Advice after your nerve block for surgery
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It is important to continue looking after your mouth and teeth after your cancer treatment is finished as some of the side effects are lifelong.
Going back to your dentist
It is important that you have a regular dentist in a dental practice you can see for lifelong check-ups and care. The aim will be to get you back to the ongoing care of your own dentist whenever this is appropriate. Check that your dentist knows you have had head and neck cancer treatment. Your own dentist should see you on a regular basis in order to manage any problems at an early stage. If they have any concerns, they may refer you back to specialist care for advice or a further treatment plan.
Check your mouth regularly
You should follow the mouth care plan agreed with your dentist or hygienist. Check your mouth regularly for ulcers, signs of tooth decay or red, white or dark patches. Tooth decay may appear at the tips and edges of the teeth or at bottom near the gum line so check these areas regularly.
Diet
Sugar causes dental decay. When you eat sugary foods, the bacteria in dental plaque quickly turns the sugar into acid. This damages your teeth by breaking down the enamel on the outside of your teeth leading to sensitivity and cavities. Therefore, to reduce your risk of decay you should reduce the overall amount of sugar in your diet, but most importantly reduce how often you have it (the amount of separate occasions when you have sugar).
Following your cancer treatment, you may have a dry mouth. This means your teeth will be at much higher risk of tooth decay as the protection the saliva gives is lost. Your risk of decay is especially high whilst you are taking nutritional supplements by mouth.
If your dietitian has advised you to have high energy drinks/snacks or nutritional supplements, then brush your teeth or use fluoride mouthwash BEFORE you have them. Brushing the teeth immediately after having nutritional supplements or sugar snacks or drinks is not recommended.
Instead, wait 30 mins before brushing your teeth.
It is important to stop taking these supplements once your dietitian has advised this. After your cancer treatment ends and your dietitians are happy that you are maintaining your weight you should avoid eating sugar between meals. Here are some tips that might help you cut down on sugary and acidic foods and drinks:
- Eat fewer foods that contained refined sugar - These include chocolate, sweets, fresh fruit juice, biscuits, cakes and buns, pastries, fruit pies, dried fruit, sweet sauces, sponge puddings, breakfast cereals, ice cream, jams, honey and fruit in syrup.
- Check labels on foods to find out if they contain sugar - Sugar can be called other names on food labels. Look out for glucose, sucrose, maltodextrin, dextrose, lactose, caramel, fructose, maltose, toffee, molasses, honey, syrup, corn sugar and hydrolysed starch. These are all alternative names for sugars.
- Choose sugar-free drinks - But it is important to be aware that some sugar-free drinks can be harmful to the teeth if they contain phosphoric acid or citric acid. Fizzy sugar-free drinks (including sparkling water) are often acidic. The safest drinks for your teeth are plain milk, still water, and tea and coffee with no added sugar.
- Eat and drink fewer acidic things - This includes fizzy drinks, orange juice, oranges and tomatoes. This is because these can break down tooth enamel. The more times you eat or drink something acidic or sugary, the more acid attacks there are on your teeth. It is important to limit these foods and drinks to mealtimes, no more than four times a day. Limit fruit juices, smoothies, squash and fizzy drinks to a minimum, ideally no more than once per week and ideally with a meal as opposed to having it to sip on throughout the day.
Oral Hygiene
Brushing your teeth and gums with a medium bristle manual or electric toothbrush will help remove plaque. It will also help to spread fluoride toothpaste around your teeth and remove any food debris which may collect if you have a dry mouth. Your normal toothbrush will not reach all the way in between your teeth so you will need to use special interdental brushes or dental floss in the tighter spaces as advised by your dentist. Putting toothpaste on the interdental brushes helps to get it into the spaces between your teeth.
Protecting your teeth
Brush your teeth at least twice a day using a high fluoride toothpaste (e.g. Duraphat 5000ppm). This needs to be prescribed by your dentist and should only be used by you. This strengthens the hard, outer layer (enamel) on your teeth and helps protect them from decay. It can also help reduce tooth sensitivity. After brushing, do not rinse away the excess toothpaste, just spit the excess out, giving the remaining toothpaste a chance to keep working.
Use an alcohol free 0.05% Fluoride (225ppm) mouthwash 3-4 times a day at separate times to brushing (e.g. straight after lunch or dinner).
Once you have finished your radiotherapy you can add extra protection by using a re-mineralising mousse (such as GC Tooth Mousse) after having anything with sugar in it.
Saliva Replacement
Saliva helps protect teeth from decay and gum disease. Your cancer treatment may mean that you have less saliva, so your teeth are at a higher risk of decay and gum disease. Chewing sugar-free gum is sometimes helpful if you have a dry mouth.
Chewing sugar free, xylitol or sorbitol containing gum can be helpful. Some saliva substitutes may also contain flavourings and sugar. Glandosane® saliva substitute should NOT be used in patients with teeth due to the high acidity. Alternatives are Oral Balance Biotene gel, or Saliva Orthana spray.
Jaw Exercises
Following surgery or radiotherapy you may have difficulty opening your mouth as wide as before due to limitations in mouth opening. This may have an impact on your ability to eat, maintain your teeth or place dentures in your mouth. It may also lead to difficulty for your dentist in examining your teeth, particularly if you have any back teeth remaining. This condition can get worse with time, so it is important that you continue to carry out jaw exercises for at least a year after cancer treatment.
Extractions
Following radiotherapy, any area of jaw covered by the radiotherapy will not heal normally if damaged. That means that if a dental extraction is necessary in the future there is a risk that areas of exposed, non-healing bone can remain in the mouth. This is called osteoradionecrosis (ORN). If you have teeth which need taking out and are in the site of previous radiotherapy, you may need to be treated by your local maxillofacial/oral surgery department to reduce the risk of ORN. Your own dentist can refer you for this.
Obturator
If you have an obturator, it may become loose as you heal after surgery. It may need some adjustment or you may need to have a new one made. If you have surgery without radiotherapy, a replacement obturator can usually be made a few weeks after surgery. To make a replacement obturator you may need 4 to 6 appointments to take impressions and measurements. Each appointment will be 1 to 2 weeks apart.
If you have surgery and radiotherapy, it usually best to wait approximately six months before making a new obturator to allow the tissues to settle. If the obturator is causing ulcers ask to see your specialist Restorative dentist. Clean an obturator in the same way as ordinary dentures.
Contact us
If you have any queries relating to this information, please contact the Oral and maxilofacial surgery service.
About this information
Service:
Oral and maxilofacial surgery
Reference:
M/002
Approval date:
25 June 2026
Review date:
1 June 2029
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.