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Oral Care During Head and Neck Cancer Treatment
Dry mouth, difficulty swallowing, lack of taste, and/or painful ulcerations,  can be a common side effect when someone receives chemotherapy and radiation to the head and neck.  There are lots of things we can do to manage and improve your symptoms.  Above all, hey will improve once treatment is over, but the following can be used as a guide to help you get through treatment:

General Guidelines

  • Mouth sores and pain may be caused by radiation or chemotherapy.  Other medicines may also cause changes in the mouth.

  • You will need to see your dentist for a dental exam before you start any treatments. If some teeth need to be repaired, you will need time to heal before you start your radiation treatments. They may also recommend fluoride treatments. If you do not have a dentist, we can give you the names of some local dentists that can help you.

  • Most mouth sores can be prevented by good, daily mouth care before starting treatment and good, daily mouth care that continues during treatment.  Your nurse can tell you when it is no longer necessary to do your daily mouth care.  Generally, this is after your treatment is finished and the last mouth sore or pain is gone.

  • Medications to reduce mouth pain can be local applications, swish in the mouth solutions and/or pain medicines. Any medication chosen for you will depend on the amount of discomfort you are having and the type of mouth sores or pain you have.

  • Mouthrinse solution should be made each day in a clean container.  Mix one teaspoon of table salt & one teaspoon of baking soda into one quart (4 cups) of water.  Shake before each use.  You can cut the recipe in half and make less at a time if you want.


Daily Mouth Care

  • Gently brush your teeth &/or dentures with an extra soft toothbrush and fluoride toothpaste after each meal and at bedtime.  Brushing loosens debris and helps produce saliva with helps fight infection.  You can soften the toothbrush by rinsing the bristles under warm water before you start brushing.

  • If you wear dentures, be sure to take them out for mouth care. You will also need to brush and clean your dentures each time.

  • After brushing, rinse your mouth with the salt/baking soda/water rinse (recipe above).  Rinse after each meal and at bedtime. Rinsing your mouth helps remove debris loosened by brushing.  Rinsing also helps your mouth produce saliva. If you wear dentures, remove then and then rinse your mouth. 

  • Floss your teeth gently with unwaxed dental floss once a day.  DO NOT FLOSS if pain or bleeding occurs or if your healthcare provider tells you your blood counts are low.

  • Inspect your mouth after finishing mouth care.  Examine the roof of your mouth, inside the cheeks, gums, the tongue and under the tongue.  If you wear dentures, examine your mouth without your dentures in place.

  • Keep your lips moist.  You may use Chapstick, Blistex, or Aquaphor on your lips, but be sure not to put anything on your lips 2 hours before your radiation treatment.  If you have a sore or lesion on your lip, do not wipe your fingers or lip ointment over the sore and then to other areas of your lips or skin.  If the sore or lesion is infected, doing this can spread the infection.

  • Drink lot of fluids (no alcohol) throughout the day

  • Do not use mouthwashes that contain alcohol or hydrogen peroxide (like Listerine, Scope, Act Restoring, etc.).  Read the product label before using.


  • Avoid spicy or acidic foods, toothpicks, tobacco products and alcohol throughout treatments.

  • Your doctor may also recommend you take injections of a medication called Amifostine.  This medication helps to prevent dry mouth and may help prevent mouth sores. The nurse and doctor will review this with you if they think you need it.

  • Replace your toothbrush during treatment, especially if you have mouth sores.  A new toothbrush each month is a good idea. 

  • Our dietician will see you during your treatments and she would be glad to see you if you have any additional questions or concerns. Just let your healthcare provider know if you would like to see her before you get started.

  • Notify your healthcare provider with any mouth changes or problems.


As Treatment Continues

  • If your mouth starts to get sore, you will need to increase your mouth care and baking soda/salt water rinses to every 4 hours when awake and at least once during the night. If you develop mouth sores, mouth care may need to be done every 2 hours during the day.

  • Remember to continue to drink lots of fluids throughout the day. Dry mouth is common with radiation to the head and neck areas.

  • If you wear dentures and start to develop mouth sores, you should not wear them. They may irritate the gums and mouth.

  • Your doctor may prescribe medications for you to take if you start to develop mouth pain and/or sores. Specific directions for those medications will be given at that time.

  • Our dietician is available to help with food and supplement recommendations or to help you with any other related problems.

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