Sore mouth and problems with your teeth
The cells lining your mouth are sensitive to radiation. So radiotherapy is likely to make your mouth sore and you might have ulcers after a week or so. This is called oral mucositis.
The soreness usually only lasts while you are having treatment and for a few weeks afterwards. Your doctor, nurse or radiographer can give you painkillers to help. Following a mouthwash routine from the start of radiotherapy will also help.
You might need to have a fine feeding tube into your nose if your mouth is sore and stopping you from eating or drinking properly. The tube is called a nasogastric tube. Or you might have a tube put directly into your stomach through your skin. This tube is called a percutaneous endoscopic gastrostomy tube (PEG tube).
Voice over: When having radiotherapy to your head and neck, you can experience many different side effects. One of these might be a sore mouth.
Louise: Mouth soreness and throat soreness with head and neck radiotherapy is very common unfortunately. If the soreness is on the outside on your skin, they might recommend particular creams that you can use to help with that.
If the pain is internal, you may be referred to the doctor and the doctor will suggest some medication to help control the pain.
Charlie: Probably I think it was from week 2 to week 3 when the radiotherapy side effects started really impacting me. At that point, really, I was unable to eat. The ability to take food down your food tract with that level of inflammation and ulcers was just too difficult.
Louise: Mouth soreness can continue for up to 3 months. The team will support you during that time, whether that be with some medication or some skin care advice. They'll also check your mouth quite regularly to make sure you don't have an infection which might be slowing down the recovery time.
Charlie: They always checked the condition of my mouth and made sure that it was in good health, recovering, and if there was any issues they just supported and advised me on the best way to deal with it.
Voice over: For information on other head and neck radiotherapy side effects, visit the Cancer Research UK website.
Dry mouth
Your treatment might affect the salivary glands so that they produce less or no saliva. It can be uncomfortable to chew or swallow. Let your radiographer or doctor know if you're having problems.
After the treatment ends it can take some time for saliva production to get back to normal. If the radiotherapy treatment area includes the salivary glands, you might have a permanently dry mouth afterwards. Your doctor will talk to you about this before you start treatment.
Some of the following tips might help:
- Ask your doctor to prescribe medicines that stimulate saliva.
- Sip drinks often to keep your mouth moist.
- Moisten your food with sauces, gravy, cream, custard or ice cream.
- Chewing sugarless gum can make your salivary glands produce more saliva.
- Clean your tongue with a liquid made from a teaspoonful of bicarbonate of soda in a litre of warm water.
- Use lip balm to keep your lips moisturised.
- Use moistened cotton wool or a soft toothbrush to clean your tongue.
- Ask your doctor to prescribe artificial saliva sprays or gels.
Voice over: When having radiotherapy to your head and neck, you can experience many different side effects. One of these might be a dry mouth.
Charlie: My saliva glands were very close to some of the areas affected by cancer, so they did warn me that there was a high likelihood that my saliva glands would have some problems.
Louise: Radiotherapy can cause damage to the salivary glands. There are lots of things you can do to help with that. Small sips of water can ensure that your mouth stays moist. Little spritzer sprays or nebulisers, steam treatments can also help.
Charlie: Even now my saliva glands still don't work as well as they did beforehand. You'll find me sipping on water on a regular basis to offset the impact of the saliva gland limitation.
Voice over: For information on other head and neck radiotherapy side effects, visit the Cancer Research UK website.
Thrush infection
Radiotherapy can also make it easier for infections of the mouth to develop, such as thrush. The radiotherapy team will check your mouth regularly during your treatment.
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.
Taste changes
Radiotherapy can also affect your taste buds. You might 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 tastier. You might 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.
The radiotherapy team can arrange for you to talk to a hospital dietitian for advice about overcoming taste changes.
Voice over: When having radiotherapy to your head and neck, you can experience many different side effects. One of these might be changes to how things taste.
Louise: You may find that your taste alters. If this is the case, you might find that food and drinks that you previously loved do taste very different. Sometimes people report they taste a bit metallic. If this is the case, please consult your dietitian and they will be able to support you with that.
Tasha: It's like a battery taste. I don't know how I know that, but that's how I'd best describe it. It’s very unpleasant. So anything you're eating, you can't taste that food. It's just metallic taste.
At the end of my treatment, it still carried on, but it was slowly dying down and then when it went, I was very happy because I ate as much as I wanted.
Voice over: For information on other head and neck radiotherapy side effects visit the Cancer Research UK website.
Problems with your teeth
You visit a dentist before you start radiotherapy to the head and neck. They look for any teeth that might be decaying or already decayed and will remove them. This is because radiotherapy makes it more likely that your teeth will decay so it's best to take them out first to avoid problems. Your mouth will also not heal as quickly after radiotherapy.
You'll also need to go for check ups at the dentist more often. Fluoride treatment might help to protect your teeth. You can have this as a mouthwash to use twice a day.
Remember to tell your dentist that you have had radiotherapy to your mouth before you have any dental work. Your dentist might need to change the way they treat you. They may also need to talk to your radiotherapy doctor before giving you any treatment.
Voice over: When having radiotherapy to your head and neck, you can experience many different side effects. One of these might affect how you care for your teeth.
Louise: Radiotherapy can cause some bone weakening, so as a result of that, we would recommend you are referred to a dentist before you start a course of radiotherapy.
They will look at all of your teeth and any teeth that already appear weak and damaged may be removed before you start treatment.
Tasha: The dentist and even the doctors and consultants said that after you've had radiotherapy and if it's been near the mouth area or teeth that it can make dental treatments more painful, and I did find that.
Charlie: Post treatment you have to really, really look after your teeth, so I go to the dentist every 3 months. Any problems with your teeth have to be nipped in the bud.
Voice over: For information on other head and neck radiotherapy side effects, visit the Cancer Research UK website.
Things you can do to help
There are some things you can to stop any further irritation to your mouth. These include:
Eating and drinking
Some food and drinks can irritate your mouth and might be painful to eat. These include:
- spicy food
- alcohol - especially spirits
- dry food, such as crisps, might scratch your mouth
- very hot food or drinks
Because of this it can be best to eat a bland diet for a while. And soft foods such as potato and porridge.
Mouth care
A dry, sore mouth is more prone to infection. So your doctor or nurse will give you mouthwashes and a mouth care routine to follow. This helps keep your mouth healthy during your treatment.
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 might need to clean them more than twice a day.
Smoking
Smoking can make the soreness worse. You can try to cut down on smoking. Talk to your radiotherapy team about nicotine replacement treatments to help with this.
Dentures
Wearing false teeth (dentures) may make your mouth more sore during radiotherapy. You might find it more comfortable to take them out for some time during the day.