When you’re faced with a cancer diagnosis, your primary concern is likely to be, “How do we cure it?” You’ll be focused on understanding your treatment options and finding the best treatment for you and the specific type of cancer you have. What you might not think to ask about at the time, however, are the many side effects of cancer treatment and the ways in which those treatments might affect you during and after treatment.
If you have radiation, one of these side effects is dry mouth, or xerostomia. It typically begins during your treatment, and may be long-lasting, even after your treatment has ended. Understanding and anticipating dry mouth can help you ask the right questions and allow you to take steps to manage it from the beginning of your journey.
What Causes Xerostomia
Treatment for head and neck cancer, particularly radiation treatment, can damage the glands in your mouth that produce saliva, resulting in dry mouth (xerostomia). Radiation therapy targets cancer cells, but sometimes it also hurts non-cancerous cells such as those in the glands that produce your saliva. The salivary glands become damaged, reducing or eliminating their ability to provide adequate saliva.
Dry mouth is often a significant side effect of treatment, impacting your oral health and your ability to chew, swallow, taste, and speak. It can begin during your treatment and can persist for weeks, months, or years. For some people, dry mouth will never go away completely.
Why is Saliva Important?
Saliva plays an important role in your overall oral health.
- It cleans your mouth and washes away food from your teeth and gums.
- It facilitates good oral hygiene.
- It helps protect your teeth from decay by providing a calcium and mineral source to teeth.
- It fights germs in your mouth, including yeast and bacteria that affect gum health and cause cavities.
- It moistens your mouth and helps you speak, chew, taste, and swallow, as well as use removable dentures.
- It helps protect the tissues lining your mouth.
How Might Dry Mouth Affect Me?
People suffering from dry mouth can experience a number of things, including:
- You might need to drink more water, especially while eating.
- You may find it hard to chew or swallow dry foods.
- You might discover that that food and drink taste different.
- Your saliva may become thickened or discolored (brown or yellow).
- You can experience changes in the sound of your voice.
- It may become difficult to wear dentures.
- You may experience oral yeast (candida) infections.
- You may have problems with your oral health, including tooth sensitivity, cavities, bleeding, or infections. Dry mouth puts you at increased risk for rapidly progressive tooth damage, dental abscess, gum inflammation, and gum disease. Dental disease may lead to tooth loss and damage of the jaw bone.
How Can I Manage Dry Mouth?
There are a number of strategies that can help reduce the discomfort and risks associated with dry mouth.
Before you begin treatment:
- Ask your doctor about medications that may reduce or prevent dry mouth. Medications are available that can help to protect your salivary glands during treatment, such as amifostine (Ethyol). Other medications can help maintain or stimulate saliva production, such as pilocarpine (Salagen) or cevimeline (Evoxac). Incorporating these medications into your treatment regimen may be recommended to minimize the impact of radiation treatment on saliva production.
- Prevention of dental damage with fluoride applied to the teeth by your dentist and daily applications with a mouth guard have been shown to be effective and important in prevention of dental damage.
During and After Treatment:
- Maintain good daily oral hygiene, which may include using high strength prescription fluoride, remineralizing products, and antibacterial products.
- See your dentist regularly (every 3 to 4 months). Dental care is more important than ever for head and neck cancer patients.
- Use moisturizing, alcohol-free mouthwash, especially those specifically intended for dry mouth, such as Biotene or Oasis.
- Use saliva substitutes, such as Lubricity, or mouth rinses containing complex polysaccharides, hyetellose, hyprolose, or carmellose.
- Stay hydrated. Carry a water bottle whenever possible, and try to drink at least 64 ounces of fluids every day.
- Suck on sugar-free hard candy (especially tart flavors) or chew sugar-free gum. Look for products containing xylitol.
- When eating, moisten your foods with sauces, gravies, or dressings. Limit foods that are dry or hard to swallow, such as peanut butter, tough meats, and breads.
- Avoid alcohol, and limit caffeine.
- Apply wax- or lanolin-based lip balms with sunscreen. Avoid petrolatum and petrolatum-containing products.
- Sleep with a humidifier in your room to alleviate nighttime discomfort.
As with any side effect of treatment, if it becomes troublesome, speak with your medical team about interventions that may help.
More Tips for Managing Dry Mouth
If you are newly diagnosed with oral, head and neck cancer:
- Get a complete oral and dental evaluation, and receive treatment for any active dental disease. Maintaining or restoring dental health and receiving preventative care are important parts of comprehensive care.
- Your dentist should communicate with your cancer team.
As a cancer survivor:
- Be sure your dentist is aware of your cancer and all cancer treatment you have received. He or she should communicate with your cancer team and seek the advice of experienced dental providers if complex dental/oral conditions arise.
- Seek out oral care support groups who may have useful information.
Dry Mouth Resources
- Infographic: A shareable resource focusing on strategies to alleviate the discomforts associated with dry mouth.
- Flyer: A downloadable resource that highlights the importance of saliva to oral health, and how dry mouth may affect individuals being treated for head and neck cancer.
- Rack Card: A downloadable resource that lists strategies to reduce the discomforts associated with dry mouth.
- Patient Video: Cliff shares how dry mouth has impacted his life after receiving radiation therapy.
- ReduceDryMouth.com: Learn more about a medication (Ethyol) that may help protect your salivary glands during radiation treatment.
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