Linda and Todd --

You should go to the Oral Cancer Foundation web site itself and check out the extensive information available on dental issues. Since dental problems are one of the MAJOR side-effects of radiation to the mouth I am astonished that your cancer center does not focus on this. Hopefully David can find you a referral and you must see him/her BEFORE treatment.

To summarize: Generally, a CCC will have the person who is about to undergo radiation therapy affecting the mouth and throat to have:

1. An up-front complete dental examination to ensure that all the teeth in the radiation field are sufficiently sound. They can have fillings or crowns but need to be healthy. Reason is the need to avoid, as much as possible, extensive or invasive dental procedures after treatment, as these areas may be slow to heal and in some cases, may develop radionecrosis of the jawbone.

2. Any dental work (fillings, etc.) needed will be done beforehand. Any unsound teeth may be removed. In the latter case, the area needs to heal somewhat before treatment.

3. Dental "trays" may be made (most CCCs do this) for the daily application of a flouride gel during and post-treatment. This will, in part, help prevent the rampant decay that can affect radiated teeth. This procedure will need to be continued indefinitely post-treatment.

4. Meticulous oral hygiene is needed during treatment and afterwards. However, mouth sores and inflammation associated with the radiation may make some procedures difficult and painful. This can be ameliorated by brushing with an ultra-soft toothbrush, such as the one made by the Oral Balance folks (can also use a baby's toothbrush), use Biotene toothpaste (none containing sodium laurel sulfate), and using a mouthwash that does not contain alcohol. Biotene dry mouth mouthwash is best. These products are widely available at Target, Wal-Mart, Rite-Aid and other vendors. Using a salt/soda rinse often (several times a day) also helps. There is also a soft "ultra floss" which is less apt to cut a fragile mouth.

5. There is risk of trismus (again, check OCF web site) - this is the inability to open the jaw. The best thing to use is a device called TheraBite (my husband used one all through treatment for his tonsillar cancer and has no trismus) -- it was prescribed by his ENT and insurance paid for it. If this is not an option, there are exercises that can be done with one's fingers to help preserve jaw function.

6. Saliva is very important to dental health (and many other things such as swallowing!) and it would be good to know about your husband's radiation plan -- wil he be getting IMRT and if so, how much of his salivary glands will be affected by the radiation field? Do the doctors feel that he will retain some salivary function? (Usually IMRT allows this, but how much depends on the radiation planning). Is amifostine (Ethyol) available? A nasty drug but it does help preserve salivary glands -- my husband took it throughout (with effort) but even a short course helps.

Anyway, much more on the OCF web site -- Gail