Special
Care Instructions for Radiation Patients
How
to Use Brush-on Fluoride (head and neck radiation patient)
1. The best time to use fluoride
is at bedtime.
2. Remove partial or full
dentures from the mouth.
3. Brush teeth thoroughly
with soft toothbrush and regular toothpaste. Floss teeth by sliding
the floss up and down each side of each tooth. A supersoft toothbrush,
such as one made by Biotene, can usually be used without causing the
gums to hurt or bleed. Note: It is very important to remove all food
and plaque from between teeth before using fluoride. Food and plaque
can prevent the fluoride from reaching the surface of the tooth.
4. Place a thin ribbon of
the fluoride gel onto your toothbrush. . Either 0.4% stannous fluoride
(Gel Kam) or 1.1% sodium fluoride (Prevident) may be used. Thoroughly
brush the fluoride into all surfaces of the teeth, especially where
the tooth meets the gum tissue.
5. Allow the fluoride to
remain on the teeth for 5 minutes.
6. After 5 minutes, thoroughly
expectorate (spit out) the residual fluoride. Very Important - do not
rinse mouth, drink or eat for at least 30 minutes after fluoride use.
7. Head and neck radiation
therapy patients should begin fluoride use no longer than one week after
radiation therapy is completed. Repeat daily for as long as you have
natural teeth remaining!!
RADIATON
CARIES- WHY DOES IT OCCUR?
Radiation caries is defined
as tooth decay that results from radiation-induced dry mouth (xerostomia).
The increased incidence of tooth decay in postradiation patients is
caused by radiation to the major salivary glands and is not due to radiation
of individual teeth. This means that patients having received radiation
to one or more of the major salivary glands are susceptible to radiation
caries whether or not teeth have been included in the field of radiation.
Radiation caries can occur because of the inability of the saliva to
destroy bacteria that causes tooth decay and its inability to remineralize
the tooth enamel. The decrease in salivary flow and salivary pH also
contribute to the process of tooth decay.
NOTE: RADIATION CARIES
CAN OCCUR WITHIN WEEKS AFTER RADIATION THERAPY IS COMPLETED.
SUGGESTIONS
TO HELP ALLEVIATE DRY MOUTH (XEROSTOMIA) CAUSED BY RADIATION
1. Use pilocarpine (Salagen)
5mg, qid, (prescription required.)
2. Try special food preparation - blended and moist foods are easier
to swallow.
3. Use artificial saliva (available over-the-counter.)
4. Sip plain water throughout the day (usually preferred over artificial
saliva by most patients.)
5. Try Biotene brand, over-the-counter, dry mouth products (toothpaste,
alcohol- free mouth rinse and OralBalance lubricating gel.)
6. Avoid the use of alcohol-based mouth rinses.
7. Try water and glycerin (few drops only) mixed in a small aerosol
spray bottle.
8. Avoid the use of tobacco and alcoholic beverages.
ORAL
CARE DURING HEAD AND NECK RADIOTHERAPY
It is extremely important
to keep the mouth clean and healthy during head and neck radiation,
to help reduce the risk of oral infection. A professional dental cleaning
prior to radiation is highly recommended. Following are some suggestions
for reducing oral complications during head and neck radiation.
1. The radiation oncologist
or dentist will prescribe antiviral and antifungal medications when
appropriate. These medications are usually very effective in lowering
the risk of viral and fungal (thrush) infections in the mouth. Fewer
infections in the mouth results in less pain and better nutrition.
2. Toothbrushing should be
performed at least twice daily. Supersoft toothbrushes* are available
that will not cause irritation, if used appropriately. Brushing should
be done in a gentle, circular motion. To be thorough, brush teeth in
a systematic fashion to include all surfaces of every tooth. Flossing
is recommended as well as the use of a water-irrigating device, on a
low setting, to eliminate food between teeth.
Hint: The bristles
of the supersoft toothbrush will become even softer if held under warm
water before use.
Hint: It is a good
idea to gently brush the tongue, palate and gums with a supersoft toothbrush
on a daily basis in order to remove harmful germs.
Hint: If a particular
toothpaste burns or irritates the mouth, try a toothpaste that is specially
made for children or people with dry mouth.*
3. Saline or saltwater and
baking soda rinses (1 tsp. salt and 1 tsp. baking soda to one quart
of water) may be used throughout the day to sooth the sore and dry mouth.
When using mouthrinses, be sure to stagger their use throughout the
day, allowing at least one hour before another mouthrinse. Using several
different mouthrinses at one time will reduce their effectiveness.
4. To ease the pain of mouth
ulcers, rinse with viscous lidocaine about 15 minutes before eating.
Some pharmacies can also make flavored lollipops with medications that
have a numbing effect (tetracaine) to use before eating. Eat small bites
and chew thoroughly when using these numbing medicines to reduce the
risk of choking.
5. Keep mouth and lips well
lubricated with a water-based lubricant*. Petroleum jelly repels water
and is not recommended for use.
6. When the mouth is sore,
remove dentures and leave them out until the mouth heals. All full dentures
and partial dentures should be disinfected before each use. Dentures
without metal may be soaked daily in a fresh solution of Clorox and
water (1 tbs. Clorox to 1/2 cup of water). Rinse the dentures well before
placing them back in the mouth.
*Biotene supersoft toothbrush,
mouthrinse without alcohol, water-based lubricant (OralBalance) and
toothpaste are specially made for people with dry and sore mouths. They
can be obtained through most pharmacies and are over-the-counter. The
manufacturer of these products is Laclede , 15011 Staff Court, Gardena,
CA 90248, 1-800-922-5856.
