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Table 1 Oral care prior to and post cancer treatment in head and neck cancer survivors

From: Oral and dental health 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