• Avoid spices and coarse foods such as raw vegetables, dry crackers, and nuts.
• Remember that acidic foods and liquids can cause mouth and throat irritation.
• Don't smoke, chew tobacco, or drink alcohol.
• Stay away from sugary snacks because they can promote tooth decay.
• Clean your mouth and teeth often, using the method your dentist or doctor recommends.
• Use only alcohol-free mouthwash; many commercial mouthwashes contain alcohol which has a drying effect on mouth tissues.

Mouth Care
Radiation treatment for head and neck cancer can increase your chances of getting cavities in your teeth. Mouth care designed to prevent problems will be a very important part of your treatment. Before starting radiation therapy, make an appointment for a complete dental/oral checkup. Ask your dentist and radiation oncologist to consult before your radiation treatments begin.

Your dentist probably will want to see you often during your radiation therapy to help you care for your mouth and teeth. This is a good way to reduce the risk of tooth decay and help you deal with possible problems such as soreness of the tissues in your mouth. It's important that you follow the dentist's advice while you're receiving radiation therapy. Most likely, your dentist will suggest that you:

• Clean your teeth and gums thoroughly with a soft brush at least 4 times a day (after meals and at bedtime).
• Use a fluoride toothpaste that contains no abrasives.
• Floss gently between teeth daily if you flossed regularly before your illness. Use waxed, non-shredding dental floss.
• Rinse your mouth gently and frequently with a salt and baking soda solution especially after you brush. Use 1/2 teaspoon of salt and 1/2 teaspoon of baking soda in a large glass of warm water. Follow with a plain water rinse.
• Apply fluoride regularly as prescribed by your dentist.

Your dentist can explain how to mix the salt and baking soda mouthwash and how to use the fluoride treatment method that best suits your needs. You can probably get printed instructions for proper dental care at the dentist's office. If dry mouth continues after your treatment is complete, you will need to continue the mouth care recommended during treatment. Always share your dentist's instructions with your radiation nurse.

Dealing with Mouth or Throat Problems
Soreness in your mouth or throat may appear in the second or third week of external radiation therapy and it will most likely have disappeared within a month or so after your treatments have ended. You may have trouble swallowing during this time because your mouth feels dry. Your doctor or dentist can prescribe medicine for mouth discomfort and tell you about methods to relieve other mouth problems during and following your radiation therapy. If you wear dentures you may notice that they no longer fit well. This occurs if the radiation causes your gums to swell. You may need to stop wearing your dentures until your radiation therapy is over. It's important not to risk denture-induced gum sores because they may become infected and heal slowly.

Your salivary glands may produce less saliva than usual, making your mouth feel dry. Unfortunately dry mouth may continue to be a problem even after treatment is over. You may be given medication to help lessen this side effect. It's helpful to sip cool drinks throughout the day. Although many radiation therapy patients have said that drinking carbonated beverages helps relieve dry mouth, water probably is your best choice. In the morning, fill a large container with ice, add water, and carry it with you during the day so that you can take frequent sips. Keep a glass of cool water at your bedside at night, too. Sugar-free candy or gum also may help; be careful about overuse of these products as they can cause diarrhea in some people. Avoid tobacco and alcoholic drinks because they tend to dry and irritate your mouth tissues. Moisten food with gravies and sauces to make eating easier. If these measures are not enough, ask your dentist, radiation oncologist, or nurse about products that either replace or stimulate your own saliva. Artificial saliva and medication to increase saliva production are available.

Tips on Eating
You may find that it's difficult or painful to swallow. Some patients say that they feel as if something is stuck in their throat. Soreness or dryness in your mouth or throat can also make it hard to eat. The earlier section on eating problems in this booklet may be helpful. In addition, some of the following tips may help to make eating more comfortable:

• Choose foods that taste good to you and are easy to eat.
• Try changing the consistency of foods by adding fluids and using sauces and gravies to make them softer.
• Avoid highly spiced foods and textures that are dry and rough, such as crackers.
• Eat small meals, and eat more frequently than usual.
• Cut your food into small, bite-sized pieces.
• Ask your doctor for special liquid medicines to reduce the pain in your throat so that you can eat and swallow more easily.
• Ask your doctor about liquid food supplements that are easier to swallow than solids. They can help you get enough calories each day to avoid losing weight.
• If you are being treated for lung cancer, it's important to keep mucus and other secretions thin and manageable; drinking extra fluids can help.
• If familiar foods no longer taste good, try new foods and use different methods of food preparation.