Specific issues that may present
One of the main problems for mouth cancer patients dry mouth a consequence of radiotherapy and or drug treatments. This can make the mouth feel uncomfortable, and can affect eating, drinking and swallowing. A lack of saliva also means that patients have less protection from soft tissue infections in the mouth and dental decay.
The care of the patient after mouth cancer treatment will depend on the presentation. Simple advice which can be of help for patients includes:
- Avoiding tobacco and alcohol
- Maintaining hydration of the mouth – may need artificial saliva or salivary stimulants
- Avoiding hot drinks and spicy foods if these cause symptoms
- Using a humidifier at night if dryness an issue
Brushing teeth gently after each meal with a soft toothbrush
This is a complication of radiation therapy and may appear in the first 2-3 weeks of treatment. It may present simply as patchy redness through to frank ulceration of the oral mucosa. Its occurrence is related to radiation dose and target site. If a combined radio/chemotherapy approach is used, Mucoscitis can be more severe. It is important to distinguish Mucocitis from bacterial or fungal lesions and mouth swabs should be taken.
Radiotherapy may reduce saliva production and damage taste buds. As a result patients may complain that food tastes excessively salty. This may lead to reduced intake or a switch in diet to highly sugared foods. The alteration in taste and the inflammation is usually transient, with recovery of taste in 3-4 months following the cessation of therapy. Dry mouth however can be an enduring phenomenon.
Treatments for Mucoscitis are symptomatic and may include topical oral corticosteroids, antacids, topical lidocaine and sucralfate (all off licence). Oral analgesia is occasionally necessary.
A relatively uncommon but severe side effect of radiation treatment, Osteonecrosis of the mandible leads to tissue death. It presents as a non-healing hypoxic wound and surgery is sometimes needed to remove the tissue (and any involved teeth) the wound will be left open and will epithelialize eventually.
The inability to open the mouth adequately. This can arise either from surgery disturbing the function of the muscles/jaw or from radiotherapy induced fibrosis of the muscles of mastication. The management is physiotherapy and preventative measures involve encouraging movement at the time of radiotherapy or as soon after surgery as possible.