Oral care during Radiotherapy to the head and neck region The Sussex Cancer Centre Information for patients
Introduction This leaflet describes the effects radiotherapy can have when your mouth is included in the area being treated and will give you suggestions on how to minimise these effects. Radiotherapy affects the lining of your mouth and you will be more likely to develop infections and soreness. This soreness will continue after treatment is finished. Recovery time will depend on many factors. Care of your teeth, lips and gums Bicarbonate of soda mouthwash. Make a solution using a teaspoon of bicarbonate in a small tumbler of water and use this as a mouthwash after each meal and more often as the treatment progresses. This will help your mouth to feel fresh and stop thick saliva sticking to the inside of your mouth. Use only mouth washes given to you by the team at the hospital, do not use mouthwashes from the chemist or supermarket which may contain alcohol and could irritate your mouth during treatment. Brush your teeth regularly; at least after each meal using a soft toothbrush and toothpaste containing flouride. A normal toothbrush may feel too harsh try using a baby toothbrush or a sponge applicator which we can give to you. If your lips are sore or cracked, keep them moisturised using aqueous cream or dry mouth gel. The surface of your tongue may appear white and rough; this build-up on the surface of your tongue is called slough. Remove it using a soft toothbrush. 2
If you are using any liquid medication for oral thrush use it as a mouthwash and hold it in your mouth before you swallow. We recommend that you stop smoking as this irritates the lining of the mouth and reduces the blood supply. If you carry on smoking the side effects of the treatment will be worse and the recovery time will be longer. If you would like advice on stopping smoking, please speak to your keyworker. When you have dentures (In addition to the above) Dentures may be uncomfortable, if your mouth is sore remove them. Clean your dentures thoroughly after use and leave them to soak in a fresh cleaning solution overnight. If you are going to have new dentures made please wait at least three months after treatment has finished to give your gums time to heal. Dry mouth (Xerostomia) The parotid glands produce saliva, when these glands are exposed to radiation they become damaged. This damage causes a dry mouth, causing discomfort and making it difficult to chew and swallow. Depending on the dose of radiation and the direction of the beams the dry mouth may be temporary or permanent. We will recommend dry mouth products and saliva substitutes to help you with this. You may also find that your saliva becomes thick and stringy as the treatment progresses. Although this is very unpleasant, it is a temporary side effect and it will pass. Rinsing with bicarbonate 3
of soda solution will help prevent the saliva sticking to the inside of your mouth. Please continue to drink lots of water (or use your feeding tube) to thin out the saliva. We may suggest using a nebuliser (steam inhalation) during treatment and after treatment to help with this. Suggestions Rinse regularly with bicarbonate of soda solution. Carry a small bottle of water with you, some patients find fizzy water useful. Water in a spray bottle can be useful. Avoid sugary drinks as they will encourage tooth decay. Suck sugar free sweets or chew sugar free gum. Artificial saliva and other dry mouth products may be useful, the head and neck support team will advise you. Avoid alcohol, as it will increase mouth dryness. Taste changes Radiotherapy can affect the taste buds and your food may taste odd for a while. Patients have different experiences of this. Food may taste metallic or salty, some patients say their food tastes like cardboard. If you experience any of this remember that the taste changes will carry on for up to 18 months, so try different foods at different times. These changes are temporary and you will notice an improvement in the weeks and months after treatment has finished. 4
Suggestions Some foods will taste unusual but your taste will change from week to week so keep trying different foods. Use extra herbs and seasonings to improve the flavour of the food. Do not use hot spices like chilli or curry powder as these may cause pain. Gravy and sauces can also help to add flavour and moistness to your meals. You might find you prefer stronger flavours smoked ham or bacon or stronger, mature cheese. Try a wide variety of foods with different tastes and textures. You will soon learn which ones suit you best. Try foods at different temperatures to see what suits you best. Rinse your mouth before eating to freshen the taste buds. Mucositis Mucositis, which is ulceration of the inside of the mouth, is a common side effect of radiation and can be very painful. Your mouth will be examined at least once each week by the support team. A preventative mouthwash may be prescribed at the beginning of treatment. Mucositis is treated with gel, mouthwash and spray and pain control; we will ensure that you have the medication you require to help with this uncomfortable symptom. 5
Oral thrush (Candidiasis) The fungal infection oral thrush is a common amongst patients having radiotherapy to the head and neck area. It is normally treated with an antifungal agent such as Nystatin or Fluconazole. We may need to repeat this medication until the radiotherapy is finished. Trismus This is the medical term used when the jaw/s become stiff making it difficult to open the mouth. You may experience this after your surgery and radiotherapy can make it worse. You will see a speech and language therapist regularly throughout the treatment who will give you advice. He / she may also give you specific exercise to do which will minimise the Trismus. 6
Useful telephone numbers Macmillan head and neck cancer specialist nurses Brighton 01273 696955 Ext. 7435 Worthing 01903 205111 Ext. 4501 Eastbourne 07760554037 Macmillan head and neck specialist radiographer 01273 696955 Ext. 7436 Macmillan speech and language therapists Brighton 01273 696955 Ext. 7211 Eastbourne 01424 755255 Ext. 8639 Macmillan dietitian Brighton 01273 696955 Ext. 4348 Worthing 01903 205111 Ext. 4549 Hastings 01424 758177 Macmillan psychological support team 01273 664694 ENT enquiries 01273 696955 Ext. 4801 Maxillofacial enquiries 01273 696955 Ext. 4756 Cancer Centre reception 01273 696955 Ext. 4324 Radiotherapy reception 01273 664901 Chemotherapy Royal Sussex County Hospital 01273 696955 Ext. 4799 Eastbourne District General Hospital 01323 417400 Ext. 3020 Howard 1 Ward 01273 696955 Ext. 4051 Level 8A East Ward 01273 696955 Ext. 4345/6 Macmillan Information Line 0808 808 0000 (including Macmillan benefits helpline) Countrywide supplies 0800 783 1659 (Tracheostomy and Laryngectomy service) NHS Free smoking helpline 0800 0224332 Benefits enquiry line, Brighton and Hove 0800 882200 Sussex Cancer Network 01273 545355 Support Group for all laryngectomy patients; contact your key worker. 7
Useful websites www.mouthcancerfoundation.com www.click2quit.com www.macmillan.org.uk www.smokefree.nhs.uk www.sussexcancer.net www.alcoholics-anonymous.org.uk www.nhs.uk/livewell/alcohol www.headstartcancersupport.org.uk Brighton and Sussex University Hospitals NHS Trust Disclaimer The information in this leaflet is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner. C P I G Ref number: 459 Publication Date: June 2012 Review Date: June 2014 carer and patient information group approved