My consultant has suggested that I use a toothpaste and mouthwash with a 'high' fluoride content. My mouth is very sensitive following radiotherapy and cannot tolerate the flavoured varieties that I have tried.

Does anyone know of nuetral flavoured products that might be suitable?

Thank you

This message has been edited. Last edited by: Dr Vinod K Joshi,

Hello Maria

Here is some advice on precautions to take before starting and after radiation therapy for a mouth cancer in which the parotid glands and side of jaw and neck get 'blasted'.

There are two issues here: 1) the need to improve the mineralisation of the teeth before oral hygiene gets difficult owing to an uncomfortable mouth and 2) the need to compensate for risk of 'tooth-decay' that arises from decreased salivary gland function (as a consequence of surgery or radiotherapy). The danger is 'radiation' caries caused by changes in the quantity (reduced) and quality (less buffering ability) of your saliva.

I advise patients with a dry mouth to keep (as following radiotherapy) a very high standard of oral hygiene. I advise my patients to brush four times daily and to follow that with using a fluoride mouthrinse to prevent tooth demineralization . The message is that a low fluoride (from the toothpaste and mouthrinse) application several times daily to the teeth is more effective than a high concentration used once at night. After this, twice daily supplement the normal brushing with additional brushing using using interspace and interdental brushes. Use the interdental brushes to clean areas normally missed by the regular toothbrush. Use the interspace single-tufted brush to clean the entire gum-line of the teeth twice a day. The single tufted brush should be applied along the gum-line and moved back and forth while following the scalloped outline of the gum into the interproximal embrasures. Download to see how: videoclip. After brushing the teeth, use a fluoride mouth rinse for 1 minute ( Fluorigard mouth rinse). Additionally at night, before bed, do a 5-minute scrub of the teeth with a Fluoride gel(e.g. Colgate's Fluorigard GelKam) or high fluoride toothpaste (e.g. Duraphat 5000 ) and then spit out any excess gel. Do not rinse out in order to leave the teeth lightly coated overnight.

An alternative way of applying the gel at night is to use a thin custom gel-applicator trays, similar to that used for whitening teeth, to carry the fluoride gel over the teeth. The trays should cover all tooth structures without irritating the gingival or mucosal tissues. The trays should be placed on the teeth and left in place for 5 minutes. If gel oozes out of the tray, you are using too much. After 5 minutes, remove the trays and spit out any excess gel. Patients should start using fluoride mouthrinse and gels several days before radiation therapy begins. I advise the use of thin custom gel-applicator trays, similar to that used for whitening teeth, with the advice to smear the inside of it with the fluoride gel. The trays should cover all tooth structures without irritating the gingival or mucosal tissues. The advice is to start with a daily 5-minute application of a 1.1% neutral pH sodium fluoride gel or a 0.4% stannous fluoride (unflavored) gel. Patients with porcelain crowns or resin or glass ionomer restorations should use the neutral pH fluoride. We use Colgate's Gel Kam which is 0.63% stannous fluoride, but there are other brands.

The trays should be placed on the teeth and left in place for 5 minutes. If gel oozes out of the tray, you are using too much. After 5 minutes, remove the trays and spit out any excess gel. Do not rinse. Do not eat or drink for 30 minutes , preferably one should to go to bed!

For the above, any 1.1% neutral pH sodium fluoride gel or a 0.4% stannous fluoride (unflavored) gel can be used. Patients with porcelain crowns or resin or glass ionomer restorations should use the neutral pH fluoride.

A new product that may help remineralise the teeth is GC Tooth Mousse. See page 13 of this brochure.

GC Tooth Mousse is a topical, water based, sugar free creme that contains Casein Phosphopeptide – Amorphous Calcium Phosphate under the brand name of Recaldent. It helps remineralise teeth and is supposed to help with 'radiation caries'. Tooth Mousse can be applied at any time during the day or night. After cleaning teeth in the normal way, remove excess saliva from the mouth (via spitting, swallowing, or patting teeth dry with tissue) and apply the creme using a clean finger or cotton tip. It should be left undisturbed for three minutes for day application then spread around mouth with tongue and held for another two minutes before being spat out. Avoid food or drink for 30 minutes. Tooth Mousse can also be applied just before going to bed and the entire application can be left to slowly dissolve overnight. It isn't sold in pharmacies so try this online shop.

The water-pik is useful in washing out food debris, but it won't shift plaque. Brushes used properly are still the best.

Patients should start using fluoride mouthrinses and fluoride gels several days before radiation therapy begins. Unfortunately, patients with radiation-induced salivary gland dysfunction must continue these daily fluoride applications for life. There is some good advice at the links given on the PROFESSIONALS > COMPLICATIONS page

Best wishes
Vinod

This message has been edited. Last edited by: Dr Vinod K Joshi,