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Special Needs: Chemotherapy and Head and Neck Radiation Patients

By Nancy Symonds, RDH (Registered Dental Hygienist)

Special Mouth Instructions for Chemotherapy Patients

Before Treatment

Consult with your doctor before chemotherapy begins to see if you will be prone to mouth infections, sores, or bleeding. Around 40% of chemotherapy patients will have mouth problems that start soon after chemotherapy begins and should clear up a few weeks after chemo has been completed. Keep your mouth moist and clean using the baking/soda salt rinse (see Rinses in Mouth Care During Treatment) and practicing good oral hygiene to keep it that way.

During Treatment

Always check with your cancer doctor to see if your blood counts are satisfactory and if you need antibiotic premedication before any dental work or a dental cleaning is done. The best time to schedule a dental appointment is before your next chemotherapy treatment when you blood counts are satisfactory.

Chemotherapy patients should ask their dentist for fluoride if their mouths become dry for longer than 6 weeks.

After Treatment

Make sure your dentist knows your special medical category so that your dentist can consult with your cancer doctor. Your doctor will let you know when you will be able to go back for regular dental appointments. This will be based on your blood counts and your risk for infection.

Ask your doctor if you will need antibiotic premedication for any invasive procedure including a dental cleaning. You will need antibiotic premedication if you have an indwelling venous catheter or port.

Stay on the fluoride treatments if your mouth remains dry.

REMEMBER: Read Dealing With Mouth Problems if you have mouth problems during treatment.

Special Mouth Instructions for Head and Neck Radiation Patients

During Radiation Treatment

Always notify your dental office that you are having radiation treatment so that they can check with your radiation oncologist before your visit to discuss necessary treatment for your specific condition. You may need antibiotic premedication before any dental work or dental cleaning is done. An ultrasonic scaler (water scaler) should not be used for dental cleanings and no deep scaling which could expose the bone.

Many of the head and neck radiation patients will experience mouth problems during radiation treatment due to the effect of radiation on the salivary glands. Your doctor will try to lessen these effects as much as possible with shields that will protect the salivary glands, but this is not always possible. Approximately one week after radiation begins, your mouth may become noticeably drier, your tissues may become thinner and more prone to infections, and your taste may be altered.

These problems will usually end from several weeks to months after the radiation treatment has ended; however, dry mouth may persist. Dry mouth promotes decay of the teeth and you will need to have fluoride tray treatments every day for the rest of your life. Follow the fluoride treatments instructions above. By keeping your mouth moist and clean, you will have a better chance of avoiding mouth soreness and infections.

Use the baking soda/salt rinse often to help keep your mouth moist and clean (see Rinses in Mouth Care During Treatment).

After Treatment

All Head and Neck Patients

There may have been permanent changes to your mouth due to the radiation therapy which will put you into a special medical-dental category. Check with your cancer doctor to see if you need antibiotic premedication before your dental visits.

Patients Without Teeth

No new dentures until gums have returned to normal. This may take 6 months to a year or more.

Dentures should fit without soft relines and cause no irritation to the gums.

Have an oral cancer examination every time you have a dental check-up.

Patients With Teeth

Continue the daily fluoride treatments for the rest of their life. Do not use an acidulated or flavored fluoride. See fluoride tray instructions in Mouth Care During Treatment

Have dental check-ups regularly and always have an oral cancer examination during your visit.

There must be no trauma to your mouth tissues, gums, or bone during any dental procedure. No ultrasonic scalers or deep scaling during cleanings as this may cause bone exposure.

Dentures or partials must fit with no soft relines or irritation to the gums.

No teeth removed or periodontal (gum) surgery without consulting your radiation oncologist or dentist who did the preradiation work-up.

REMEMBER: Read Dealing With Mouth Problems, if you have mouth problems during treatment.

— © Copyright 1998, Nancy Symonds, RDH