Caring for the Mouth During Chemotherapy Or Radiotherapy to the Head and Neck – Information for Patients

Caring for the mouth during Chemotherapy or Radiotherapy to the head and neck – information for patients

UHB is a no smoking Trust Introduction This booklet is designed to give you information about some of the ways in which chemotherapy or radiotherapy to the head and neck can affect your mouth. We hope it will answer some of the questions that you or those who care for you may have at this time. It is not meant to replace the discussion between you and your doctor, but helps you understand more about what is discussed.

How should I prepare for my cancer treatment? Radiotherapy and chemotherapy are treatments that are used to treat cancer, including that of the head and neck. Radiotherapy to the head and neck and chemotherapy can have side effects in the mouth. Your oral (mouth) health needs to be as good as possible before the start of treatment to avoid problems later. You will be referred to the consultant restorative dentist who works as part of the head and neck team. They will give you a thorough dental check up before your treatment starts. Throughout your radiotherapy or chemotherapy your mouth needs careful monitoring by either a dental health professional or an appropriately trained nurse. What can I expect during cancer treatment? About two weeks after the start of treatment you may notice an increase in mouth ulcers and mouth soreness. Your mouth will become dry and there will be a loss of taste. These changes will make it difficult to swallow, eat and clean your teeth. They are worst between two and eight weeks after starting treatment, after which they may gradually improve. This leaflet explains what can be done to help you cope with the unwanted effects of treatment.

It is important that you make a list of all medicines you are taking and bring it with you to all your follow-up clinic appointments. If you have any questions at all, please ask your surgeon, oncologist or nurse. It may help to write down questions as you think of them so that you have them ready. It may also help to bring someone with you when you attend your outpatient appointments.

2 | PI20_1791_03 Care of the Mouth during Chemotherapy or Radiotherapy to the Head Unwanted What should I effects of What happens? What can I do? avoid? treatment Dry Mouth Saliva moistens and Sip sugar free drinks, Fizzy drinks, diet drinks lubricates the mouth. cold water or tooth and fruit juice are acidic It protects against tooth friendly drinks. and they make your decay, erosion and teeth sensitive and If drinking is difficult try sensitivity. damage the enamel. If sucking chipped ice or you have to drink these, Radiotherapy damages sugar free ice-lollies. then drink them ice the glands which Try saliva substitutes cold with a straw. produce saliva and can which are available on make the mouth dry. Many prescription prescription. Always This may make eating medicines are acidic or choose one which and denture wearing sugary and may contains fluoride such more difficult or damage the teeth or as Saliva Orthana. uncomfortable. In a the mouth lining. small number of Add flavourless Check with your doctor patients, saliva may not vegetable oil, vegetable for alternatives. return following oil spread, or butter to Avoid any sugary drinks radiotherapy. your tongue as this will or acidic food and drink lubricate your mouth. within one hour of Apply petroleum jelly or bedtime for teeth lip balm to your lips if protection. they are dry. Tooth Radiotherapy damages Brush your teeth and Avoid food and drink Decay the glands which gums at least twice containing even small produce saliva. Saliva daily with a fluoride amounts of sugar moistens the mouth paste. It is between meals or and protects against recommended that you before bedtime. tooth decay, sensitivity clean your teeth before Limit sweet food and and erosion. The meals rather than after sugary drinks to absence of saliva them. mealtimes only and increases the risk of Always use an alcohol avoid added sugar tooth decay. free mouthwash or gel where possible. as directed by your dentist before treatment starts. A suitable mouthwash will be prescribed by your oncology team when treatment starts. Drinking black tea without sugar is good for your teeth. You may add milk if you wish.

PI20_1791_03 Care of the Mouth during Chemotherapy or Radiotherapy to the Head | 3 Unwanted What should I effects of What happens? What can I do? avoid? treatment Tooth Radiotherapy damages Brush teeth before acid Avoid acidic foods and erosion the glands that produce exposure. Brushing drinks, especially citrus saliva. Saliva protects after may actually fruits, fruit juices and the teeth from the increase tooth damage. fizzy drinks. These can effects of acid, food, be particularly harmful Have alkaline food such drink and the effects to teeth and gums. as cheese or milk at the associated with end of your meals to Avoid brushing your indigestion such as neutralise the acid. teeth when acids may come up into the mouth. Persistent vomiting also leads to acid reaching the mouth. Without saliva, teeth can wear and become sensitive when exposed to acid. Loss of The taste buds are There is little you can Sweet food or drinks taste or damaged by do to improve this, are a great temptation altered radiotherapy and although concentrating at this time but if taken taste chemotherapy. Usually on food that you enjoy, between meals or at the effect of this is using sauces and bedtime you may temporary, although seasonings or being rapidly get tooth decay. following radiotherapy around strong food some patients report smells may help. longer lasting changes. Taste usually returns, but as it does you may notice an unpleasant taste for a time, but this should improve. Difficulty Dryness and soreness of Rinse your mouth or Avoid alcohol. This will swallowing the mouth makes gargle with Difflam, a increase mouth dryness. swallowing difficult. pain relieving mouthwash, before eating. Difflam mouthwash can be diluted if it causes stinging in your mouth. Eat moist food (by adding sauces or gravy), avoid spicy food and sip water frequently.

4 | PI20_1791_03 Care of the Mouth during Chemotherapy or Radiotherapy to the Head Unwanted What should I effects of What happens? What can I do? avoid? treatment Jaw The muscles that move Gentle jaw exercises can Avoid taking too large stiffness the jaw can become be taught to you. bites of food. (also called stiff as a result of You may be given an trismus) radiotherapy. appliance to help you; you will be shown how to use it. Difficulty Lack of saliva and See your dentist if the Leaving your dentures with mouth soreness make dentures become out during the dentures dentures difficult to painful. radiotherapy treatment wear. can make them difficult KY jelly is a useful to accommodate to lubricant to add under when you need to use dentures. them later. Clean your dentures If dentures are old or carefully after each meal poorly fitting you will or at least twice daily. need new ones – but it Clean your dentures is best to leave replacing with toothpaste or non- them until 4 – 6 months perfumed soap and a after radiotherapy is brush. completed and your Dentures should be mouth is no longer sore. removed at night for cleaning and soaked in an appropriate cleanser. Dentures should be kept wet at all times when they are not worn.

PI20_1791_03 Care of the Mouth during Chemotherapy or Radiotherapy to the Head | 5 Unwanted What should I effects of What happens? What can I do? avoid? treatment Sore mouth Radiotherapy and Clean your teeth with a Avoid hard, spicy, salty, chemotherapy damage fluoride tooth paste and acidic foods, hot foods normal cells as well as a soft toothbrush. and drinks. cancer cells. Difflam spray (a pain Avoid alcohol and The inside of the relieving mouthwash) tobacco; they make mouth, tongue and may be useful to relieve your mouth sore, dry throat may become red, pain; use prior to and worse. sore and ulcerated. brushing. Strongly flavoured You may find it If you have a thrush toothpaste will be uncomfortable to eat, infection, you may need uncomfortable to use speak, swallow and medication which can and should be avoided. brush your teeth. be prescribed by your oncology team. You Soreness following should make sure any chemotherapy usually infection is treated. gets better after about one week. The soreness Soft chilled foods and may also be due to a nutritional drinks can thrush infection. help if eating is difficult and you can also try eating with a small plastic round edged spoon, and drinking through a straw if the corners of your mouth are sore. Coated The papillae, fine hair- Regular gentle brushing Avoid trying to scrub tongue like projections on the of the tongue with a the debris on your upper surface of the soft toothbrush and tongue away and tongue, may grow toothpaste can help to making your mouth longer as you use your reduce this, but do not sore. tongue less. Debris can brush too hard as this A coated tongue is a accumulate and the can make the tongue common side-effect tongue may become sore. from radiotherapy stained, white, yellow Gentle use of a tongue treatment and should or brown. scrapper can be useful. improve after your treatment finishes. A small amount of salt in a cup of water can be helpful as a mouthwash.

6 | PI20_1791_03 Care of the Mouth during Chemotherapy or Radiotherapy to the Head Unwanted What should I effects of What happens? What can I do? avoid? treatment Loss of Mouth soreness, Eat high energy foods It may be necessary to weight dryness and difficulty in such as pasta, bread eat some sugary foods swallowing will reduce dipped in gravy, yams, to keep your weight your appetite and sweet potato puree, up, and ensure your enthusiasm for food. creamed potato, body has the best porridge or mashed chance of recovering banana. from your treatment. This will be discussed Ask to see a dietitian if with the dietician. you are losing weight. If you need to build up calories with sugary food, try to maintain your fluoride regime to minimise the chances of damaging your teeth. Supplement drinks may need to be supplied. Osteorad- Osteoradionecrosis is a Ensure that you have a The removal of teeth ionecrosis term used for when thorough dental check- from irradiated bone bones die. Following up from a restorative after radiotherapy your treatment, part of dentist used to dealing should be avoided as the jawbone (usually with head and neck far as possible. the lower jaw) may die cancer patients before Your consultant in as a complication of your treatment starts. restorative dentistry radiotherapy. We will arrange this for may have to advise that you. It sometimes happens some teeth that may for no obvious reason After treatment, if your cause trouble later and often long after the dentist is concerned should be extracted radiotherapy has about your teeth and before the radiotherapy finished. It may also be extractions maybe begins, to reduce the provoked by minor required, then it should risk of future problems. trauma to the bone always be with such as when a tooth is reference to the dental extracted, or by a hospital. dental infection. It is difficult to treat and is often painful, especially if the fragile bone fractures.

PI20_1791_03 Care of the Mouth during Chemotherapy or Radiotherapy to the Head | 7 Local sources of further information You can visit any of the cancer information centres listed below:

Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre, Sandwell general Hospital (Main reception) Lyndon, West Bromwich, B71 4HJ Tel: 0121 507 3792

University Hospitals Birmingham NHS Foundation Trust The Patrick Room, Cancer Centre, Heritage Building (Queen Elizabeth Hospital Birmingham) Edgbaston, Birmingham, B15 2TH Tel: 0121 371 3539 About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication.

Do you really need to go to A&E? Check symptoms online quickly and safely. A free service for NHS patients. uhb.nhs.uk/ask

Oncology Queen Elizabeth Hospital Birmingham Mindelsohn Way, Edgbaston Birmingham, B15 2GW Telephone: 0121 627 2000

PI20/1791/03 Author: Simone Kelly Date: January 2021 Review date: January 2023