Mouth Care after Directions for Fluoride Trays Head and Neck Radiotherapy u At bedtime, remove dentures from mouth. Brush and floss teeth thoroughly. Note: It is very u Get your teeth cleaned every 3-6 months. important to remove all food and plaque from u Get dental x-rays every 6 months to 1 year to help teeth before using fluoride. Food and plaque can detect dental problems early. prevent the fluoride from reaching the surface of u Use your fluoride EVERY DAY! the tooth. u Place a thin ribbon of the prescribed fluoride gel Why Use Fluoride Trays? into each tooth space of the upper and lower trays. Spread fluoride into a thin film coating Daily fluoride (0.4% stannous or prescription the inside of the trays by using a cotton-tipped 1.1% sodium fluoride) will help teeth resist the applicator, finger or toothbrush. tooth decay caused by xerostomia (dry mouth). u Place the trays on your upper and lower teeth Radiation therapy to the head and neck area can and let them remain in place for 5-10 minutes. lead to destruction of all teeth in a short time. This Only a small amount of fluoride should come out Mouth Care for is due to permanent changes in the quality and of the base of the trays, otherwise there may be quantity of saliva. Compliance with the following too much fluoride in the trays. fluoride regimen will greatly reduce the risk of tooth u After 5-10 minutes, remove the trays and Head and Neck problems after cancer therapy. thoroughly spit out the residual fluoride. u Very important - do not rinse mouth, drink or eat Radiation Therapy for at least 30 minutes after fluoride use. u Begin using fluoride in the custom trays no longer than one week after radiotherapy is completed. Patients Custom Fluoride Trays u Repeat daily for the rest of your life! Remember that tooth decay can occur in a matter of weeks if fluoride is not used properly.

Care for Fluoride Trays u Rinse and dry trays thoroughly after each use. To clean, brush with a toothbrush and toothpaste or use a denture cleaner. u Occasionally, the trays can be disinfected in a solution of bleach and water: 1 tbs. of bleach in Radiation Caries (Tooth Decay) 1/2 cup of water. Soak them for about 15 minutes. Rinse thoroughly. Patient information from the u If the trays become covered with hard water UF Health deposits, soak them in white vinegar overnight Oral Medicine Clinic and brush them the next morning. P.O. Box 100414 u Do not use hot water or heat on the trays! Gainesville, Fl. 32610 (352) 273-6741

This patient did not use fluoride as directed. Dental Examination Before Oral Hygiene use any oral lubricating products immediately Head and Neck Radiation Therapy u Brush your teeth twice daily. Use a super-soft before your radiation treatment. toothbrush to minimize discomfort when you have u If you continue to have burning mouth after completing radiation therapy, it is possible that A dental examination and x-rays before beginning sore gums. u you could have a fungal infection, also called head and neck radiation therapy will help identify Brush in a gentle, circular motion to include all surfaces of every tooth. Floss daily but gently, thrush or candidiasis. Your doctor or dentist teeth that are in poor condition. Severe gum disease, can prescribe an antifungal medication for you. tooth decay, or teeth with abscesses (infection) especially if your mouth is sore. u Each day, gently brush your tongue and tissues You should disinfect your fluoride trays and tooth may need to be removed before starting radiation brush daily. Eating yogurt may also help reduce therapy if they are in the area receiving a high dose with a soft toothbrush to remove germs. u Soften the bristles of your toothbrush with warm the recurrence of thrush by introducing good of radiation. If teeth are removed after radiation organisms into your mouth and digestive system. therapy, the jaw bone may not heal properly and a water before use. u serious complication can result. The problem with Use a water-irrigating device (low setting) to poor healing is a lifelong risk and depends on the remove food from your mouth and teeth. Dry Mouth u dose and location of the radiation, particularly to Disinfect your toothbrush at least once weekly by u Pilocarpine (Salagen) 5mg, qid, (prescription the jaws. After radiation therapy, you should always soaking in a fresh solution of bleach and water required) MAY be helpful in stimulating saliva in check with your radiation oncologist before getting (1 tbs. bleach per ½ cup water). Thoroughly rinse some cases. any teeth removed or before having surgery that toothbrush before placing in your mouth. Change u Try special food preparation. Blended and moist affects the gums. toothbrush weekly. foods are easier to swallow. u Toothpastes formulated for children or dry mouth u Sip liquids with your meals. A dental evaluation should be performed as soon as may minimize burning or irritation. u Try sugarless candy or gum to stimulate salivary u possible after a diagnosis requiring radiation therapy. When your mouth is no longer sore, you can use flow. A professional dental cleaning 1-2 weeks before the regular toothpaste, a regular soft toothbrush or an u Try over-the-counter artificial saliva products. start of radiation therapy is recommended. If teeth electric toothbrush with soft bristles. u Sip plain water throughout the day (sometimes need to be removed, a period of at least 2 weeks preferred over artificial saliva.) is recommended for healing to take place before Sore Mouth u Avoid the use of alcohol-based mouth rinses. starting radiation therapy. It is important to have u Use saltwater and baking soda rinses (1 tsp u Try water and glycerin (few drops only) mixed in a the dental evaluation soon after diagnosis so that salt and 1 tsp. baking soda in one quart of fresh small aerosol spray bottle. treatment can proceed with minimal delay. water) throughout the day to sooth your mouth. u Avoid the use of tobacco and alcoholic beverages. To increase effectiveness, stagger the use of u Avoid sugary foods that can cause cavities. It is also important to visit your dentist before head mouth rinses and fluoride throughout the day, u Avoid sharp, crunchy foods, like taco chips, that and neck radiation to learn how to take care of your allowing at least one hour between each rinse. could scrape your mouth. teeth and mouth during and after radiation therapy. u For pain, you may be prescribed a rinse u Avoid toothpicks because they can hurt the Severe tooth decay (radiation caries) is a very containing a numbing medication to use 15 tissues in your mouth. Ask your dentist about an common problem after radiation. Radiation caries minutes before eating. Eat small bites and chew interproximal brush to clean between your teeth. can occur because of the inability of the saliva to thoroughly to reduce the risk of choking when destroy bacteria that cause tooth decay, in addition using these medications. Taste Loss to the inability of the saliva to strengthen the enamel u Remove dentures if your mouth is sore. Avoid u Usually taste begins to slowly return after of the teeth. Radiation caries (tooth decay) can using them until your mouth heals. Disinfect all radiation therapy. Most people recovers their occur within weeks after completion of radiation dentures daily with an antimicrobial denture taste by 4-6 months after therapy is completed. therapy and can be a lifelong problem. Your dental cleaner. Dentures without metal may be soaked visit will include impressions of your teeth and mouth in a fresh solution of bleach and water (1tbs. to create custom fluoride trays. Daily application of bleach in ½ cup of water). Rinse the dentures well prescription fluoride gel in custom trays will help before placing them in mouth. Please contact the Oral Medicine Clinic with prevent tooth decay that can result from head and u Keep your mouth and lips well lubricated with a any questions about your oral health. neck radiation therapy. water-based lubricant, not petroleum jelly. Do not (352) 273-6741