Management of Oral Health
Interventions for Oral Dryness
- Apply saliva substitutes every 2-4 hours (oral sprays preferred) as recommended by the National Comprehensive Cancer Network 1
- More frequent application of saliva substitutes (every 1-2 hours) may be necessary, according to the National Comprehensive Cancer Network 1
- Consider referral to a dental specialist, as suggested by the National Comprehensive Cancer Network 1
- Use artificial saliva products as an alternative to natural saliva 2, 3, 4
- Muscarinic agonists, such as pilocarpine (5 mg three times daily) and cevimeline (30 mg three times daily), may be used to treat dry mouth symptoms 3, 5
- Manage xerostomia with frequent sips of water, room humidification, and oral sprays or gels with neutral pH containing fluoride and electrolytes 2, 4, 5
Oral Rinses and Hygiene
- Use alcohol-free rinses every 2-3 hours, as stated in the British Journal of Dermatology guidelines 6
- Brush teeth and gums four times daily with a soft-bristled toothbrush 7
- Use prescription-strength fluoride toothpaste to prevent caries 8
- Floss daily with waxed floss to minimize trauma to gingiva 9
- Use a bland oral rinse (1 teaspoon salt, 1 teaspoon baking soda in 4 cups of water) several times daily, as recommended by the American Society of Clinical Oncology 9
- Apply non-petroleum-based lubricants to oral mucosa 9
- Use plant or animal-based fats for moisturization rather than petroleum products 9
Diet and Lifestyle
- Advise consuming a low-sucrose diet 8
- Avoid caffeine, spicy and highly acidic foods 8
- Avoid alcohol and tobacco products 7
Dental Care and Examination
- Schedule regular dental examinations every 6 months 8, 9
- Refer to periodontist for thorough evaluation if gingival lesions worsen 8
- Refer to oral surgeon if osteonecrosis is suspected 8
- Remove dentures before performing oral care 7
- Clean dentures with toothpaste and rinse with water 7
- Soak dentures in antimicrobial solution (e.g., chlorhexidine 0.2%) for 10 minutes before insertion 7
Management Approach
| Severity | Management Approach |
|---|---|
| Mild | Non-pharmacological interventions, sugar-free gum/lozenges, increased hydration |
| Moderate | Continue mild interventions + saliva substitutes (OGT sprays preferred) |
| Severe | All above + pilocarpine 5 mg three to four times daily |