Teeth and Mouth Care

This information aims to help you understand how the treatment of Head and Neck Cancer may affect your mouth. It may help answer some of your questions and help you think of other questions that you may want to ask; it is not intended to replace advice or discussion between you and your cancer care team.

Your cancer care team may recommend a pre-treatment check-up with your regular dentist (or refer you to a dentist that works with the multidisciplinary team), to discuss side-effects of head and neck cancer treatment and how you may manage these.

How Head and Neck Cancer May Affect Oral Health

Treatments for Head and Neck Cancer, especially radiation therapy, can cause side effects. These issues may arise early during treatment, or be experienced later and persist for the remainder of life. Side effects may affect the teeth, lining of the mouth or jawbone, such as:

Dry mouth (xerostomia)
Radiation therapy may affect the salivary glands and change the quality and quantity of saliva produced. This may cause dental decay, gum disease and difficulties with speaking or chewing.

Tooth decay
Saliva is the body’s natural defence against tooth decay. Without adequate saliva to wet the mouth, wash away food and neutralise the acids produced by plaque, the teeth are at a greater risk of rapid and aggressive tooth decay. 

An increase in mouth ulcers or inflammation (mucositis)
When cancer treatments break down the cells that line the mouth and leave the tissue inflamed, there is a risk of ulceration and infection.

Taste disturbance
Cancer treatments may alter the sense of taste; it is often reversible but may take many months or sometimes even years after the treatment is completed. However, if your work or lifestyle depends on your ability to taste food (e.g. you are a cook or a wine-maker) you should discuss your concerns with your doctor.

Difficulty opening your mouth fully (trismus)
Sometimes surgery or radiotherapy may make it difficult to open your mouth wide. This may be permanent or temporary and may limit your ability to eat normal food leading to poor nutrition. Trismus can also affect your ability to speak and clean your teeth.

Bone death (Osteoradionecrosis)
The death of some of the jawbone may occur in some patients having radiation therapy. Special care needs to be taken after radiotherapy if you are having extraction of a tooth or surgery on the jaw.

These side effects may hurt and make it difficult to eat, speak or swallow. It is important to take care of your teeth and mouth during head and neck cancer treatment because infections can be harmful and slow down your treatment.

Where Can I Find Support?

A dentist is an important member of the cancer care team before, during and after Head and Neck Cancer treatment. Many people only see their dentist when they have a problem, but after radiotherapy is very important to prevent problems before they start. By having regular dental check-ups, side effects can often be prevented or reduced.

• Before treatment: It is a good idea to have a dental check-up. Your dentist (or a dentist that works with the multidisciplinary team) will check the health of your mouth and teeth and give you a plan to keep your mouth healthy. Sometimes teeth that are decayed are unhealthy, need to be removed before radiation therapy to reduce the risk of problems after treatment.
• During treatment: Your dentist will look out for any mouth side effects that you may have.
• After treatment: Visit the dentist every six months for a check-up, the side effects of radiation therapy on your teeth can last for your whole life.

Keeping Your Teeth and Mouth Healthy

Good dental hygiene at home is important to maintaining a healthy mouth and teeth. Tooth decay is much faster and more severe after radiotherapy. The following are things that you can do help keep your teeth and mouth healthy:

• Drink plenty of water and chew sugar-free chewing gum to keep your mouth moist.
• Gently brush your teeth, gums and tongue with a soft toothbrush after every meal and at bed time.
• Gently floss your teeth every day.
• Use high-strength fluoride toothpaste.
• Use an alcohol-free mouthwash.
• Reduce intake of foods that may accelerate tooth decay, such as those high in sugar or acid content.

You may also like to watch Mouthcare Video for Head and Neck Cancer Patients. 

Tooth Extractions

Your dentist may recommend taking out teeth that are broken, infected, or decayed. This is because unhealthy teeth may cause problems after radiation therapy such as osteoradionecrosis (bone death). These teeth are usually removed before the radiation therapy starts because bone and gum that has be radiated may not heal after a tooth extraction.

Importance of Ongoing Dental Care

Your dentist plays an important role in your treatment for head and neck cancer. Side effects can often be prevented or reduced through regular dental check-ups before, during and after treatment. After your treatment, you should visit your dentist every 3 months for a check-up because the side effects of radiation therapy on your teeth can be long lasting.

Questions to Ask Your Doctor

• Will my cancer treatment affect my oral health? 
• Do you think I would benefit from seeing a dentist?
• What can I do to improve my oral health?
• Should I be using special products to improve my oral hygiene?
• Will changes to my oral health be permanent?
• Will I need any tooth extractions?