Preventing local and/or systemic infection is one of the main aims of managing oral symptoms. Evidence strongly supports a consultation with a dental team experienced in caring for patients undergoing treatment for head and neck cancer PRIOR to the start of radiation therapy.rr It is important that any dental treatment is undertaken in a timely manner, to allow for sufficient wound healing prior to the commencement of radiation/chemoradiation therapy.
Ideally, a thorough dental assessment should be undertaken by an oncology dental specialist approximately 1 month prior to the patient starting treatment.
Oral cavity monitoring should occur more frequently during chemo- and radiation therapy, to enable early intervention and reduced severity of side effects which include:
- oral mucositis - this is the most significant acute side effect reported by patients undergoing treatment for head and neck cancer, and is a potential source of life-threatening infection. Onset of oral mucositis typically occurs by the third week of treatment. Symptoms can be more severe, and onset earlier (within 7-12 days) if the patient is receiving concurrent chemoradiotherapy
- oral infection - preventing local and systemic infections is an important part of therapy. A fungal, bacterial or viral culture is recommended if infection is suspected. The incidence of candidal colonisation usually increases throughout the course of treatment, particularly in the presence of xerostomia
- xerostomia - or dry mouth, is a common and significant side-effect of radiation to the oral tissues including salivary glands, mucosal membranes, jaw muscles and bone. Patients experiencing xerostomia are more susceptible to periodontal disease, caries and oral fungal and bacterial infection
- fibrosis - of the jaw muscles is another recognised side-effect of radiation therapy and can result in trismus. Early referral to a speech pathologist to commence appropriate therapy may be helpful to prevent or reduce fibrosis.
Basic oral care should be encouraged as this may reduce the incidence, severity and duration of oral complications, which in turn can reduce the need for dose modifications. It is imperative that patients continue their oral care regimen throughout their course of cancer therapy and beyond.
Read more about mouth care for patients receiving chemotherapy and/or radiotherapy in the patient information sheet
Read more about how to manage problems caused by radiotherapy to the head and neck in the patient information sheet.
Read more about oral mucositis.
Long-term management and follow-up of patients after radiation therapy is recommended. Patients should be reviewed by a dentist at least every 3 months after completing radiation therapy. Regular follow-up will facilitate the management of any chronic complications that may occur, such as osteoradionecrosis (ORN) of the jaw.