# Mouth care and oral mucositis prevention during head and neck radiotherapy

Source: https://onco.cc/protocols/head-and-neck-radiotherapy-oral-mucositis/  
OnCo record `head-and-neck-radiotherapy-oral-mucositis` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Radiotherapy to the head and neck makes the lining of the mouth and throat sore, usually from the second or third week. Keeping the mouth clean on a regular routine, a benzydamine mouthwash, and in many centres a low-level light treatment inside the mouth help prevent it; pain relief and help with eating matter as much as anything else.

## Summary

The MASCC/ISOO 2020 guideline (the latest full edition) is the reference. For head and neck radiotherapy it suggests a multiagent combination oral care protocol (level III), recommends benzydamine mouthwash for moderate-dose radiotherapy below 50 Gy (level I) and suggests it with chemoradiotherapy (level II), and recommends intraoral photobiomodulation with low-level laser for radiotherapy alone (level II) and for chemoradiotherapy (level I), following the parameters of one of the protocols in its Table 2 and telling patients that animal data on tumour effects conflict. It suggests against chlorhexidine for prevention (level III), recommends against sucralfate, suggests honey (level II) and, with caution, oral glutamine with chemoradiotherapy (level II), and suggests topical morphine 0.2% mouthwash for pain with chemoradiotherapy (level III). Professional oral care, patient education and saline or bicarbonate rinses carry expert opinion only: dental assessment before treatment, education to support self-care, and bland rinses for clearance and comfort. The MASCC/ISOO Delphi (2024) adds how to assess: the WHO scale by the clinician, weekly or more often in high-grade mucositis, with a patient-reported measure (OMWQ and OMDQ, or PRO-CTCAE items). Where no intervention is recommended, pain relief, dietary support and preventing secondary infection carry management.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: oral mucositis during radiotherapy; radiation mucositis; sore mouth during head and neck radiotherapy; mouth care during radiotherapy; photobiomodulation for mucositis; benzydamine mouthwash; Difflam during radiotherapy

## Connected records

- ideas: [Photobiomodulation and a taste and swallowing programme for mouth and throat toxicity](https://onco.cc/ideas/idea-moon-mucositis-taste-programme/), [Photobiomodulation to prevent oral mucositis available in every head and neck radiotherapy centre](https://onco.cc/ideas/idea-pu-photobiomodulation-every-head-neck-centre/)
- protocols: [Dental assessment before head and neck radiotherapy and osteoradionecrosis prevention](https://onco.cc/protocols/head-and-neck-radiotherapy-dental-assessment-osteoradionecrosis/), [Immobilisation mask for head and neck and brain radiotherapy, including mask anxiety](https://onco.cc/protocols/head-and-neck-radiotherapy-immobilisation-mask/), [Oral care and oral mucositis prevention during cancer treatment](https://onco.cc/protocols/oral-mucositis-prevention-and-oral-care/)
- cancers: [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [Oral cavity cancer (mouth and tongue)](https://onco.cc/cancers/oral-cavity-cancer/), [Oropharyngeal cancer (tonsil and base of tongue)](https://onco.cc/cancers/oropharyngeal-cancer/)
- technologies: [Glutamine for mucositis and neuropathy](https://onco.cc/technologies/glutamine-mucositis-neuropathy/), [Honey for radiation mucositis](https://onco.cc/technologies/honey-radiation-mucositis/), [Photobiomodulation (low-level laser) for oral mucositis](https://onco.cc/technologies/photobiomodulation-mucositis/)
- terms: [Mucositis and stomatitis](https://onco.cc/terms/mucositis/)

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