Oral complications at 6 months after radiation therapy for head and neck cancer

Objective: To examine oral complications 6 months after modern radiation therapy (RT) for head and neck cancer (HNC). Methods: Prospective multicenter cohort study of patients with HNC receiving intensity-modulated radiation therapy or more advanced RT. Stimulated whole salivary flow, maximal mouth opening, oral mucositis, oral pain, oral health-related quality of life (OH-QOL), and oral hygiene practices were measured in 372 subjects pre-RT and 216 subjects at 6 months from the start of RT. Results: Mean stimulated whole salivary flow declined from 1.09 to 0.47 ml/min at 6 months (p <.0001). Mean maximal mouth opening reduced from 45.58 to 42.53 mm at 6 months (p <.0001). 8.1% of subjects had some oral mucositis at 6 months, including 3.8% with oral ulceration. Mean overall pain score was unchanged. OH-QOL was reduced at 6 months, with changes related to dry mouth, sticky saliva, swallowing solid foods, and sense of taste (p ≤.0001). At 6 months, there was greater frequency of using dental floss and greater proportion using supplemental fluoride (p <.0001). Conclusions: Despite advances in RT techniques, patients with HNC experience oral complications 6 months after RT, with resulting negative impacts on oral function and quality of life.