.Check your mouth every day.

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Why Should I Seea Dentist?You may be surprised that your dentistis important in your cancer treatment.If you go to the dentist before radiationbegins, you can help prevent seriousmouth problems. Side effects oftenhappen because a person’s mouth isnot healthy before radiation starts. Notall mouth problems can be avoided butthe fewer side effects you have, themore likely you will stay on your can-cer treatment schedule.

It’s important for your dentist andcancer doctor to talk to each otherbefore your radiation treatmentbegins. Be sure to give your dentistyour cancer doctor’s phone number.

When Should I See a Dentist?

You need to see the dentist at least 2weeks before your first radiationtreatment. If you have already startedradiation and didn’t go to a dentist, seeone as soon as possible.

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What Will the Dentistand Dental Hygienist Do?• Check your teeth.

• Take x-rays.

• Take care of mouth problems.

• Show you how to take care of yourmouth to prevent side effects.

The dentist will do a complete exam.

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What Can I Do To KeepMy Mouth Healthy?You can do a lot to keep your mouthhealthy during radiation. The firststep is to see a dentist before youstart cancer treatment. Once yourtreatment starts, it’s important to lookin your mouth every day for sores orother changes. These tips can helpprevent and treat a sore mouth:

Keep your mouth moist.

• Drink a lot of water.

• Suck ice chips.

• Use sugarless gumor sugar-free hardcandy.

• Use a saliva substi-tute to helpmoisten yourmouth.

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Clean your mouth, tongue, and gums.

• Brush your teeth, gums, andtongue with an extra-soft tooth-brush after every meal andat bedtime. If it hurts,soften the bristles in warmwater.

• Use a fluoridetoothpaste.

• Use the specialfluoride gelthat yourdentist prescribes.

• Don’t use mouthwashes with alco-hol in them.

• Floss your teeth gently every day. Ifyour gums bleed and hurt, avoidthe areas that are bleeding or sore,but keep flossing your other teeth.

• Rinse your mouth several times aday with a solution of 1/4 teaspoonbaking soda and 1/8 teaspoon saltin one cup of warm water. Followwith a plain water rinse.

• Dentures that don’t fit well can causeproblems. Talk to your cancer doctoror dentist about your dentures.

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Sipping liquids with your meal willmake eating easier.

If Your Mouth Is Sore, Watch WhatYou Eat and Drink.

• Choose foods that are good for youand easy to chew and swallow.

• Take small bites of food, chewslowly, and sip liquids with yourmeals.

• Eat moist, soft foods such as cookedcereals, mashed potatoes, andscrambled eggs.

• If you have trouble swallowing,soften your food with gravy, sauces,broth, yogurt, or other liquids.

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Call Your Doctor or Nurse When YourMouth Hurts.

• Work with them to find medicinesto help control the pain.

• If the pain continues, talk to yourcancer doctor about strongermedicines.

Remember To Stay Away From

• Sharp, crunchy foods, liketaco chips, that couldscrape or cut yourmouth.

• Foods that are hot,spicy, or high inacid, like citrusfruits and juices,which canirritate yourmouth.

• Sugary foods, like candy or soda,that could cause cavities.

• Toothpicks, because they can cutyour mouth.

• All tobacco products.

• Alcoholic drinks.

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Your child has special dental needs.

Do Children Get MouthProblems Too?Radiation causes other side effects inchildren, depending on the child’s age.

Problems with teeth are the most com-mon. Permanent teeth may be slow tocome in and may look different fromnormal teeth. Teeth may fall out. Thedentist will check your child’s jaws forany growth problems.

Before radiation begins, take yourchild to a dentist. The dentist willcheck your child’s mouth carefully andpull loose teeth or those that maybecome loose during treatment. Askthe dentist or hygienist what you cando to help your child with mouth care.

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Remember:• Visit your dentist before your

radiation treatment starts.

• Take good care of your mouthduring treatment.

• Talk to your dentist about usingfluoride gel to help prevent all thecavities that radiation causes.

• Talk regularly with your cancerdoctor and dentist about any mouthproblems you have during and afterradiation treatment.

Call your cancer doctor or dentist ifyou have any mouth problems.

AcknowledgmentsThe individuals listed here provided assistance in developing,reviewing, and field testing all of the campaign publications.The campaign sponsors would like to thank them for theircontributions.

Scientific CommitteeGerry Barker, R.D.H., M.A.University of Missouri-Kansas CityKansas City, MOSusan L. Beck, R.N., Ph.D., A.O.C.N.University of UtahSalt Lake City, UTMarylin Dodd, R.N., Ph.D.University of California, San FranciscoSan Francisco, CAJoel Epstein, D.M.D., M.S.D., F.R.C.D.British Columbia Cancer Agency and Vancouver Hospitaland Health Sciences CentreVancouver, CanadaPhilip Fox, D.D.S.National Institute of Dental and Craniofacial ResearchBethesda, MDDeborah McGuire, R.N., Ph.D.Emory UniversityAtlanta, GADouglas Peterson, D.M.D., Ph.D.University of ConnecticutFarmington, CTMark M. Schubert, D.D.S., M.S.D.University of WashingtonSeattle, WAJohn Wingard, M.D.University of FloridaGainesville, FL

Field TestersOlubunmi Abayomi, M.D.Howard University HospitalWashington, DCAlice Bass, B.S.N., O.C.N.Greater Southeast Community HospitalWashington, DCBetsy Bischoff, R.N., M.S.Georgetown University Medical CenterWashington, DCAndrea Bonnick, D.D.S.Howard UniversityWashington, DCDorothy Chesley, R.N., Ph.D.Texas Nursing FoundationAustin, TXNancy E. Leupold, M.S.Support for People with Oral andHead and Neck Cancer (SPOHNC)Locust Valley, NYAlice Mahan, B.S., R.T.T.Howard University HospitalWashington, DCMiKaela Olsen, R.N., M.S., O.C.N.UCSF Stanford Health CareStanford, CAPeter Passero, D.D.S.Prizm Dental Partners and Management GroupMcLean, VAK. Vendrell Rankin, D.D.S.Baylor College of DentistryDallas, TX

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Publication No. 99-4362