Head & Neck

Dental and Oral Side Effects

People with head and neck cancer often have dental and oral side effects from the cancer and its treatment. You and your health care team can take steps to help prevent and manage these side effects. Your team may include various specialists to help with dental problems, including your usual dentist, other dental specialists, a dietitian and a speech therapist.

The risk of dental side effects is lower for people with good oral health before treatment. If possible, see a dentist before treatment begins to treat decayed or infected teeth or other mouth problems. This early step can help prevent side effects or make them less severe. Also, it is important to maintain good dental hygiene during treatment. General dental hygiene recommendations for people with head and neck cancer include the following:

  • Brush your teeth and gums with a soft-bristled toothbrush two or three times each day.
  • Use fluoride toothpaste with a mild taste. Flavored toothpaste can irritate your mouth.
  • If you usually floss, keep flossing at least once a day. If flossing causes bleeding or other problems, tell your health care team. If you do not usually floss, ask your health care team if you should start.

After treatment begins, check your mouth every day because many of the dental and oral problems caused by treatment can be seen or felt. The following are common dental and oral side effects, along with strategies to manage them. If you have side effects, tell your health care team as soon as possible. The sooner your team members know, the sooner they can help control them.

Dry Mouth

Dry mouth occurs when the glands that make saliva are damaged, which often happens after radiation therapy. It can be uncomfortable and increases the risk of cavities and oral infections. Ask your doctor if any over-the-counter or prescription medications may help.

What to Try

  • Drink 8 to 10 cups of liquid a day. Keep a water bottle nearby at all times to help remind you to drink.
  • Suck on ice chips.
  • Chew sugarless gum or suck on sugarless hard candy to stimulate saliva.
  • Drink smoothies and slushies.
  • Avoid soda, fruit juice, caffeine, cigarettes, chewing tobacco and alcohol, which can dry out the mouth.
  • Avoid foods that stick to the roof of the mouth, such as peanut butter.

Jaw Stiffness

Surgery, radiation therapy and stress can cause jaw stiffness, which, in turn, can cause problems swallowing. Jaw stiffness can result in malnutrition and slower healing time, and can be difficult to treat once it occurs. Preventing jaw stiffness is important and is more likely to be successful than treating it after it occurs.

What to Try

  • Ask your doctor if exercising your jaw muscles is appropriate for you. A common exercise is to open and close your mouth as far as you can without causing pain.
  • Ask your doctor if a prescription medicine could help relax your muscles or relieve your pain.

Mouth Pain and Soreness

Pain and soreness of the mouth are common in people with head and neck cancer and can affect quality of life. Good hygiene and changes in your diet may help.

What to Try

  • Try topical medications for pain. Rinse your mouth before applying the medication to the gums or lining of the mouth.
  • When eating, take small bites and chew slowly. Sip liquids with your meals.
  • Eat moist, soft foods, such as applesauce, cooked cereals and scrambled eggs.
  • Avoid foods that are sharp, crunchy, hot, spicy or acidic.
  • Do not eat or drink foods or beverages that are very hot or very cold.
  • Avoid alcohol and all forms of tobacco.

Oral Mucositis (mouth sores)

Oral mucositis is an inflammation of mucous membranes in the mouth. It can appear as red, burn-like sores or as ulcer-like sores in the mouth. It is often caused by chemotherapy or radiation therapy.

What to Try

  • Ask your doctor about medications that can help prevent or minimize oral mucositis.
  • Swish ice chips in your mouth.
  • Keep your teeth and mouth clean. Brush your teeth every four hours and also at bedtime.
  • Use a soft-bristled toothbrush, and replace your toothbrush often.
  • Keep your mouth moist by drinking water or using a water-soluble lubricating jelly.

Swallowing Problems

If you have swallowing problems, you may be referred to a speech therapist. A speech therapist can teach you techniques to make swallowing easier. Call your health care team right away if you cough or choke while you are eating.

What to Try

  • Chop or puree your food in a blender or food processor.
  • Try eating soft or liquid foods. Thick fluids may be easier to swallow than thin ones.
  • Drink high-calorie and high-protein liquids, such as protein shakes, especially if you are unable to eat enough regular protein-rich food.

Tooth Decay

Tooth decay is more likely to occur in people being treated for head and neck cancer. In addition to good dental hygiene, the following may help prevent tooth decay.

What to Try

  • Avoid sugary foods and drinks, which can cause cavities. If you use gum or hard candy to help control dry mouth, choose sugar-free options.
  • Sip water to help with dry mouth, which contributes to tooth decay.
  • Ask your dentist about fluoride gel to help prevent cavities.

Additional Resources


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