Caring For Your Teeth after Head and Neck Radiotherapy

Patient Experience

  • Reference Number: HEY944-2025
  • Departments: Oral Surgery, Dentistry and Max Fax
  • Last Updated: 1 January 2025
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Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

  • Radiotherapy is a treatment used to treat cancer
  • Radiotherapy to the head and neck can cause side effects in the mouth
  • Your mouth needs to be as healthy as possible before the start of treatment to avoid problems later
  • Infected teeth and gums can be a risk during cancer treatment, so a thorough pre-dental check-up and advice is important
  • About two weeks after the start of radiotherapy you may notice changes.

How does radiotherapy affect your teeth?

Dental decay associated with a dry mouth:

Radiotherapy to the head and neck can cause damage to the salivary glands which reduces the quality and volume of saliva produced, resulting in a dry mouth. Saliva is vital to protecting your teeth against decay as it washes the sugar (carbohydrate) off your teeth and neutralises acids. Sugar and Acid are the main cause of tooth decay. Therefore, a poor diet high in sugary foods and flavoured or fizzy drinks can lead to fast widespread dental decay.

Images showing dental decay

OsteoRadioNecrosis (ORN):

Radiotherapy reduces the blood supply to your jaw bone and therefore the ability of the bone to heal. This means, if you need a tooth removing after radiotherapy, you will likely receive Hyperbaric Oxygen (HBO) Therapy to improve the healing, but there is a chance that the bone associated with the tooth could die, causing a painful, long-standing condition called Osteoradionecrosis (ORN).

This is also why some patients may require removal of badly broken down or infected teeth before radiotherapy to reduce the risk of ORN. This condition can be very hard to treat, therefore it is easier to avoid it in the first place by looking after your teeth.

Other effects can include:

  • General soreness
  • Altered/loss of taste
  • Difficulty chewing and swallowing

These effects can improve over time and can be relieved with frequent sips of water but can often be permanent.

How to look after your teeth?

 It is vital that you look after your teeth. Fluoride alone will not protect your teeth from decay unless you clean your teeth thoroughly well and limit the frequency of sugar in your diet.

  • Water and milk are the preferred drinks.
  • Avoid sugary drinks and food, especially in between meals including: Boiled sweets, Biscuits, tea and coffee with sugar, fruit juices, fizzy drinks (including sugar free).
  • AVOID FIZZY DRINKS including FIZZY WATER as these contain carbonic acid.
  • Avoid sucking boiled sweets to relieve your dry mouth as this can cause widespread dental decay. Try and chew sugar free gum instead or discuss saliva substitutes with your dentist / doctor.
  • If you have been prescribed Fortisips, DO rinse your mouth well with water after your drink to ensure that Fortisips does not coat your teeth for the rest of the day!
  • You can use the Fluoride toothpaste only up to 3 times a day. So if you snack in between your meals, brush your teeth without toothpaste. Rinse well with water after flavoured drinks, but these are best avoided.

Why all the fluoride products?

Radiotherapy increases your risk of dental decay. Fluoride helps prevent decay by hardening the teeth. Harder teeth resist decay more effectively.

Use the Duraphat fluoride toothpaste for life:

  • Three times daily: after breakfast, lunch and dinner
  • Spit out remaining toothpaste.  Do not rise with water
  • DO NOT eat or drink for 20 minutes.

If you have access to Fluorigard outhwash:

  • Once daily post Fortisips
  • Rinse vigorously and spit out
  • DO NOT eat or drink for 20 minutes

Custom Fluoride mouth trays

  • Use daily at a different time to other fluoride
  • Load tray with Duraphat toothpaste
  • Place tray in the mouth for 10 minutes
  • Spit out excess and do not rinse, eat or drink for 20 minutes.

What else should I do?

  • Attend your dentist regularly every 3 months and tell them about any problems you are experiencing
  • Stop smoking—you can ask your doctor with help for this
  • Reduce alcohol consumption
  • Keep dentures out at night
  • Ask your dentist/doctor about over the counter pain relieving mouthwash/spray (Benzydamine hydrochloride) for severe mouth discomfort.

PLEASE register with a dentist as your teeth needs frequent checks.

If after reading it you have any concerns of require further explanation, please discuss this with a member of the healthcare team who have been caring for you.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Restorative Dentistry Department on tel: 01482 604444

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