Aunt Wang is a patient with nasopharyngeal carcinoma. She is currently receiving radiotherapy. The radiotherapy has been carried out for the 20th time. Uncle Wang told the doctor that her mouth and throat are very painful. Eating and eating have been greatly affected, making her feel very uncomfortable
It is believed that many patients with head and neck tumors have encountered similar problems during radiotherapy. So, in the face of such side effects caused by radiotherapy, what aspects should patients pay attention to in their daily oral care
What is radiation therapy associated mucositis?
Radiation therapy associated mucositis is an acute mucosal injury caused by radiation. It is one of the common complications of radiotherapy for patients with head and neck tumors. It can cause mucosal ulcer, bleeding, infection, etc., causing pain in the mouth, throat, eating and swallowing function decline, seriously affecting the quality of life of patients, increasing the risk of hospitalization and medical expenses, and even leading to the interruption of radiotherapy, affecting the survival and prognosis of patients.
Any mucosal tissue exposed to head and neck radiation from the mouth to the esophagus may suffer from acute mucosal injury, such as oral mucositis, pharyngeal and laryngeal mucositis. According to the severity of mucositis, it can be manifested as erythema, edema or erosion to varying degrees of ulcer.
What are the clinical manifestations?
In addition to causing local pain, dry mouth, eating and taste disorders, it may also lead to fever, fatigue and systemic inflammatory reactions. Mucosa damage caused by radiotherapy of head and neck tumors will reduce the immune defense ability of the body, imbalance of oral flora, and increase the risk of infection, among which the patients with seriously low immune function will also increase the risk of sepsis.
How to conduct proper oral care?
Professional oral evaluation
Before radiotherapy, patients should conduct oral evaluation, dental evaluation and treatment under the guidance of professional doctors to determine the relevant risk factors and treatment methods that are most likely to lead to oral damage of patients, and reduce the risk of local odontogenic and systemic infections.
During radiotherapy, patients should also have regular oral evaluation, which generally includes mucosal changes, pain, nutritional status and fatigue. Most patients with radiation-induced oral mucositis will gradually relieve their symptoms 2 to 4 weeks after radiotherapy.
Dental Care
According to the oral condition, it is recommended to brush teeth, gums and tongue 2~4 times gently after meals and before going to bed. Use a soft bristled toothbrush (either manually or electrically) to prevent damage to oral mucosa. Excess toothpaste should be spit out. The toothbrush must be thoroughly rinsed with water after each use. To prevent infection, the toothbrush should keep its head upward and not be immersed in disinfectant. It is recommended to replace the toothbrush at least every month to reduce the risk of infection for patients.
In order to protect enamel, it is recommended that tumor patients use toothpaste with high fluoride content (>15%) to prevent dental caries. Patients should follow the recommendations on fluoride content of toothpastes recommended by oral care experts to ensure that they can tolerate the taste of fluoride containing toothpastes. For example, some patients may not be able to tolerate toothpastes containing mint, and some patients may be contraindicated to certain ingredients.
Oral cleaning
The use of dental floss, toothpicks or dental washers may reduce the formation of dental plaque, but it must be ensured that they are used correctly to prevent unnecessary mucosal damage. Patients with head and neck tumors undergoing radiotherapy, thrombocytopenia or blood coagulation dysfunction should be careful to use dental floss, toothpicks or tooth washers. Patients wearing dentures should ensure comfort. If dentures are loose, they will stimulate oral mucosa and damage the integrity of mucosa, so they should be treated in time.
After each meal, dentures must be washed. Wash dentures thoroughly at least twice a day. Use mouthwash under the guidance of medical staff to maintain oral hygiene, prevent or treat infections, moisturize the mouth or relieve pain. Rinse your mouth at least 4 times a day after each meal, and the use period of mouthwash can be staggered from that of brushing teeth.
Nutrition and Selection of Food
Good nutrition is essential for the body to resist infection, maintain mucosal integrity, enhance mucosal tissue repair and slow down the deterioration of mucositis. All patients should be screened for nutrition. If necessary, a nutritionist can be consulted to assess the problems that may affect nutrition, such as anorexia, taste change and dysphagia. Some foods can damage the oral mucosa. Hot, rough, hard food can damage mucous membranes. Spicy, salty and sour foods may cause mucous membrane irritation, and should be avoided.
Water intake
Keep adequate water intake, drink frequently and keep your mouth moist. The following factors may cause dry lips, such as oxygen therapy, drugs (such as antidepressants, antihistamines, phenytoin sodium, steroid inhalers and opioids) and elderly cancer patients. Lubricants such as Vaseline / white paraffin and lipstick can be used to moisturize the lips. Patients undergoing head and neck radiotherapy should use water-soluble lip moisturizing products to keep the mucosa moist. Smoking and alcohol can damage mucous membranes, and electronic cigarettes are no exception. Patients should try to give up smoking and alcohol.
Author: Zhang Jili: Nurse in charge of the third ward of oncology department of Xiangya Second Hospital of Central South University
Reviewed by: Zhang Haixia, Deputy Chief Physician of Cancer Center of Xiangya Second Hospital of Central South University
Source: Cancer Center of Xiangya Second Hospital
Article link:
https://www.cn-healthcare.com/articlewm/20221015/content-1450476.html
