Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®): Supportive care - Health Professional Information [NCI] - Head / Neck Radiation Patients
Because these patients are usually not significantly neutropenic, topical antifungal agents such as nystatin rinse/pastilles and clotrimazole troches can be effective. The use of a troche may be limited by significant xerostomia. Patients who receive topical antifungals should be asked to avoid eating, drinking, or rinsing for at least 30 minutes after use. Patients with removable dentures should remove the dentures before using the topical antifungals and should also treat the dentures to avoid repeat colonization of the oral tissues by fungal organisms that are colonizing the dentures.
For persistent lesions, systemic agents such as fluconazole are very effective.
As oral and pharyngeal mucosa are exposed to radiation, taste receptors become damaged, and taste discrimination becomes increasingly compromised.[13,14] After several weeks of radiation therapy, patients commonly complain that they have no sense of taste. It will generally take 6 to 8 weeks after the end of radiation therapy for taste receptors to recover and become functional. Zinc sulfate supplements (220 mg 2 or 3 times a day) have been reported to help with recovery of the sense of taste.[15,16][Level of evidence: I]
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- Bar Ad V, Weinstein G, Dutta PR, et al.: Gabapentin for the treatment of pain related to radiation-induced mucositis in patients with head and neck tumors treated with intensity-modulated radiation therapy. Head Neck 32 (2): 173-7, 2010.
- Wong PC, Dodd MJ, Miaskowski C, et al.: Mucositis pain induced by radiation therapy: prevalence, severity, and use of self-care behaviors. J Pain Symptom Manage 32 (1): 27-37, 2006.
- Lin LC, Que J, Lin LK, et al.: Zinc supplementation to improve mucositis and dermatitis in patients after radiotherapy for head-and-neck cancers: a double-blind, randomized study. Int J Radiat Oncol Biol Phys 65 (3): 745-50, 2006.
- Madan PD, Sequeira PS, Shenoy K, et al.: The effect of three mouthwashes on radiation-induced oral mucositis in patients with head and neck malignancies: a randomized control trial. J Cancer Res Ther 4 (1): 3-8, 2008 Jan-Mar.
- Lalla RV, Latortue MC, Hong CH, et al.: A systematic review of oral fungal infections in patients receiving cancer therapy. Support Care Cancer 18 (8): 985-92, 2010.
- Nelson GM: Biology of taste buds and the clinical problem of taste loss. Anat Rec 253 (3): 70-8, 1998.
- Zheng WK, Inokuchi A, Yamamoto T, et al.: Taste dysfunction in irradiated patients with head and neck cancer. Fukuoka Igaku Zasshi 93 (4): 64-76, 2002.
- Silverman S Jr: Complications of treatment. In: Silverman S Jr, ed.: Oral Cancer. 5th ed. Hamilton, Canada: BC Decker Inc, 2003, pp 113-28.
- Ripamonti C, Zecca E, Brunelli C, et al.: A randomized, controlled clinical trial to evaluate the effects of zinc sulfate on cancer patients with taste alterations caused by head and neck irradiation. Cancer 82 (10): 1938-45, 1998.