Download Oral hygiene of a patient receiving radiation therapy in the mouth

Guideline
Department of Oncology
Nro 65.00.04E
1 (3)
16.5.2017
Oral hygiene of a patient receiving radiation therapy in the mouth and neck
area
Oral hygiene is important during radiation therapy
Good oral and dental health is necessary before radiation therapy. Take good care of your
mouth and teeth, as radiation therapy causes an inflammatory reaction in the mucous
membranes, decreases saliva production and causes drying of the mouth. In a clean
mouth, the inflammation caused by radiation therapy will heal faster. An oral infection may
be caused by a fungal infection, which can be identified by white patches or growth on the
tongue or the mucous membranes of the cheek. The treating physician may prescribe a
medication to treat the infection.
Brushing your teeth
Do not brush your teeth immediately after eating, as the saliva becomes acidic from eating.
Brushing combined with the acidic saliva will erode the surface of teeth.
If your toothpaste irritates the mucous membranes of the mouth, switch to a milder one that
does not irritate the mouth or then use only water. If it is not possible to brush your teeth
with a toothbrush, you can use a disinfecting mouthwash for cleaning your mouth, e.g. Biotene®. Rinse your mouth out with a disinfecting solution in the morning and evening.
Using xylitol and fluorine
End meals and snacks with xylitol products (for instance xylitol chewing gum or
drops) if you are able to suck on drops or chew gum. If the condition of your mouth allows,
use xylitol gum or drops also between meals. Xylitol improves the saliva's protective effect
on teeth and increases saliva production.
In the evenings after brushing your teeth, use fluorine tablets or a mouthwash (Fludent 0.25
mg® and Xylisuu® sucking tablets or sodium fluoride solution). Fluoride strengthens the
teeth when used regularly.
Treating a sore mouth
Eat mild-tasting lukewarm food and drink only water when you are thirsty. Spicy, hot food
and strong, hot beverages easily cause irritation of the mouth. You can try to alleviate a
burning sensation in the mouth by sucking on ice cubes. Lukewarm chamomile tea can also alleviate pain.
Use a topical anaesthetic (e.g. Lidocaine mouthwash) for mucous membranes before a
meal if eating has become difficult due to soreness of the mouth. The anaesthetic for mucous membranes works better when you flush your mouth with saline solution first. Swallow
a small amount of the anaesthetic. Your throat becomes numb and it is easier to swallow.
Joint Municipal Authority of the Pirkanmaa Hospital District  www.pshp.fi
Guideline
Department of Oncology
Nro 65.00.04E
2 (3)
16.5.2017
Rinse your mouth after meals with saline solution or water and use the mouthwash intended for radiation therapy patients twice daily. To protect the mucous membranes, you can
use e.g. the Antepsin® mixture or the Alsucral® solution. Medication used to protect the
mucous membranes may decrease the effectiveness of other medications used in the form
of mouthwashes (e.g. topical anaesthetic and antifungal medication), so use it only after
the medication.
When necessary, use mouth-moistening products for a dry mouth (Salisynt®, Oralbalance® gel) several times a day starting from the first week of radiation therapy. Mouthmoistening products lubricate the mouth and make it easier to talk and swallow.
In addition, painkillers are often necessary for treating a sore mouth. The treating physician
will provide you instructions on how to use the different medications.
Dental prosthesis care
Brush dental prostheses carefully and backwash your mouth with water or saline always after a meal.
Use dental prostheses as little as possible during radiation therapy. The gums swell due to
radiation treatment, and dental prosthetics can easily cause sore abrasions in the mouth.
Keep the dental prosthetics in water. Apply mouth-moistening gel (Oralbalance®) on the
inner surfaces of dental prosthetics. This decreases the abrasive effect of dental prosthetics.
You may also easily get a fungal infection in your mouth during radiation therapy. Apply the
antifungal drug prescribed by your physician on your dental prosthetics. In this way, the
fungus causing the infection is destroyed also in the dental prosthetics.
After radiation therapy
The immediate side effects caused by radiation therapy, such as pain and difficulty speaking, continue approximately 2–5 weeks after treatment. The side effects will slowly go
away, but there may be permanent changes to your sense of taste or saliva production.
When the protective effect of saliva decreases, the teeth develop cavities quickly and the
gums develop infections easily. Visit your dentist at regular intervals after radiation therapy.
You should also continue tooth-friendly eating habits and careful dental care.
Substances used in oral hygiene
For flushing the mouth: Saline, prepared or self-made; 1 tablespoon of table salt in 1 litre of
water, which is then boiled and cooled down.
For cleaning the teeth and mouth: Biotene® mouthwash
For numbing the mouth: Lidocaine mouthwash (prescription drug)
Joint Municipal Authority of the Pirkanmaa Hospital District  www.pshp.fi
Guideline
Department of Oncology
Nro 65.00.04E
3 (3)
16.5.2017
For protecting the mucous membranes: Antepsin® mixture, Alsucral®, mouthwash for radiation therapy patients (prescription drug)
For moistening the mouth: Salisynt®, Oralbalance®
For strengthening the teeth: Xylitol chewing gums and drops, Fludent ® and Xylisuu® sucking tablets and sodium fluoride solution.
Joint Municipal Authority of the Pirkanmaa Hospital District  www.pshp.fi