Table 1.

Oral care prior to and post cancer treatment in head and neck cancer survivors

Pre – Cancer Treatment	o Pre-treatment assessment 2–3 weeks prior to cancer therapy o Comprehensive head and neck, oral mucosa, dental and periodontal examination o Radiographs to assess dental and periodontal status o Baseline jaw range of motion (interincisal opening), baseline resting and stimulated saliva o Advanced caries, advanced periodontal disease: definitive treatment may require surgery with goal of 1–2 weeks of healing time o Periodontal debridement maintenance; oral hygiene instruction o Custom fluoride carriers, custom oral positioning devices
During Cancer Treatment	o Individual treatment as cancer type and planned treatment indications o Oral hygiene reinforced o Small carious lesions may be treated with fluoride and/or sealants; daily fluoride applications o Symptom management: Pain: topical analgesic and anesthetic agents; systemic analgesics; dry mouth: hydration, oral rinses and coating agents; lip management o Mucositis reduction: Patient education: o Regular brushing, flossing; prosthesis cleaning o Bland oral rinses, water based/wax or lanolin lip lubricant o Fluoridated toothpaste; or home fluoride trays daily in high risk patients o Soft toothbrushes; Electric or ultrasonic brushes for tolerated patients o Super-soft brush for severe mucositis or foam brush with chlorhexidine if brushing not possible o Dietary instruction; nutritional guidance, tobacco and alcohol avoidance
Post – Cancer Treatment	o Monitoring, prevention and management of oral complications (mucositis, dry mouth, mucosal pain, taste change, infection, dental demineralization, dental caries, periodontal disease, soft tissue/osteonecrosis etc.) o Checking for cancer recurrence or secondary primary cancer o Dental caries prevention, periodontal maintenance o Determine frequency of dental hygiene follow-up interval based on level of hyposalivation, demineralization/caries rate and patient’s oral hygiene post-radiotherapy; patients with dry mouth, may require hygiene and recall every 3–4 months o Patient education o Fluoridated toothpaste; in high risk patients home fluoride trays daily o Good oral hygiene, soft toothbrushes or electric or ultrasonic brushes, flossing o Maintain lubrication of mouth and lips o Encourage non-cariogenic diet and cessation of tobacco & alcohol