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Hello, I’m Evelyn and I’m a qualified dentist and have experience working in Oral and Maxillofacial Surgery.
Mouth problems are a common result of head and neck cancer or its treatment. Getting support from a dental professional from early in the process can really help to minimise discomfort and improve your quality of life.
Dental care should be provided in conjunction with your oncology team, as unfortunately, increased susceptibility to dental disease can be life-long after head and neck cancer.
If you’ve been diagnosed with head and neck cancer, you should be referred to a specialist clinic for a full dental assessment before treatment starts. This clinic should continue seeing you during and after treatment.
They should give you a full oral assessment, ideally at least a month before starting treatment. This should to give you adequate time to heal if you need any dental treatment.
At the assessment, your dentist should:
You should also keep attending your local dentist as they will be able to offer support as well. You should tell the dentist about your diagnosis, what medications you are taking and your proposed treatment dates.
Invasive dental treatment should be avoided if possible during cancer treatment, but if treatment is required your dentist will consider how this is best delivered. A dental professional should support you to maintain a high standard of oral hygiene.
You should carry on having regular check-ups with a dental professional after treatment. This will allow support for the management of side effects and to pick up any dental disease and provide treatment if required.
If you had radiotherapy in this area, then you will remain at high risk of dental decay afterwards. Your dentist will advise on prevention strategies suitable for you which may include:
After radiotherapy to the jaws, the blood supply to the bone is reduced. This may lead to parts of the jaw bone dying. This is known as osteoradionecrosis (ORN).
Symptoms include pain, swelling, numbness, loose teeth, a discharge or a break in the lining of the mouth (mucosa). If you develop any of these symptoms it’s important to seek advice from your doctor or dentist.
To reduce your risk of developing ORN:
Dry mouth (xerostomia) can happen during treatment with some types of chemotherapy, but usually returns to normal at the end of treatment. Dry mouth post-radiotherapy tends to be longer-lasting and problematic.
There are a few different methods that can help – it’s a good idea to try different ones and see which works for you.
Caring for your mouth is an essential part of your head and neck cancer therapy. Keeping your mouth clean and healthy will make things more comfortable and help to make your cancer journey a little bit easier.
If you have any concerns a member of your oncology team will be more than happy to give you some advice.
Read more on this blog.
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Hello Evelyn. I am now into my seventh year post-treatments for floor of mouth cancer - extensive surgery followed by twenty fractions of radiotherapy - so suffer from the usual side effects. A dry mouth is certainly something I have learnt to live with, but the use of a dry mouth gel at night helps a lot.
Last year I also had to undergo a further procedure to remove a few remaining supporting teeth, the bridge work and a dental implant ( six years post-radiotherapy ) due to the long-term side effects from the RT. So I would hope that any risk of me developing ORN may have diminished by now ... ?
Regarding dental care of my remaining natural top teeth, - I visit the dental hygienist every three months, keep up with regular six-monthly check-ups and occasionally have the fluoride gel applied. In between times I use a high-fluoride mouth rinse so hope to retain my smile ... even though it's now 'half gummy' !
Thank you for posting this very useful information,
My husband has just completed intensive chemo and 7weeks of radiotherapy. We ere given virtually no advice beforehand and now he has finished his teeth are very stained black and gums have receded back a huge amount. Hygenist has started to try and remove staining but has already cost us £35 and he has got to back again as it is so bad. Cant get a dentist checkup until end of May .Do you think that's acceptable or right? Diana
Thank you for your comment. I'm sorry to hear about your husbands situation. It is difficult to comment on an individual scenario as each hospital will have their own protocol and varying availability of services and specialists. If your husband had radiotherapy directly to the jaws then he will be at risk of ORN and will require careful dental management. If he is suffering from a dry mouth I hope the tips in the blog are useful. Maintaining an excellent oral hygiene is very important as this will help reduce his likelihood of developing problems. I would recommend you discuss this with your oncology/surgical team as they may be able to refer him to a local specialist where his treatment should be provided under the NHS. I hope this helps.
I had an operation to cure my mouth cancer in march 2011. It was followed by twenty RT treatments. The operation left me unable to eat or drink. I feed via a tube in my stomach. About a year after the main operation I had to have another much smaller operation to remove part of my jaw as the bone had died. It looked quite bad before as part of the jaw bone became viable and had to be dressed every day. It was successful. I am now quite used to my new life and quite used to feeding via a machine at night. The main problems for me is the loneliness as I have never had a family of my own. I had to move back in with my parents. I was lucky they were able to take me in. I am too ill to work full time.
hi i have a lump whch is visable inside and out for over a year and its only because the emergency dentist demanded i visit my Dr and ask for a scan i got one couple of weeks ago. The drs (even tonight as i have earache for around a yr plus im barely eating and drinking) half read my scan results mumbling bout sizes,then said need blood test asap and gave me amoxacilian AGAIN. Not one dr has looked in my mouth except quickly, felt under my ear (which is painful) pressing asking if it hurts once ive jumped out the seat. I know you cant tell me anything really but surely i should b looked properly.
Plus side is my ar of dentists which is soooooo bad i have now made an appointment with the dentist who said about it (still ages away for app) as i dont know how,why, or what........loved your bit of advice as its the first.
What should i do please ?
Hello Homechoice and stik73. Just to say that there is a group here specifically for Head and Neck Cancer ... if you click here it will take you there.
I'm glad to hear you are adjusting to the changes since your surgery, and that you have the support of your parents. I'm very sorry to hear about your loneliness, have you had a look at the groups Joycee mentioned, or if you feel like talking to someone you can call the Macmillan support line on 0808 808 0000 (Mon-Fri 9am-8pm) for a friendly chat and advice. I hope this helps.
If you are in pain then you should ask your doctor about pain relief in the meantime. Hopefully your medical team will have answers for you soon, you might find it useful to write down your questions incase you forget when you are there. You could also call the Macmillan support line if you want to talk things through with someone.
That's great that you have arranged to see the dentist again. It is very common to have a fear of going to the dentist but if you explain that I'm sure they will understand and be able to help, talk you through everything and make it as easy as possible for you.
I wish you all the best,
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