Head and neck radiotherapy side effects: mouth and teeth

The cells lining your mouth are sensitive to radiation. So radiotherapy to your mouth is likely to make it sore. The soreness usually only lasts while you are having treatment and for a couple of weeks afterwards. You may find that some things are too strong for you to cope with, such as

• Highly flavoured or spiced foods
• Strong alcohol
• Smoking

You may have to eat a bland or soft diet for a while. Dry foods can hurt and scratch your mouth. You may also find that hot foods or drinks make your mouth more sore. Try eating your food when it is just warm.

A dry, sore mouth is more prone to infection. So your doctor or nurse may give you mouthwashes and a mouth care routine to follow. This is to help keep your mouth healthy during your treatment. You may not feel like doing it every day, but 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 may need to clean them more than twice a day.

Sometimes the skin inside your mouth can break down during radiotherapy. If this happens to you, the radiotherapy staff will give you painkillers to help you cope with it. You may need to have a fine feeding tube into your nose if your mouth is very sore, because it will be painful to eat or drink.

Your treatment may affect the salivary glands so that they produce less, or no, saliva. It can be uncomfortable to chew or swallow. It can take a long time (6 months or more) for saliva production to get back to normal after treatment. If the radiotherapy treatment is aimed at the salivary glands, you may have a permanently dry mouth afterwards.

If you have a severely dry mouth, talk to your radiotherapist. Some of the following tips may help

• Clean your tongue with a liquid made from a teaspoonful of bicarbonate of soda in a litre of warm water - use moistened cotton wool or a soft toothbrush
• Sip drinks often to keep your mouth moist
• Fizzy drinks can refresh your mouth
• Moisten your food with sauces, gravy, cream, custard or ice cream
• Chewing gum can make your salivary glands produce more saliva
• Get your doctor to prescribe Salivix boiled sweets, lozenges, and artificial saliva sprays or gels
• Ask your doctor to prescribe medicines that stimulate saliva - such as pilocarpine
• Don't eat chocolate and pastry, as they tend to make your mouth more dry
• Use lip balm or Vaseline regularly if your lips are dry
• Moisten the inside of your mouth at night with a small amount of olive oil

The treatment may also make it easier for infections of the mouth to develop, such as 'thrush'. 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. It is important for your radiotherapy staff to check your mouth regularly during your treatment.

If you wear dentures they may make your mouth more sore during radiotherapy treatment and you may find it more comfortable to take them out for some periods during the day.

Your taste buds may also be affected by radiotherapy to the head or neck area. You may 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 more tasty, but you may have to leave these until after 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 CancerHelp UK section about chemotherapy effects on your mouth has tips on coping with taste changes. A glass of sherry before a meal can make food taste better.

The radiotherapy staff can arrange for you to talk to a hospital dietician for advice about overcoming taste changes.

Radiotherapy to your mouth can make you more likely to get tooth decay. You'll need to go for check ups at the dentist more often. Fluoride treatment may help to protect your teeth. You can have this as a mouthwash to use twice a day. Sometimes you might need to have some teeth taken out before you start treatment. If you are having radiotherapy to your mouth, face, or neck your radiotherapist may refer you for a dental examination before your radiotherapy.

Remember to tell your dentist that you have had radiotherapy to your mouth before you have any dental work. Your dentist may need to change the way they treat you and may need to talk to your radiotherapist before giving you any treatment.

There is more information about coping with mouth problems in the section about coping physically with cancer of CancerHelp UK.