Published: May 2003
Restorative treatment not accomplished prior to radiation therapy may be performed during the first two weeks of radiation or until the patient begins to experience mucositis.
Ulcerations and dry, friable tissues may easily become infected. Culture suspected infections and prescribe treatment in cooperation with the radiation oncologist. Fungal infections should be treated with a topical antifungal agent, preferably one without sugar.
Guidance in food selection should be offered in order to maintain the patient's nutritional status and to control caries.
When the muscles of mastication are in the direct field of radiation, instruct the patient to exercise the muscles three times daily by opening and closing the mouth 20 times as far as possible without causing pain. Opening against gentle pressure generated by placing the hand against the midline mandible may also be helpful. This exercise may lessen the degree of trismus experienced by the patient.
Patient Home Care
Excellent oral hygiene must be maintained. The teeth should be brushed with an extra-soft nylon bristle toothbrush after each meal and at bedtime. Dental floss should be used daily. If the oral tissues become painful, the mouth may be rinsed with a topical anesthetic before brushing. Softening the toothbrush in hot water before use may be helpful. Plaque may be wiped from the oral tissues with gauze moistened in a baking soda-saline solution. Water irrigating devices should be used only on the lowest setting. Sharp objects should not be put in the mouth.
The mouth must be kept as moist and clean as possible to reduce development of infection and pain. Over-the-counter alcohol-based mouthwashes and full-strength peroxide should not be used due to their drying and irritating effects. Long-term use of diluted peroxide solutions may disrupt the normal oral flora.
The mouth should be rinsed with a baking soda-saline solution frequently throughout the day, followed by a plain water rinse. The solution may be prepared by mixing 1-2 tsp(s) of baking soda and 1/2 tsp of salt with one quart of water. Salt may be eliminated according to patient preference. This solution may be put in a disposable irrigation bag and hung overhead to allow the solution to flow through the mouth.
The solution must not be swallowed.
Daily fluoride gel applications in custom gel-applicator trays should continue unless pain from mucositis becomes significant. As soon as the mucositis resolves, the patient should resume daily gel application.
Patients should not wear removable prostheses
if any irritation, mucositis or ulceration develops. Some radiation oncologists request that the patient not wear dentures throughout the entire therapy period. Dentures should be cleansed daily and soaked in an antimicrobial denture-soaking solution. When out of the mouth, they should be stored in clean water that is changed daily. Denture adhesives should not be used.
Suggestions for symptomatic relief of xerostomia and mucositis pain should be offered to the patient.