How to Treat the Oral Side Effects of Head and Neck Radiation Therapy
Mucositis
Mucositis usually resolves once therapy is completed. Prophylactic measures may help reduce the severity and duration of mucositis. This includes maintaining good oral hygiene and rinsing with sodium bicarbonate solution (baking soda and water), even before mucositis develops. Additionally, avoiding spicy, hot, and acidic foods may help reduce the severity and duration of mucositis.
It is recommended that one brushes with a mild toothpaste when experiencing mucositis. Many people find that fruit flavored toothpastes are not as caustic as mint flavored ones. There are several mouth rinses that provide relief during episodes of mucositis, one of which known asmagic mouthwash is a unique mixture that your dentist or oncologist can fabricate which often includes viscous lidocaine, diphenhydramine, maalox and sometimes other ingredients. Other mucosal coating agents include kaopectate®, amphojel®, gelclair®, muguard®, and hydroxypropyl methylcellulose film-forming agents. Further rinses used to treat mucositis include mouthrinses that your dental oncologist or physician may prescribe.
Trismus
It is important to visit a dental oncologist and physical therapist, ideally before beginning treatment, to help prevent developing trismus. Certain jaw exercises may help to treat trismus and restore jaw function. Various exercises are outlined by Memorial Sloan Kettering below.
The goal of the exercises is to maintain the same vertical dimension of opening before and after radiation therapy. It is extremely important to conduct these exercises daily.
Many patients find that devices such as Therabite® and Dynasplint® help treat trismus.
Xerostomia
Xerostomia, or the subjective sensation of dry mouth, is associated with an increased risk of dental decay (cavities).
It is important to recognize that along with xerostomia, the protective effects of saliva are lost. Protective effects? what? Yes, believe it or not, saliva naturally protects not only the soft tissues in your mouth but also your teeth.
Saliva bathes and lubricates the oral cavity, washing away food and debris. Without this natural washing action, the risk of cavities is increased. So what does this mean? It means it is important to visit the dentist as frequently as every three months rather than every six months. Additionally, it is recommended that you maintain excellent oral hygiene (brushing twice daily, flossing daily). Your dentist may prescribe a prescription-strength fluoridated dentrifice to be used at night to help prevent cavities.
Other xerostomic treatments include methods to increase the sensation of moisture in the mouth as well as to stimulate salivary flow. For example, drinking water frequently, sleeping with a humidifier and rubbing olive oil on oral tissues may provide relief. There are several salivary substitutes/mouth-wetting agents that are over the counter and may alleviate the sensation of dry mouth. In addition, chewing sugar-free gum, and sucking on lemon drops or mints may help stimulate salivary flow. If over the counter substitutes or stimulants do not provide relief, your dentist may consult with your physician to prescribe a salivary stimulant. Though these stimulants are effective, they are associated with a variety of side effects and thus are not the first line of treatment.
Dysguesia
Taste alteration, reduced taste sensation and loss of taste are associated often depend on several factors including radiation dosage, the location of field of the radiation and the salivary flow. Saliva actually plays a crucial role in the sensation of taste. Thus, treating taste alteration often is similar to treating salivary function. Additionally, zinc supplements may help treat taste alterations.
Osteoradionecrosis of the Jaw
Originally posted at laurenlevidmd.com
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References
Epstein, Joel, Carl Haveman, Michaell Huber, Douglas Peterson, Jacqueline Plemons, Spencer Redding, Nicholas Sanfilippo, Mark Schubert, and Stephen Sonis. Oral Health in Cancer Therapy: A Guide for Health Care Professionals. 2008. Monograph compilation from 2008 Conference. University of Texas Health Science Center, San Antonio.
Little, James W. Dental Management of the Medically Compromised Patient. St. Louis: Mosby, 2002. Print.
Neville, Brad W. Oral and Maxillofacial Pathology. St. Louis, MO: Saunders/Elsevier, 2009. Print.
“Radiation Therapy for Cancer.” National Cancer Institute. National Cancer Institute, n.d. Web. 08 Oct. 2014.
“Radiation Therapy to the Head and Neck.” Memorial Sloan Kettering Cancer Center. Memorial Sloan Kettering Cancer Center, n.d. Web. 09 Oct. 2014.
To read more articles on dental oncology and how oral health and cancer therapy are related follow Lauren Levi, DMD on Twitter and Facebook. Lauren Levi, DMD is a dental oncologist who treats cancer patients throughout their cancer treatment. She actively writes and lectures about the oral and dental side effects of cancer therapy.
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