Majd Al Mardini DDS, FRCD(C)
Cert. Maxillofacial Prosthodontist
883 Upper Wentworth, Suite 209
Hamilton, Ontario, L9A 4Y6
PH: 905-296-4521
Fax: 905-296-4522
www.dralmardini.com
prostho@dralmardini.com
Mouth Care for Radiation Therapy
Patients (Head and Neck Area)
Mouth care is essential for patients receiving radiation therapy to the head and
neck area because the therapy can cause temporary and permanent changes to the
mouth. Therefore, it is important to recognize side effects and learn how to treat
them. Caring for your mouth will help you minimize changes and possible risk of
severe health problems.
Before receiving any radiation therapy to this area, you oral health should be
evaluated. We will:
 Evaluate you for infection and/or mouth disease
 Decide to perform any necessary procedures (or refer you to appropriate
resource)
 Determine oral care guidelines
It is important that you do not have any gum surgery or teeth removed within
areas of your mouth that have been treated with radiation. Having surgery on a
radiated jawbone may create severe healing complications, including serious
infections or osteoradionecrosis (bone death). Before oral surgery, have your local
dentist contact your Oncologist or our office to discuss the treatment limitations.
Temporary Changes
Most temporary changes usually get better within a few weeks after radiation is
completed, but some may take longer. These changes may be painful and/or make
it difficult for you to eat, swallow or talk. Temporary changes may include:
Soreness (Mucositis)
 Mouth or throat soreness
 Painful gums or tongue
 Mouth and/or throat sores (ulcers), which may also increase your risk of
getting an infection
Taste Alteration
You may also experience taste changes; some foods may begin to taste bitter,
metallic or seem to have no taste. Most taste changes will improve over time.
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Permanent Changes
Dry Mouth (Xerostomia)
Radiation therapy leads to a decrease in the amount of saliva or “spit” that the
major salivary glands produce. Because saliva helps to protect the teeth and fight
bacteria in the mouth, this change can cause your teeth to become very susceptible
to decay rapidly.
Jawbone
Radiation therapy to the lower area of the face affects blood circulation in your
jawbone, available oxygen and cell population, which can prevent or slow your
bone ability to heal sores or wounds. Always tell your dentist before having any
dental work done that you have had radiation therapy.
Muscle Trismus (Fibrosis)
Generally develops 3 to 6 months after treatment and may be due to infection,
damage to the TMJ, fibrosis of the muscles of mastication or a combination,
causing limited jaw opening. Limited jaw opening may complicate eating and
oral hygiene. Use of exercise may lessen the severity of any subsequent trismus
and speed recovery. Exercise seems to be the best method of treatment (via
tongue blades, chewing on soft rubber or Therabite Device that is described by
your doctor).
Meet with Your Dentist
Before radiation therapy
It is important to prevent or reduce problems from occurring by having your teeth
cleaned before you begin radiation therapy.
After radiation therapy
To prevent infection in the gum tissues, it is important that you have your teeth
cleaned within six months after radiation therapy is completed, and then every six
months. Before having any dental work, always tell your dentist that you have had
radiation therapy. You may have your cavities filled, crowns or simple root canals
done after the temporary effects from radiation have subsided. If needed, you may
have dental x-rays and local anesthesia since they do not disturb the jawbone.
Practice Daily Oral Care
This will be a lifelong routine.
1. Wash your hands before you do any oral care.
2. Carefully floss your teeth before you brush them.
If you are flossing daily, floss your teeth with waxed dental floss. Flossing may
become difficult if mouth sores develop. If this happens, discuss flossing with
your dentist before you stop this important hygiene step. If flossing is not one of
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your routine hygiene habits, speak to your dentist about the correct method before
beginning to floss.
3. Brush your teeth, gums and tongue after each meal and before bedtime with a
soft-bristled toothbrush (e.g., Butler Gum sensitive bristled, Colgate sensitive
bristled or Biotene soft toothbrush). Because the bristles on soft or sensitive
toothbrushes are softer, your brushing motion must be slower to allow the bristles
to flow along the gum line and clean off the food and plaque deposits. Use regular
flavored fluoride toothpaste without tartar control. If you cannot brush your teeth
after meals, rinse your mouth with water.
4. After brushing your teeth, rinse your mouth with a baking soda solution.
Do not use any alcohol or phenol containing mouth rinses that may irritate your
mouth. Each day, make your own baking soda solution by mixing 1 teaspoon of
baking soda with 12 to 14 ounces of water (e.g., a 16-ounce water “sports” bottle).
Swish 1 to 2 ounces of the baking soda solution in your mouth for 30 seconds and
then spit it out. You may also gargle with the rinse for several seconds before
spitting it out. Rinse every two or three hours while you are awake, especially
after meals and at bedtime. Do not rinse with the baking soda more than six times
a day.
5. Apply fluoride once a day to your teeth preferably at bedtime. Fluoride gel
(stannous fluoride 0.4% products like Gel-Kam or Omni Gel) can be purchased at
your local pharmacy counter without a prescription. Do not buy “spicy” fluoride
flavorings like cinnamon as it may burn your mouth. You may also make an
appointment with a dental oncologist to receive fluoride therapy.
Apply Fluoride
Fluoride carriers are the ideal method of fluoride application.
1. Apply a thin layer (1/3 of the depth of the carrier) of fluoride in the carrier, and
then place the carriers over your teeth for 10 minutes. Spit out any excess saliva
or fluoride during the 10 minutes. Do not swallow any of the fluoride or saliva
mixed with the fluoride.
2. Remove your carriers, and spit out any remaining fluoride from your mouth.
3. Rinse the carriers in cool water, and clean the remaining fluoride gel from the
inside of the carriers with your toothbrush.
4. Store carriers in a cool, well-ventilated place until the next wearing.
5. Do not rinse your mouth, eat or drink for 30 minutes after using the fluoride. If
you need new fluoride carriers, please bring the models of your teeth to your
Dental Oncologist. Most carriers last three to five years. Your dental oncologist
may suggest a brush-on fluoride application. If a brush-on fluoride is suggested:
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a. Select a second soft-bristled toothbrush to use only with the fluoride treatment.
b. Thoroughly apply the fluoride so that it covers all the surfaces of your teeth.
Keep the fluoride on your teeth for 10 minutes. After 10 minutes, spit out the
remaining fluoride. Do not rinse your mouth, eat or drink for 30 minutes after
using the fluoride.
Use Caution with Dentures, Partials and Removable Prosthesis
Be careful when inserting or removing dentures, partials or removable prosthesis.
Always remove your dentures during your radiation therapy treatment. If your
dentures, partials or removable prosthesis fit poorly, you may want to leave them
out completely during your radiation therapy. They may injure your gum tissue
and possibly interfere with your treatment due to ulcerations. If you have any
problems, tell your dental oncologist. At bedtime, soak your dentures, partials and
removable prosthesis in a container of over-the counter denture cleaning solution.
Soak and clean them thoroughly with water before placing them in your mouth.
Keep Your Mouth and Lips Moist
Your lips and the inside of your mouth may become dry because of fever,
medication or changes related to radiation therapy.
To help keep your mouth moist during radiation therapy treatment:
 Rinse your mouth with a baking soda solution after meals and at bedtime.
Do not rinse with baking soda more than six times a day. (See above).
 Drink 2 to 3 liters of non-alcoholic, non-acidic, non-caffeinated fluids
each day, such as water or flavored non-carbonated beverages, unless your
doctor has instructed otherwise.
 Suck (do not chew) on ice chips or popsicles. You can also chew sugarless
gum. Do not use mints or hard candies.
 Use a lubricant such as aloe-vera or lanolin on your lips. You can also use
unflavored lip balm or moisturizer. Ask your dental oncologist or
pharmacist for suggestions on particular brands.
 Tell your doctor or nurse if your mouth continues to feel dry.
Manage Your Diet During Radiation Therapy
It is important to keep your diet soft and non-irritating during your radiation
therapy, especially during the last several weeks. To help prevent soreness, eat
only those things that feel good in your mouth.
Do:
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
Eat foods that are soft, liquid, blended or moist like broth, gelatin,
puddings, milkshakes, cooked cereals and frozen juice bars.
Eat foods that are a cold or like warm temperature.
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Eat smaller bites of food, chewing slowly, and sip liquids with your meals.
Drink 2 to 3 liters of nonalcoholic, non-caffeinated fluids each day like
non-acidic juices and/or sports drinks.
Do not:
 Eat crunchy, abrasive foods like chips, popcorn, granola bars, etc.
 Eat hot foods, liquids or spicy food items.
 Eat irritating, acidic, salty or highly seasoned foods.
Side Effect Relief
If You Develop Mouth Ulcers
If you notice sores (ulcers), bleeding white patches or a white coating on your
tongue, tell your doctor or nurse. If the sores are painful or keep you from eating,
ask your doctor about products that may help reduce the discomfort and relieve
the pain. If the ulcers become severe, you may need to eat finely ground, pureed
foods or use liquid nutritional supplements.
If You Develop A Sore Mouth
If your mouth becomes too sore to brush your teeth, you can do these things to
help your mouth feel better:
 Drink plenty of water between meals.
 Use a soft-bristled toothbrush when brushing. If your toothpaste burns, use
baking soda.
 Rinse your mouth with either a prescription mouthwash (ask your dentist
about this) and/or with the baking soda solution.
 Use the baking soda rinse every two or three hours while awake, such as
after meals and at bedtime. Do not rinse with the baking soda more than
six times a day.
 If you continue to experience mouth soreness, tell your doctor or nurse.
If you have any problems or questions about the care of your mouth or teeth,
please call us at:
Almardini Prosthodontics
Monday through Thursday, 9 a.m. to 5 p.m.
(905) 296-4521
References:
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Adapted in part from the , “Mouth Care for Radiation Therapy Patients (Head and
Neck Area)”, The University of Texas M. D. Anderson Cancer Center Patient Education
Office.
Maxillofacial Rehabilitation, John Beumer III, 1996.
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