Mouth Cancer Action Month

November was a rather busy month for awareness days, weeks and months, and whilst it’s a couple of days late, the following blog recognizes Mouth Cancer Action Month. Here’s one of our Ask An Expert dentists, Judith and Lynsey, to share with you some information and tips on coping with mouth cancer.

Mouth problems are a common side effect of head and neck cancer and its treatment. Getting support from a dental professional early in the process can really help to minimise discomfort and improve your quality of life. 

Before treatment – get a specialist assessment:

If you’ve been diagnosed with head and neck cancer, you will likely be referred to a specialist clinic for a full dental assessment before treatment starts. This clinic will likely continue seeing you during and after treatment.

At the assessment, your dentist will:

• Identify and treat any existing dental disease
• Assess your risk of developing dental disease in the future
• Advise you on good mouth hygiene and how to prevent dental problems during treatment
• Give diet advice
• Smooth sharp edges of teeth or fillings to prevent trauma to the mouth lining
• Assess dentures if you wear them. You may be advised to remove your dentures during your therapy, or reduce the time you wear them to avoid discomfort.

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. 

During treatment – good mouth hygiene tips:

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. They will most likely liaise with your oncology team to work out the best time during your treatment to have any urgent dental work done. A dental professional should support you to help prevent any causes of infection and ensure your mouth is kept healthy and clean.

• They may advise you to use alcohol-free chlorhexidine mouthwash.
• Brush with a soft toothbrush if possible. Tepe do a silk brush which is so gentle and will help keep a sore mouth clean
• There are various mild toothpastes available for example OroNurse, these might be useful if mint flavoured toothpaste is irritating your mouth.
• If you experience discomfort to the point where you cannot brush, then you can soak gauze or small sponges in chlorhexidine mouthwash or water and use them to clean inside the mouth, but make sure you resume normal tooth brushing as soon as you can.
• Patients at risk of aspiration should sit upright and have suction available during cleaning.
• Avoid: hard foods, spicy foods, strongly-flavoured toothpastes, alcohol, smoking, fizzy drinks, acidic fruit, and fruit drinks - these can contribute to side effects and damage the teeth and mouth lining.

Common side effects:

• Mucositis – acute inflammation of the mucosa (lining of the mouth) which may occur following radiotherapy or chemotherapy. It can cause the mucosa to become uncomfortable, red and sometimes ulcerated (typically healing 2-3 weeks after treatment) We would advise avoiding foods, drinks and mouthwashes that irritate your mouth.  Stick to plain, bland, softer foods. There are also lots of products that can be applied directly to the mouth to help make things more comfortable such as Gelclair Mucodis or Caphosol mouthwash or Difflam spray or mouthwash. Most of these products require a prescription.  Your oncologist, oncology nurse and dentist can help you with this.
• Dry mouth (xerostomia) – saliva becomes thick and there is less of it. This can be a permanent side effect. Sipping lots of water and using sugar free sweets can help stimulate saliva flow.  There are also saliva substitutes and replacements that come in the forms of gels/sprays that can be prescribed for you.  Speak to your GP or oncology team about these.
• Infections – commonly thrush (candida). This is usually seen as a white coating or white plaques inside the mouth – antifungal medicine will be provided if this is detected.
• Loss of appetite and altered taste (during treatment).
• Jaw stiffness (trismus) can also be long lasting.

After treatment:

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. 

Prevention of dental decay:

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:

• Using high fluoride concentrated toothpaste or mouthwashes. Fluoride mouthwash can be used once daily at a different time from tooth brushing.
• Regular application of fluoride varnish to minimise tooth decay. This can be done by your dentist up to twice per year.
• Rinsing dentures after meals and cleaning them at least once daily by brushing with a toothbrush. It is advisable to do this over a basin filled with water to prevent damage if dropped. The dentures should be soaked in either chlorhexidine mouthwash or dilute sodium hypochlorite solution (Milton) overnight, provided there are no metal components. Dentures should always be removed at night.

Osteoradionecrosis:

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:

• Stop smoking or cut down.
• Make sure dentures fit correctly.
• See your dentist regularly.
• Maintain an excellent standard of oral hygiene (assisted by a dental professional).
• If a dental extraction becomes necessary, please seek advice as precautions are necessary and you will usually be treated by a specialist. 

Coping with a dry mouth:

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. Some are available over the counter and some are prescription only.

• Medication
• Sugar free chewing gum
• Frequent sips of water
• Gels or lozenges
• Pastilles (only for edentulous patients as they are acidic and cause damage and sensitivity to the teeth)
• Acupuncture 

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.

Please feel free to visit our Ask An Expert section and ask any further questions that you might have about mouth cancers – our professionals are more than happy to help. If you're affected by a head and neck cancer, you might also like to visit our head and neck cancer group.