• Radiotherapy and Chemotherapy can have unwanted side effects in the mouth
• Your oral health needs to be a good as possible before and throughout your treatment to avoid problems later on
• You will be seen by the Consultant in Restorative Dentistry either Mr Brindley or our Locum Consultant Mr Farooq, you may be referred to our Dental Therapist Rachael for further treatment
• During your appointment with the Consultant, you may have an xray taken and a discussion about your teeth and gums.

• Everybody reacts differently to Chemotherapy and Radiotherapy but here are some common issues that can occur in the mouth
• Mucositits is when the linings in your mouth and digestive tract become inflamed, this can be painful, try using the Difflam mouthwash or ask for advice on the radiotherapy or chemotherapy department
• Your mouth may become dry and we can provide dry mouth samples and advice for a dry mouth or look at the links on this page
• You may have altered taste throughout your treatment, your dietician may be able to give you advice to help

• Caffeinated drinks can make your mouth drier, try decaffeinated versions
• Sugar in tea and coffee numerous times a day can increase the risk of dental decay, swap to sweeteners or natural alternatives like Stevia
• Fizzy drinks and flavoured water can contain lots of sugar which can damage your teeth, try to drink as much plain water as possible to prevent dental decay and erosion

• Chew sugar free chewing gum
• Use dry mouth gels
• Put a humidifier in your bedroom at night to moisten the air
• Drink plenty of water
• Try steam inhalation

Oralieve

The Head Cases Support Group

Macmillan

Brenda’s easy to swallow cookbook

Pre-Treatment Assessment

Following your diagnosis you may be referred to see a consultant in Restorative Dentistry. This is to ensure your dental health is fully assessed and monitored throughout your treatment, and to avoid unscheduled interruptions to chemotherapy/radiotherapy due to dental complications. This assessment allows comprehensive planning of your care to ensure the most appropriate treatment is provided in compliance with national guidelines.

We aim to carryout your assessment within the first week following your referral. If you have not heard anything in that time please contact Sharon Wilde

What to expect at this appointment

• Full dental examination by the Restorative consultant
• Dental x-rays if required
• To discuss and agree a treatment plan
• If further care is required with a dental therapist or any dental extractions a referral to other members of the team will be made.
• You may be given a prescription to take to your doctor. This is for preventative mouthwashes and toothpastes
• Further reviews / appointments will be made following this initial assessment as part of your on going care.

Summary

Your dental care is an important part of your treatment and routine
check-ups with your own general dental practitioner should be maintained. They will be kept informed of your treatment throughout and may be asked to carryout any simple dental treatment.

Please bring a list of medications to your appointment and any other appointments that have been made regarding your treatment .

Please speak to a member of staff if you need this leaflet in large print, braille, audio or another language.

Mrs S. Wilde: Secretary 01782 674182

Introduction

This leaflet 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.

Radiotherapy and chemotherapy are treatments that are used to treat cancers, including those of the head and neck.

How should I prepare for my cancer treatment?

Radiotherapy and chemotherapy to the head and neck can have side effects in the mouth. Your oral health needs to be as good as possible before the start of treatment to avoid later problems. You will be seen by the Consultant in Restorative Dentistry either Mr Brindley or our Locum Consultant Mr Farooq, you may be referred to our Dental Therapist Rachael for further treatment. During your appointment with the Consultant, you may have an xray taken and a discussion about your teeth and gums.

During Radiotherapy

Saliva moistens and lubricates the mouth. It protects against tooth decay and erosion/sensitivity. It also aids swallowing and speech. Radiotherapy frequency damages the glands which produce saliva and can make your mouth dry. Mucositis is a common side effect during radiotherapy, it affects the lining of your mouth and can cause mouth ulcers and pain or difficulty in swallowing.

During Chemotherapy

Chemotherapy can also cause mucositis, this is when the linings in your mouth and digestive tract become inflamed, this can be painful- try using the Difflam mouthwash or ask for advice on the radiotherapy or chemotherapy department. Chemotherapy can also reduce the white cell count which may make you prone to dental infections.

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 may feel uncomfortable towards the end of treatment and for up to 6 weeks after the completion of your treatment. Your mouth may also become dry and your taste can be affected. These changes will make it difficult to swallow, eat and clean your teeth.

What Might happen?

Short term effects

• Dry mouth (but can also be long term)
• Altered taste
• Difficulty swallowing
• Sore mouth
• Coated tongue
• Fungal infections

Long term effects

• Tooth decay
• Teeth erosion

What to Avoid

• Fizzy drinks and flavoured water- these can contain lots of sugar which can damage your teeth, try to drink as much plain water as possible to prevent dental decay and erosion
• Food or drinks containing sugar should be avoided in between meal times, especially 1 hour before bedtime
• Check with your doctor for alternative sugar free medicines
• Avoid tobacco products including vaping
• Avoid alcohol and products containing alcohol
• Avoid spicy/acidic foods
• Do not scrub your teeth, brush gently
• Avoid drinks with caffeine like tea- switch to decaffeinated, this may help with a dry mouth.

What can I do?

• Take regular sips of water to keep your mouth moist (bottled water tastes better)
• Brush your teeth and tongue 3 x daily after meals with a soft small headed toothbrush. If the bristles are too rigid soften them in warm water.
• When possible use the interdental brushes / floss advised by your hygienist to clean the spaces in between your teeth.
• Brush with Duraphat 5000ppm toothpaste spit out after brushing, (do not rinse)
• Difflam Oral rinse 4 x daily during your treatment– may help with soreness. (on prescription)
• To reduce bacteria levels, use alcohol free Corsodyl (chlorhexidine) mouthwash 2 x daily, dilute if needed.
• Chew sugar free chewing gum to encourage saliva flow
• Have dietary foods such as milk or cheese at the end of meals to help neutralise any acid in your mouth.
• A teaspoon of sodium bicarbonate in a cup of warm water can be used as a mouthwash and help with a coated tongue.
• Soft, chilled foods and adding gravy/sauces to food may help with swallowing.

Prevention of Dental Decay

If you find it difficult to reduce your sugar intake remember the frequency of sugar is worse than the actual amount consumed, therefore sugary foods/sugary drink consumed over a short period of time is less harmful than if they are eaten over a period of hours

Things to watch out for:

• Ensure (nutritional drinks)– these are needed as part of your recovery but you should try consume within 5-10mins to minimize the risk of dental decay.
• carbonated drinks
• Tea and coffee containing sugar (swap for sweeteners)

Other things to consider

• Reduce excessive periods of sugar intake per day, stick to meal times only.
• Improve oral hygiene including tooth brushing technique and interdental cleaning.
• Check for ‘hidden sugars’ in processed foods
• Check for medications containing sugar. If in doubt check with your dietician.

Please speak to a member of staff if you need this leaflet in large print, braille, audio or another language.