Mouth and teeth after head and neck radiotherapy
This page tells you about problems you may get with your mouth and teeth after radiotherapy to your head and neck. You can find information about
The cells lining your mouth are sensitive to radiation. So radiotherapy to your mouth is likely to make it sore. This is called oral mucositis. The soreness usually only lasts while you are having treatment and for a few weeks afterwards.
Eating and drinking
While your mouth is sore you may find that some foods or drinks are too strong for you to cope with. These include highly flavoured or spiced foods, and strong alcohol.
You may have to eat a bland or soft diet for a while. Dry foods can hurt and scratch your mouth. You may also find that hot foods or drinks make your mouth more sore. Try eating your food when it is just warm.
A dry, sore mouth is more prone to infection. So your doctor or nurse may give you mouthwashes and a mouth care routine to follow. This is to help keep your mouth healthy during your treatment. You may not feel like doing it every day, but it is important to keep your mouth clean and as healthy as possible. It's best to use a small soft toothbrush to clean your teeth. And you may need to clean them more than twice a day.
Smoking may make the soreness worse. You can try to cut down on smoking. Or you could talk to your doctor, nurse or radiographer about nicotine replacement treatments.
Sometimes the delicate lining inside your mouth can break down (ulcerate) during radiotherapy. If this happens to you, the radiotherapy staff will give you painkillers to help you cope with it.
You may need to have a fine feeding tube into your nose if your mouth is very sore, because it will be painful to eat or drink. The tube is called a nasogastric tube. Or you may have a tube put directly into the stomach through the skin and muscle of the abdomen. The tube is called a percutaneous endoscopic gastrostomy tube (PEG tube).
If you wear dentures they may make your mouth more sore during radiotherapy treatment. You may find it more comfortable to take them out for some periods during the day.
Your treatment may affect the salivary glands so that they produce less, or no, saliva. It can be uncomfortable to chew or swallow. In the early days of the treatment your saliva may become very thick and difficult to swallow.
After the treatment ends it can take a long time (6 months or more) for saliva production to get back to normal. If the radiotherapy treatment area included the salivary glands, you may have a permanently dry mouth afterwards.
If you have a severely dry mouth, talk to your radiotherapy doctor (clinical oncologist) or radiographer. Some of the following tips may help
- Clean your tongue with a liquid made from a teaspoonful of bicarbonate of soda in a litre of warm water
- Use moistened cotton wool or a soft toothbrush to clean your tongue
- Sip drinks often to keep your mouth moist
- Fizzy drinks can refresh your mouth
- Moisten your food with sauces, gravy, cream, custard or ice cream
- Chewing gum can make your salivary glands produce more saliva
- Get your doctor to prescribe boiled sweets that boost saliva production, lozenges, and artificial saliva sprays or gels
- Ask your doctor to prescribe medicines that stimulate saliva
- Don't eat chocolate and pastry, because they tend to make your mouth more dry
- Use lip balm or Vaseline regularly if your lips are dry
- Moisten the inside of your mouth at night with a small amount of olive oil
The treatment may also make it easier for infections of the mouth to develop, such as thrush. Let your doctor or nurse know if you have any white patches on the inside of your mouth or on your tongue. They can prescribe medicines to help. It is important for your radiotherapy staff to check your mouth regularly during your treatment.
Your taste buds may also be affected by radiotherapy to the head or neck area. You may notice changes in the way your food tastes. Some people say their food has a metallic taste. Others say that all foods taste the same.
There are some tips on making food more tasty, but you need to wait to try these until your mouth has recovered from the treatment and is not sore any more.
You could try using more herbs and spices to flavour your food, as well as using strong tasting sauces like sweet and sour. Sharp tasting foods, such as fresh fruit and sharp boiled sweets can be refreshing but only use these after your mouth has healed. Our section about cancer drugs and your mouth has tips on coping with taste changes. A glass of sherry before a meal can make food taste better.
The radiotherapy staff can arrange for you to talk to a hospital dietician for advice about overcoming taste changes.
Radiotherapy to your mouth can make you more likely to get tooth decay. You'll need to go for check ups at the dentist more often. Fluoride treatment may help to protect your teeth. You can have this as a mouthwash to use twice a day. Sometimes you might need to have some teeth taken out before you start treatment. Before radiotherapy to your mouth, face, or neck your radiotherapy doctor may refer you for a dental examination.
Remember to tell your dentist that you have had radiotherapy to your mouth before you have any dental work. Your dentist may need to change the way they treat you. They may also need to talk to your radiotherapy doctor before giving you any treatment.
There is also detailed information about the general side effects of radiotherapy. There are pages about other side effects of head and neck radiotherapy, including
You can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.
Our general organisations page gives details of people who can provide information about radiotherapy. Some organisations can put you in touch with a cancer support group. Our cancer and treatments reading list has information about books, leaflets and other resources about radiotherapy treatment.
If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.
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