Table 1 Long-term caries prevention strategies for patients with head and neck cancer after discharge to primary care
Stage | Toothbrushing | Toothpaste | Inter-dental cleaning | Mouthwash | Other measures |
|---|---|---|---|---|---|
After cancer treatment | Resume twice daily toothbrushing with a manual or electric toothbrush as soon as acute symptoms of treatment have subsided. In cases where patients have post-operative trismus, recommend the use of smaller toothbrushes with regular strength bristles (eg single-tufted brush) | Continue/ resume 5,000 ppm fluoridated toothpaste as soon as any mucositis symptoms have resolved. In patients with a high caries risk or those with reduced salivary flow, prescribe 2,800 ppm (<16 yo) or 5,000 ppm (>16 yo) fluoridated toothpaste. On patients with xerostomia as a result of radiotherapy, use CPP-ACP Tooth Mousse (GC Europe) by gently can be applied to the teeth twice daily | Encourage once daily inter-dental cleaning with inter-dental brushes or floss | Fluoridated mouthwash at other times than toothbrushing | Advise to spit but not rinse toothpaste. For patients on long-term Oral Nutritional Supplements, dietary counselling is needed to mitigate the risks. Encourage patients to brush their teeth or rinse with a fluoridated mouthwash before ONS. Consider use of upper and lower soft splints to be worn at night which can be used as fluoride/CPP-ACP Tooth Mousse (GC Europe) reservoirs |
