INSTRUCTIONS FOR PATIENTS UNDERGOING RADIATION TREATMENTS TO THE HEAD AND NECK This information is designed to answer some of your questions during radiation treatments. GENERAL INFORMATION You are about to begin receiving radiation treatments to your mouth, throat, or nasal cavity. To help reduce unwanted complications and/or delays in your treatment, your physician requires your complete cooperation. During treatment the areas involved will become dry, sore, and often appear to be infected. You may experience thickened saliva, difficulty in swallowing, changes in taste, and nausea. These reactions cannot be avoided. However, they can be reduced by self-care throughout your treatments. The information provided in this pamphlet is designed to assist you in maintaining proper oral and nutritional health. We recommend that you do not smoke tobacco or drink alcohol during your treatments, as these will be irritating to your mouth and throat and may increase reactions in these areas. MOUTH/THROAT/NOSE IRRIGATION Approximately 7-10 days after beginning treatment, you may experience some soreness and dryness in your mouth. To aid in your comfort, the following is suggested: Mix ½ tsp salt in two cups of water. Use generous amounts 4-6 times a day, swishing and gargling actively. (Use after meals and at other convenient times). DENTAL CARE If you have dentures of any type, a dentist who is familiar with the problems resulting from radiation treatments should examine these. Unless your doctors tell you that you may use your dentures normally, leave them out during the course of treatment until you are told to wear them again. If you have teeth, you may need to see a dentist familiar with the problems associated with radiation treatments. Radiation treatments can cause a decrease in the amount of saliva in the mouth. This is called Xerostomia. If left untreated, it can cause your teeth to decay to the point where they may break off at the gum tissue. You need to consult your dentist for an oral examination. Another problem that can occur following radiation therapy is a severe infection in the jaw. Be aware that after radiation treatments, the areas that have been treated heal much more slowly. For this reason, following the guidelines given best prevents these problems. There are two important parts to your oral examination. First, your mouth will be carefully examined to check all teeth for decay. This will include x-rays of your teeth and jaws. Second, you will be given special instructions for the care of your mouth, including fluoride therapy. Careful attention to your oral care will prevent most of the problems of decay and infection in your teeth and jaws. YOU MUST COOPERATE AND TAKE AN ACTIVE PART IN YOUR TREATMENT! SORE MOUTH AND THROAT Brush teeth with soft toothbrush after every meal and at bedtime. Floss teeth as usual. Perform mouth/throat care at least 4-6 times per day. Consult dentist for oral care and instruction of use of fluoride application. Use topical anesthetic prior to meals and when needed. Use Carafate® or Vitamin E. Minimize use of dentures; see your dentist if they are not fitting well. Utilize pain medications. Frequently inspect your mouth for infection. Modify your diet to include soft, non-acid, non-spicy foods and avoid extreme temperatures. Maintain hydration, the drinking of fluids. Avoid hard, coarse foods. PAIN RELIEF During your treatments, your mouth and throat will become uncomfortable. Losing your taste is a major problem. Mouth rinses as described in the previous paragraphs should be used first when problems begin. Continuing pain should be treated with either Aspergum®, crushed aspirin (2 in a cup of water used as a rinse and swallowed), or medication prescribed by your doctors. Notify your doctor of any earaches or sudden loss of hearing. This may be due to hardening of earwax or an accumulation of fluid in the ear. SKIN CARE Proper care of the skin includes keeping it clean and dry. Wash with lukewarm water and pat dry without removing the marks outlining the area of your radiation treatments. This skin may become red and irritated during the treatments. The staff may recommend the use of over-the-counter ointments available at The Regional Cancer Center or at most drug stores. Do not use salves, lotions, ointments or powders on the treated skin, unless directed to do so. You are advised not to use shaving lather/cream and a regular razor during the course of your radiation treatments but, instead, utilize an electric razor. Do not use a pre-electric or aftershave lotion. The radiation therapy will reduce the growth of hair in the treated area. LARYNGITIS When the larynx or voice box is in the treatment field, laryngitis can occur. It may be mild or severe. It usually occurs after the second week of treatment and resolves once treatment is completed. NUTRITIONAL CARE Maintaining your weight during treatments is very important, even if you are overweight. Why is this so? Patients who eat well are able to withstand the side effects of treatments better. A balanced diet can help maintain your strength and prevent body tissues from breaking down. Adequate protein in the diet helps to rebuild the normal tissues that have been affected by the treatments. Maintaining adequate nutritional intake and your weight may be difficult for a variety of reasons. These include: a loss of appetite, loss of taste, dryness of the mouth and soreness of the mouth and throat. These side effects will require you to avoid foods that are dry or those that require a lot of chewing. The soft and liquid foods listed in this pamphlet will be easier to swallow, require little or no chewing, and are not acidic or tart, so as not to cause a burning sensation. A feeling of tiredness or fatigue often accompanies treatment, but it will become progressively worse if your nutritional intake is not adequate. Many patients ask about vitamin pills. The best source of vitamins and minerals is foods. During illness, your food intake may be less than optimal, and a vitamin and mineral supplement may be needed. The best choice is a balanced multiple vitamin/mineral supplement which contains up to 100% of the "Daily Value" of most nutrients. It is not a good idea to take "mega-doses" of any vitamin or mineral, including the antioxidant nutrients, as they may interfere with the effectiveness of your treatments. Fruits and vegetables are the best sources for naturally occurring antioxidants. GENERAL GUIDELINES Eat small amounts frequently, as often as 6-8 times daily. Avoid citrus fruits and juices and acidic foods (oranges, lemons, tomatoes) if your mouth or throat is sore. Avoid hot beverages and foods and highly seasoned foods. Also, very cold foods may be irritating to some people. Avoid filling up on non-caloric beverages, such as coffee, tea, diet soda/pop. Avoid dry foods like toast or crackers unless you soak them; these may scratch delicate tissues. Use butter, gravies or cream sauces on foods to moisten them. If you are unable to chew solid foods, you can blenderize them. Although the food does not look appetizing, it can provide you with all the needed nutrients. TASTE CHANGES Sherbet or Italian Ice helps to eliminate bad tastes left in your mouth. Try different foods, spices or herbs to make foods more appealing. Chew food longer to allow more contact of the food with the taste buds. Perform mouth care before and after meals to remove residual tastes. The salt mixture mentioned previously works well Taste changes may last for months after your radiation treatment but may recover sooner depending on the radiation dose. SUGGESTIONS FOR INCREASING CALORIES AND PROTEIN Cook hot cereal with whole milk, rather than water, and add cream, sugar, butter or margarine. Add cheese to eggs or omelets. Add extra butter or margarine, gravy or cream sauces to vegetables and potatoes. Use half and half cream with making milkshakes, eggnog, puddings or cream soups. Make a higher protein, higher calorie milk by adding 1-cup dry milk powder to 1 quart of whole milk. Use this mixture as you would ordinarily use milk. Peanut butter is a good source of protein. Use it for snacks or in cooking. Spread it on toast or bread. Use "Instant Breakfast®" powders, available at grocery stores, to make milkshakes. There are a number of commercially made nutritional supplements. Some are designed to provide a completely balanced diet and can be used as the sole source of nutrition, if necessary. Most require little or no preparation if fatigue is a problem. Examples include: Boost®, Ensure®, Resource®, Enlive®, Breeze® and Resource® fruit beverage. DRY MOUTH OR THICK SALIVA Perform mouth care after each meal and report dryness to the staff. Drink 8 to 12 cups of liquid a day, and take a water bottle with you when you leave home. (Drinking lots of fluids helps to loosen mucus.) Use a straw to drink liquids. Eat soft, bland-tasting foods that are at room temperature or cold. Try blenderized fruits and vegetables, soft-cooked chicken and fish, well-thinned cereals, Popsicles®, and slushies. Add broth, soup, sauces, gravy, butter or margarine to moisten foods. Suck on lemon drops, frozen grapes, Popsicles®, or ice chips. (Avoid chewing ice as it can damage teeth.) Limit your consumption of caffeine-containing products such as coffee, tea, colas, and chocolate. Use a cool mist humidifier to moisten room air, especially at night. (Be sure to keep the humidifier clean to avoid spreading bacteria or mold in the air.) OTHER HINTS (You do not need a prescription for the following items. Most drugstores keep them behind the pharmacist's counter, instead of on the shelves.) Avoid mouthwashes such as Listerine® and Scope®. They contain alcohol, which can make mouth dryness worse. You can purchase Biotene Alcohol-free Mouthwash®, or you can make your own mouth rinse with 1 teaspoon of baking soda dissolved in 1 quart of water. Biotene® also makes antibacterial toothpaste that helps reduce gum inflammation, as well as an antibacterial chewing gum that stimulates the production of saliva. Oral moisturizers act to seal in moisture in your mouth. Your pharmacy may carry Mouth Kote®, Oral Balance®, or Oral Moist®. Saliva substitutes are helpful if your salivary glands have been removed by surgery or damaged by radiation. These products add moisture to your mouth. They can be used with oral moisturizers. Your pharmacy may carry Xerolube®, Glandosane®, or Salivart Saliva Substitute®. You may find it helpful to simply carry a bottle or spray bottle filled with water to help with mouth dryness. Return To Commonly Asked Questions