Head & Neck Radiation: Oral Side Effects

MD Anderson Cancer Center
Date: May 2012

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>> To help manage thick secretions and dry mouth, we recommend drinking plenty of fluids during the day.  If you don't drink enough fluids, the secretions get thicker.  If you're unable to drink enough fluids, we can schedule you to receive IV fluids to help keep your hydrated.  Use a recipe in your packet for the baking soda and salt mixture to help loosen the secretions.  Swish and gargle flat diet Ginger Ale.  This may help break up secretions.  Use a cool mist humidifier for your bedroom to help moisten the air.  This can help loosen the secretions.  Sleep at a 30 degree angle to help prevent gagging and possibly inhaling any secretions which can lead to pneumonia.  Ask your doctor about medicines that may help loosen or dry up the secretions.  Once you're done with treatment, the thick saliva will dry up over the next one to three months.  After the thick secretions have dried up, you will have a dry mouth which is a permanent side effect.  Over the next one to two years, your saliva glands may recover and produce more saliva.  Some patients get more saliva back than others. 

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An important part of mouth care is preventing infection.  If any part of your mouth or throat is in the treatment area, the mouth will become acidic.  This means that the Ph level in your mouth is low and this can lead to infections in the mouth.  The mouth will become acidic when you begin treatment and will remain so throughout treatment and for several months after treatment.  To prevent mouth infections, you must keep the mouth clean and alkaline which means there's a normal Ph level.  To do this, brush and floss your teeth daily as directed by your cancer dentist.  Use fluoride toothpaste or fluoride gel daily during treatment and for the rest of your life.  Start using the baking soda mixture on the first day of treatment.  Swish and gargle with it at least four to six times a day.  Try to do this before and after meals.  Rinse every day during radiation treatment and continue this routine for at least six months after treatment is complete.  Also get your teeth cleaned by a dentist two to three times a year to remove plaque buildup, check for broken teeth, and infections.  You'll need to practice good oral hygiene for the rest of your life in order to prevent tooth decay and infections. 
For dry mouth, use nonalcoholic mouthwash daily.  Use an over-the-counter oral moisturizer to help temporarily moisten the oral cavity.  Ask your doctor about medications that might help stimulate the saliva glands.  Try acupuncture; some people find it helpful.  Take small bites of solid foods and chew well.  You may need to wash foods down with fluids.  Wet your food with sauces or gravy, try to chew sugarless gum or suck on sugarless candy.  And keep bottled water with you at all times. 

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If any parts of your mouth, neck, or throat are in the treatment area, you'll have some pain in these areas.  You'll receive pain medication to help lessen the pain if needed.  It is important to take your pain medication regularly because this will help control your pain better.  Early reactions you can expect during the first two weeks of treatment are readiness and inflammation of the mouth and throat.  There's usually mild pain associated with this.  During weeks 3 through 4, ulcers will likely develop in your mouth and throat, causing an increase in pain.  During weeks 5 through 7, the ulcers may increase in size, causing even more pain.  After your last treatment, the ulcers may continue to persist or get worse for about 1 to 2 weeks before they begin to improve.  Most of these ulcers and the pain related to these ulcers will completely heel within 6 to 10 weeks after your last treatment so hang in there. 

Pain medications can cause constipation so you'll receive information on how to prevent this.  It is important to keep your bowels moving on a regular basis.  If you have severe constipation, you'll receive instructions on how to manage it.  This usually includes the use of enemas. 
If your mouth, neck, or throat is in a treatment area, it will become more and more difficult to swallow due to swelling.  About half way through treatment, you may have to avoid eating solid foods and switch to softer foods or a liquid diet.  Try to eat smaller meals more often.  If you experience difficulty swallowing, this can increase your risk of aspirating fluids which means fluid can go down into your lungs instead of your stomach.  A speech pathologist can evaluate your risk for aspiration and teach you swallowing techniques and exercises to help decrease this risk.  Once you complete treatment, the swelling in the these areas will begin to improve within two to four weeks and will continue to improve over the next few months.  As the swelling improves, so does your ability to swallow. 

Avoid the following items that can irritate the mouth and throat:  tobacco products; alcoholic beverages and any products that contain alcohol; spicy foods or foods with lots of seasoning; hot foods and liquids; acidic fruit juices such as orange juice and tomato juice; carbonated drinks; foods with sharp edges such as potato chips and pretzels; store bought toothpaste, except for those approved by your doctor; and mouthwashes with alcohol. 

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