Head and 

Neck Radiation 

Treatment and 

Your Mouth

Head and 

Neck Radiation 

Treatment and 

Your Mouth

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Institute of Dental and Craniofacial Research
Oral Health, Cancer Care, and You is 

an awareness campaign sponsored 

by the National Institute of Dental 

and Craniofacial Research (NIDCR) 

through its National Oral Health 

Information Clearinghouse (NOHIC).

This campaign is being conducted in 

partnership with the National Cancer 

Institute, the National Institute of 

Nursing Research, the Centers for 

Disease Control and Prevention, and 

the Friends of the NIDCR. For more 

information about the campaign, 

please contact NOHIC. Campaign 

publications are also available online 

at www.nidcr.nih.gov.

National Oral Health 

Information Clearinghouse

1 NOHIC Way

Bethesda, MD 20892–3500

Phone: 301–402–7364

Fax: 301–480–4098
1

Are You Being Treated 

With Radiation for Cancer 

in Your Head or Neck? 

If so, this booklet can help you. While 

head and neck radiation helps treat 

cancer, it can also cause other things 

to happen in your mouth called side 

effects. Some of these problems 

could cause you to delay or stop 

treatment.

This booklet will tell you ways to help 

prevent mouth problems so you’ll get 

the most from your cancer treatment.

To help prevent serious problems, 

see a dentist at least 2 weeks before 

starting radiation.

A dentist can help prevent mouth 

problems.
2

How Does Head and 

Neck Radiation Affect 

the Mouth?

Doctors use head and neck radiation 

to treat cancer because it kills cancer 

cells. But radiation to the head and 

neck can harm normal cells, including 

cells in the mouth. Side effects include 

problems with your teeth and gums; 

the soft, moist lining of your mouth; 

glands that make saliva (spit); and jaw 

bones.

It’s important to know that side 

effects in the mouth can be serious.

• The side effects can hurt and make 

it hard to eat, talk, and swallow. 

• You are more likely to get an infection, which can be dangerous when 

you are receiving cancer treatment.

• If the side effects are bad, you may 

not be able to keep up with your 

cancer treatment. Your doctor may 

need to cut back on your cancer 

treatment or may even stop it.
3

What Mouth Problems 

Does Head and Neck 

Radiation Cause?

You may have certain side effects in 

your mouth from head and neck 

radiation. Another person may have 

different problems. Some problems go 

away after treatment. Others last a long 

time, while some may never go away.

• Dry mouth.

• A lot of cavities.

• Loss of taste.

• Sore mouth and gums.

• Infections.

• Jaw stiffness.

• Jaw bone changes.

You can see or feel most of these problems. 

Check your mouth every day.
4

Why Should I See 

a Dentist?

You may be surprised that your dentist 

is important in your cancer treatment.

If you go to the dentist before head 

and neck radiation begins, you can 

help prevent serious mouth problems.

Side effects often happen because a 

person’s mouth is not healthy before 

radiation starts. Not all mouth problems can be avoided but the fewer 

side effects you have, the more likely 

you will stay on your cancer treatment 

schedule.

It’s important for your dentist and 

cancer doctor to talk to each other 

before your radiation treatment 

begins. Be sure to give your dentist 

your cancer doctor’s phone number. 

When Should I See a Dentist?

You need to see the dentist at least 

2 weeks before your first radiation 

treatment. If you have already started 

radiation and didn’t go to a dentist, see 

one as soon as possible.
5

What Will the Dentist 

and Dental Hygienist Do?

• Check your teeth.

• Take x-rays.

• Take care of mouth problems.

• Show you how to take care of your 

mouth to prevent side effects.

• Show you how to prevent and treat 

jaw stiffness by exercising the jaw 

muscles 3 times a day. Open and 

close the mouth as far as possible 

(without causing pain) 20 times.

The dentist will do a complete exam.
6

What Can I Do To Keep 

My Mouth Healthy?

You can do a lot to keep your mouth 

healthy during head and neck radiation. The first step is to see a dentist 

before you start cancer treatment.

Once your treatment starts, it’s important to look in your mouth every day

for sores or other changes. These 

tips can help prevent and treat a sore 

mouth:

Keep your mouth moist.

• Drink a lot of water.

• Suck ice chips.

• Use sugarless gum 

or sugar-free hard 

candy.

• Use a saliva substitute to help 

moisten your 

mouth.
7

Clean your mouth, tongue, and gums.

• Brush your teeth, gums, and tongue 

with an extra-soft toothbrush after 

every meal and at bedtime. If it 

hurts, soften the bristles in warm 

water.

• Use a fluoride toothpaste.

• Use the special fluoride 

gel that your dentist 

prescribes.

• Don’t use mouthwashes with 

alcohol in 

them.

• Floss your teeth gently every day. 

If your gums bleed and hurt, avoid 

the areas that are bleeding or sore, 

but keep flossing your other teeth.

• Rinse your mouth several times a 

day with a solution of 1/4 teaspoon 

baking soda and 1/8 teaspoon salt in 

one cup of warm water. Follow with 

a plain water rinse.

• Dentures that don’t fit well can cause 

problems. Talk to your cancer doctor 

or dentist about your dentures.
8

Sipping liquids with your meal will 

make eating easier.

If Your Mouth Is Sore, Watch What 

You Eat and Drink.

• Choose foods that are good for you 

and easy to chew and swallow. 

• Take small bites of food, chew 

slowly, and sip liquids with your 

meals.

• Eat moist, soft foods such as cooked 

cereals, mashed potatoes, and 

scrambled eggs.

• If you have trouble swallowing, 

soften your food with gravy, sauces, 

broth, yogurt, or other liquids.
9

Call Your Doctor or Nurse When Your 

Mouth Hurts.

• Work with them to find medicines 

to help control the pain.

• If the pain continues, talk to your 

cancer doctor about stronger 

medicines.

Remember To Stay Away From

• Sharp, crunchy foods, like 

taco chips, that could 

scrape or cut your 

mouth.

• Foods that are hot, 

spicy, or high in 

acid, like citrus 

fruits and juices, 

which can 

irritate your 

mouth.

• Sugary foods, like candy or soda, 

that could cause cavities.

• Toothpicks, because they can cut 

your mouth.

• All tobacco products.

• Alcoholic drinks.
10

Your child has special dental needs.

Do Children Get Mouth 

Problems Too?

Head and neck radiation causes other 

side effects in children, depending on 

the child’s age.

Problems with teeth are the most common. Permanent teeth may be slow to 

come in and may look different from 

normal teeth. Teeth may fall out. The 

dentist will check your child’s jaws for 

any growth problems.

Before radiation begins, take your 

child to a dentist. The dentist will 

check your child’s mouth carefully 

and pull loose teeth or those that may 

become loose during treatment. Ask 

the dentist or hygienist what you can 

do to help your child with mouth care.
11

Remember:

• Visit your dentist before your head 

and neck radiation treatment starts.

• Take good care of your mouth 

during treatment.

• Talk to your dentist about using 

fluoride gel to help prevent all the 

cavities that head and neck radiation causes.

• Talk regularly with your cancer 

doctor and dentist about any mouth 

problems you have during and after 

head and neck radiation treatment. 

Call your cancer doctor or dentist if 

you have any mouth problems.
Acknowledgments

The individuals listed here provided assistance in developing, 

reviewing, and field testing all of the campaign publications. 

The campaign sponsors would like to thank them for their 

contributions.

Scientific Committee

Gerry Barker, R.D.H., M.A.

University of Missouri-Kansas City

Kansas City, MO 

Susan L. Beck, R.N., Ph.D., A.O.C.N.

University of Utah 

Salt Lake City, UT

Marylin Dodd, R.N., Ph.D.

University of California, San Francisco

San Francisco, CA

Joel Epstein, D.M.D., M.S.D., F.R.C.D.

University of Washington

Seattle, WA

Philip Fox, D.D.S.

Bethesda, MD

Deborah McGuire, R.N., Ph.D.

University of Pennsylvania

Philadelphia, PA

Douglas Peterson, D.M.D., Ph.D.

University of Connecticut

Farmington, CT 

Mark M. Schubert, D.D.S., M.S.D.

University of Washington

Seattle, WA

John Wingard, M.D.

University of Florida 

Gainesville, FL

Field Testers

Olubunmi Abayomi, M.D.

Howard University Hospital

Washington, DC

Alice Bass, B.S.N., O.C.N.

Greater Southeast Community Hospital

Washington, DC

Betsy Bischoff, R.N., M.S.

Georgetown University Medical Center 

Washington, DC

Andrea Bonnick, D.D.S.

Howard University 

Washington, DC

Dorothy Chesley, R.N., Ph.D.

Texas Nursing Foundation

Austin, TX

Nancy E. Leupold, M.S.

Support for People with Oral and 

Head and Neck Cancer (SPOHNC)

Locust Valley, NY

Alice Mahan, B.S., R.T.T.

Howard University Hospital 

Washington, DC

MiKaela Olsen, R.N., M.S., O.C.N.

UCSF Stanford Health Care

Stanford, CA

Peter Passero, D.D.S.

Prizm Dental Partners and Management Group

McLean, VA

K. Vendrell Rankin, D.D.S.

Baylor College of Dentistry

Dallas, TX
C
National Institute of Dental

and Craniofacial Research

National Oral Health 

Information Clearinghouse

1 NOHIC Way

Bethesda, MD 20892–3500

301–402–7364

www.nidcr.nih.gov

This publication is not 

copyrighted. Make as many 

photocopies as you need.

U.S. Department of Health 

and Human Services

National Institutes of Health

NIH Publication No. 06–4362

Reprinted November 2005