Mouth Care During Treatment

By Nancy Symonds, RDH (Registered Dental Hygienist)

Oral Hygiene During Treatment

If you want to do all you can to prevent mouth problems during (and after) active treatment, the basic rule is to keep everything in your mouth and everything that enters your mouth immaculately clean. You wouldn't eat off of dirty dishes in a restaurant, but patients sometimes forget that if they don't keep their toothbrushes, dentures, partials, fluoride trays and carriers clean, then they are still allowing bacteria to enter their mouth even if it is their own bacteria. This can cause an infection when your immune system is low and can spread to your body.

Other rules for the mouth include the following:

Soft Tissue Care: Places where bacteria can hide as you are going through treatment are the top of and under your tongue and between the inside cheeks and your gums. Your mouth may become dry and food will stick to your soft tissues much more than normal so it is necessary to clean the tongue, gums, roof of the mouth and inside cheeks. To do this, you may use an extra soft tooth brush softened with warm water, an unflavored toothette, or gauze wrapped around your finger soaked in the baking soda/salt rinse (see rinses below).

Rinses: The baking soda/salt rinse is one to two teaspoons of baking soda and 1/2 to 1 teaspoon of salt mixed in 1 quart of warm water made fresh daily. Eliminate the salt if you are on a salt-free diet. Gently swish for 30 seconds, spit out (be sure not to swallow) and rinse with water afterwards. Rinse often, especially if your mouth is dry.

Because you will want to use this as often as necessary and it cools down fairly quickly, when you want to use some, you can heat about 1/2 cup of it in the microwave. NOTE!! We're talking warm here, NOT HOT. Hot can burn and create a most unpleasant problem. Some people, of course, may prefer a cold rinse, but it seems to work much better when warm. Try both ways to see what seems best for you.

Avoid over the counter mouth rinses as the flavorings and alcohol content may irritate and dry your mouth. Hydrogen peroxide can also irritate and dry your mouth. No water or rinses for 30 minutes after fluoride treatments.

Denture and Partial Care: Brush denture and partial after every meal. Soak denture or partial in a denture cleaner overnight, rinse them with water and rinse your mouth with the baking soda/salt solution before inserting denture or partial. Clean the container in which you soaked your denture or partial. If your mouth becomes sore, with white spots or bleeding, leave the dentures or partials out until the irritation is gone and notify your doctor immediately.

Flossing: The most effective time to floss is after your last meal and before you go to bed. You should floss before you brush so that the fluoride from your toothpaste can work on clean surfaces. At night you have much less saliva and any food left between the teeth will not be washed away by the lubricating action of the saliva. Start with eighteen inches of floss and curve the floss around your tooth so that you do not injure the gum. Then use an up and down motion on the side of the tooth to get rid of any sticky food caught there. Then move the floss to a clean section and clean the next tooth. Do not floss if you are causing the gums to bleed; you may be flossing incorrectly, your mouth may have become too sensitive, or your blood counts may be low. Do not use toothpicks, as you might cut yourself.

Brushing: Brush after eating using a soft toothbrush and a mild fluoridated toothpaste. Place the toothbrush at a 45° angle towards the gums and gently brush with a small circular motion. Brush the inside and outside of the teeth making sure that you start on the gumline, then brush the biting surfaces. You will clean the inside of the front teeth better if you insert the brush vertically for both the top and bottom. Replace the brush often as it can carry bacteria. Do not use a water-pik at this time. If your mouth becomes too sore for brushing, you may wrap gauze around your finger and dip it in the baking soda/salt rinse to clean your teeth. If your gums are bleeding, notify your doctor immediately since you may have to stop brushing and only be able to use rinses. Your doctor will tell you when you can go back to brushing again.

Fluoride Treatments

Brushing Method: Chemotherapy patients may have less saliva while going through treatment. Saliva usually returns after chemotherapy has ended. If your mouth is dry for more than 6 weeks, you may use a brush-on fluoride gel after you have flossed and brushed your teeth. Place the fluoride gel on your brush and brush for a minute, covering the entire surface of your teeth, swish, and spit out. Do not swallow, rinse with water, eat or drink anything for 30 minutes. Use a 1.1% neutral sodium fluoride gel, preferably unflavored. If tooth decay is a continuing problem, your dentist may recommend the fluoride tray method.

Fluoride Tray Method:

Head and neck radiation patients are at a lifelong risk for tooth decay due to the reduction in their saliva and an increase in decay causing bacteria. Fortunately, using fluoride once a day can prevent this rampant decay. It will be necessary to not only use the fluoride trays during treatment but also for the rest of your life. You will need to have individualized custom made trays made by your dentist for your mouth. Your dentist will prescribe a fluoride gel, such as a 1.1% neutral sodium fluoride gel preferably unflavored.

First floss and brush your teeth. Rinse and dry your fluoride trays and place a thin ribbon of fluoride gel covering the bottom of the trays. Dry your teeth with gauze or a soft cloth. Insert the trays and bite down holding the trays between your teeth for 5-10 minutes. The fluoride gel must cover the gumline as that is where you will be susceptible to decay. Use the trays separately if it is difficult to hold both in your mouth at once. Many patients do this while showering or bathing to save time. After 5-10 minutes, remove the trays and spit out the fluoride.

Do not swallow the fluoride or rinse the fluoride out with water. You may wipe off the excess fluoride with a dry cloth or gauze. And do not brush your teeth. Do not eat or drink anything for 30 minutes. If you do swallow, rinse, or brush your teeth immediately afterwards, the fluoride won't be able to protect your teeth. Also, always clean the trays after the fluoride treatment and put them in a clean container.

Important Note #1: Be certain that you confine the fluoride to the trays so you do not swallow the fluoride.

Important Note #2: For head and neck radiation patients you will have to continue with this for the rest of your life if you have a dry mouth.

Important Note #3: Stronger fluoride gels than a 1.1% neutral sodium fluoride (such as a stannous fluoride, acidulated phosphate fluoride (APF)) can etch the porcelain and composite resin restorations.

Foods That Help or Hinder Mouth Comfort

Foods to Avoid

Any food or drink that can irritate or dry your mouth such as alcohol, including mouth rinses with high alcohol content, soda pop or carbonated drinks, and caffeine. Avoid all tobacco products.

Any food that can cut the soft tissues in your mouth such as rough, crunchy, or coarse food like French bread.

Irritating foods that are too tart and acidic such as tomatoes, citrus fruits, or spicy and salty foods.

Food that is so hot it can burn your mouth such as a hot pizza.

Sweet, sticky food that can cause decay. Corn syrup is high in sugar and any ingredient that ends in "ose" is a type of sugar.

Foods to Eat

Foods high in proteins and calories and low in sugar. Calories maintain your weight and proteins rebuild your cells.

Eat smaller bites if it is difficult for you to swallow.

Eat 6 to 8 small meals a day rather than 3 large meals if you have less appetite.

Add liquid or puree your food in a blender if your mouth is dry. Choose creamed or mashed food that is easy to chew.

And when you are through eating, don't forget your mother's advice -- brush after every meal. (Remember, a little brushing now can prevent lots of problems later.)

Now that you know how to take good care of your teeth and mouth generally, if you are going to need chemotherapy or radiation treatment, be sure to read Special Needs of Chemotherapy and Head and Neck Radiation Patients, which deals with those specific situations. And if you develop some difficulties with your mouth during treatment despite your best preventive measures, see Dealing With Mouth Problems to find out what you can do to relieve the problem.

© Copyright 1998, Nancy Symonds, RDH