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Nutrition Therapy

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Xerostomia

Xerostomia (dry mouth) is most commonly caused by radiation therapy that is directed at the head and neck.[35] A number of medications may also induce xerostomia. Dry mouth may affect speech, taste sensation, ability to swallow, and use of oral prostheses. There is also an increased risk of cavities and periodontal disease because less saliva is produced to cleanse the teeth and gums.

A primary method of coping with xerostomia is to drink plenty of liquids (25–30 mL/kg per day) and eat moist foods with extra sauces, gravies, butter, or margarine.[25,36,40] In addition, hard candy, frozen desserts such as frozen grapes, chewing gum, flavored ice pops, and ice chips may be helpful.[32] Oral care is very important to help prevent infections. Irradiation to the head and neck of a patient who has permanent dry mouth symptoms may result in reduced intake of energy, iron, zinc, selenium, and other key nutrients.[41][Level of evidence: II] Special efforts should be made to help tailor meals and snacks for individuals with xerostomia.

Suggestions for lessening or alleviating dry mouth include the following:[36]

  • Perform oral hygiene at least 4 times per day (after each meal and before bedtime). (Refer to the Routine Oral Hygiene Care section of the PDQ summary on Oral Complications of Chemotherapy and Head/Neck Radiation for more information.)
  • Brush and rinse dentures after each meal.
  • Keep water handy at all times to moisten the mouth.
  • Avoid rinses containing alcohol.
  • Consume very sweet or tart foods and beverages, which may stimulate saliva.
  • Drink fruit nectar instead of juice.
  • Use a straw to drink liquids.

(Refer to the PDQ summary on Oral Complications of Chemotherapy and Head/Neck Radiation for more information on xerostomia.)

Mucositis/stomatitis

Stomatitis, or a sore mouth, can occur when cells inside the mouth, which grow and divide rapidly, are damaged by treatment such as bone marrow transplantation, chemotherapy, and radiation therapy. These treatments may also affect rapidly dividing cells in the bone marrow, which may make patients more susceptible to infection and bleeding in their mouth. By carefully choosing foods and by taking good care of their mouths, patients can usually make eating easier.[42,43,44] Individuals who have mucositis, mouth sores, or tender gums should eat foods that are soft, easy to chew and swallow, and nonirritating.[32] Some conditions may require processing foods in a blender. Irritants may include acidic, spicy, salty, and coarse-textured foods. A pilot study found that oral glutamine swishes might be helpful in reducing the duration and severity of mucositis.[45][Level of evidence: I] Glutamine may also reduce the duration and severity of stomatitis during cytotoxic chemotherapy.[45,46][Level of evidence: I]

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