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Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®): Supportive care – Patient Information [NCI]
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
General Information About Oral Complications
Oral complications are common in cancer patients, especially those with head and neck cancer.
Complications are new medical problems that occur during or after a disease, procedure, or treatment and that make recovery harder. The complications may be side effects of the disease or treatment, or they may have other causes. Oral complications affect the mouth.
Cancer patients have a high risk of oral complications for a number of reasons:
- Chemotherapy and radiation therapy slow or stop the growth of new cells.
These cancer treatments slow or stop the growth of fast growing cells, such as cancer cells. Normal cells in the lining of the mouth also grow quickly, so anticancer treatment can stop them from growing, too. This slows down the ability of oral tissue to repair itself by making new cells.
- Radiation therapy may directly damage and break down oral tissue, salivary glands, and bone.
- Chemotherapy and radiation therapy upset the healthy balance of bacteria in the mouth.
There are many different kinds of bacteria in the mouth. Some are helpful and some are harmful. Chemotherapy and radiation therapy may cause changes in the lining of the mouth and the salivary glands, which make saliva. This can upset the healthy balance of bacteria. These changes may lead to mouth sores, infections, and tooth decay.
This summary is about oral complications caused by chemotherapy and radiation therapy.
Preventing and controlling oral complications can help you continue cancer treatment and have a better quality of life.
Sometimes treatment doses need to be decreased or treatment stopped because of oral complications. Preventive care before cancer treatment begins and treating problems as soon as they appear may make oral complications less severe. When there are fewer complications, cancer treatment may work better and you may have a better quality of life.
Patients receiving treatments that affect the head and neck should have their care planned by a team of doctors and specialists.
To manage oral complications, the oncologist will work closely with your dentist and may refer you to other health professionals with special training. These may include the following specialists:
- Oncology nurse.
- Dental specialists.
- Dietitian.
- Speech therapist.
- Social worker.
The goals of oral and dental care are different before, during, and after cancer treatment:
- Before cancer treatment, the goal is to prepare for cancer treatment by treating existing oral problems.
- During cancer treatment, the goals are to prevent oral complications and manage problems that occur.
- After cancer treatment, the goals are to keep teeth and gums healthy and manage any long-term side effects of cancer and its treatment.
The most common oral complications from cancer treatment include the following:
- Oral mucositis (inflamed mucous membranes in the mouth).
- Infection.
- Salivary gland problems.
- Change in taste.
- Pain.
These complications can lead to other problems such as dehydration and malnutrition.
Oral Complications and Their Causes
Cancer treatment can cause mouth and throat problems.
Complications of chemotherapy
Oral complications caused by chemotherapy include the following:
- Inflammation and ulcers of the mucous membranes in the stomach or intestines.
- Easy bleeding in the mouth.
- Nerve damage.
Complications of radiation therapy
Oral complications caused by radiation therapy to the head and neck include the following:
- Fibrosis (growth of fibrous tissue) in the mucous membrane in the mouth.
- Tooth decay and gum disease.
- Breakdown of tissue in the area that receives radiation.
- Breakdown of bone in the area that receives radiation.
- Fibrosis of muscle in the area that receives radiation.
Complications caused by either chemotherapy or radiation therapy
The most common oral complications may be caused by either chemotherapy or radiation therapy. These include the following:
- Inflamed mucous membranes in the mouth.
- Infections in the mouth or that travel through the bloodstream. These can reach and affect cells all over the body.
- Taste changes.
- Dry mouth.
- Pain.
- Changes in dental growth and development in children.
- Malnutrition (not getting enough of the nutrients the body needs to be healthy) caused by being unable to eat.
- Dehydration (not getting the amount of water the body needs to be healthy) caused by being unable to drink.
- Tooth decay and gum disease.
Oral complications may be caused by the treatment itself (directly) or by side effects of the treatment (indirectly).
Radiation therapy can directly damage oral tissue, salivary glands, and bone. Areas treated may scar or waste away. Total-body radiation can cause permanent damage to the salivary glands. This can change the way foods taste and cause dry mouth.
Slow healing and infection are indirect complications of cancer treatment. Both chemotherapy and radiation therapy can stop cells from dividing and slow the healing process in the mouth. Chemotherapy may decrease the number of white blood cells and weaken the immune system (the organs and cells that fight infection and disease). This makes it easier to get an infection.
Complications may be acute (short-term) or chronic (long-lasting).
Acute complications are ones that occur during treatment and then go away. Chemotherapy usually causes acute complications that heal after treatment ends.
Chronic complications are ones that continue or appear months to years after treatment ends. Radiation can cause acute complications but may also cause permanent tissue damage that puts you at a lifelong risk of oral complications. The following chronic complications may continue after radiation therapy to the head or neck has ended:
- Dry mouth.
- Tooth decay.
- Infections.
- Taste changes.
- Problems in the mouth and jaw caused by loss of tissue and bone.
- Problems in the mouth and jaw caused by the growth of benign tumors in the skin and muscle.
Oral surgery or other dental work can cause problems in patients who have had radiation therapy to the head or neck. Make sure that your dentist knows your health history and the cancer treatments you received.
Preventing and Treating Oral Complications Before Chemotherapy or Radiation Therapy Begins
Finding and treating oral problems before cancer treatment begins can prevent oral complications or make them less severe.
Problems such as cavities, broken teeth, loose crowns or fillings, and gum disease can get worse or cause problems during cancer treatment. Bacteria live in the mouth and may cause an infection when the immune system is not working well or when white blood cell counts are low. If dental problems are treated before cancer treatments begin, there may be fewer or milder oral complications.
Prevention of oral complications includes a healthy diet, good oral care, and dental checkups.
Ways to prevent oral complications include the following:
- Eat a well-balanced diet. Healthy eating can help the body stand the stress of cancer treatment, help keep up your energy, fight infection, and rebuild tissue.
- Keep your mouth and teeth clean. This helps prevent cavities, mouth sores, and infections.
- Have a complete oral health exam.
Your dentist should be part of your cancer care team. It is important to choose a dentist who has experience treating patients with oral complications of cancer treatment. A checkup of your oral health at least a month before cancer treatment begins usually allows enough time for the mouth to heal if any dental work is needed. The dentist will treat teeth that have a risk of infection or decay. This will help avoid the need for dental treatments during cancer treatment. Preventive care may help lessen dry mouth, which is a common complication of radiation therapy to the head or neck.
A preventive oral health exam will check for the following:
- Mouth sores or infections.
- Tooth decay.
- Gum disease.
- Dentures that do not fit well.
- Problems moving the jaw.
- Problems with the salivary glands.
Patients receiving high-dose chemotherapy, stem cell transplant, or radiation therapy should have an oral care plan in place before treatment begins.
The goal of the oral care plan is to find and treat oral disease that may cause complications during treatment and to continue oral care during treatment and recovery. Different oral complications may occur during the different phases of a transplant. Steps can be taken ahead of time to prevent or lessen how severe these side effects will be.
Oral care during radiation therapy will depend on the following:
- Specific needs of the patient.
- The radiation dose.
- The part of the body treated.
- How long the radiation treatment lasts.
- Specific complications that occur.
It is important that patients who have head or neck cancer stop smoking.
Continuing to smoke tobacco may slow down recovery. It can also increase the risk that the head or neck cancer will recur or that a second cancer will form.
Managing Oral Complications During and After Chemotherapy or Radiation Therapy
Regular Oral Care
Good dental hygiene may help prevent or decrease complications.
It is important to keep a close watch on oral health during cancer treatment. This helps prevent, find, and treat complications as soon as possible. Keeping the mouth, teeth, and gums clean during and after cancer treatment may help decrease complications such as cavities, mouth sores, and infections.
Everyday oral care for cancer patients includes keeping the mouth clean and being gentle with the tissue lining the mouth.
Everyday oral care during chemotherapy and radiation therapy includes the following:
Brushing teeth
- Brush teeth and gums with a soft-bristle brush 2 to 3 times a day for 2 to 3 minutes. Be sure to brush the area where the teeth meet the gums and to rinse often.
- Rinse the toothbrush in hot water every 15 to 30 seconds to soften the bristles, if needed.
- Use a foam brush only if a soft-bristle brush cannot be used. Brush 2 to 3 times a day and use an antibacterial rinse. Rinse often.
- Let the toothbrush air-dry between brushings.
- Use a fluoride toothpaste with a mild taste. Flavoring may irritate the mouth, especially mint flavoring.
- If toothpaste irritates your mouth, brush with a mixture of 1/4 teaspoon of salt added to 1 cup of water.
- Use a rinse every 2 hours to decrease soreness in the mouth. Dissolve 1/4 teaspoon of salt and 1/4 teaspoon of baking soda in 1 quart of water.
- An antibacterial rinse may be used 2 to 4 times a day for gum disease. Rinse for 1 to 2 minutes.
- If dry mouth occurs, rinsing may not be enough to clean the teeth after a meal. Brushing and flossing may be needed.
Floss gently once a day. |
Lip care
Use lip care products, such as cream with lanolin, to prevent drying and cracking. |
Denture care
- Brush and rinse dentures every day. Use a soft-bristle toothbrush or one made for cleaning dentures.
- Clean with a denture cleaner recommended by your dentist.
- Keep dentures moist when not being worn. Place them in water or a denture soaking solution recommended by your dentist. Do not use hot water, which can cause the denture to lose its shape.
For special oral care during high-dose chemotherapy and stem cell transplant, see the Managing Oral Complications of High-Dose Chemotherapy and/or Stem Cell Transplant section of this summary.
Oral Mucositis
Oral mucositis is an inflammation of mucous membranes in the mouth.
The terms "oral mucositis" and "stomatitis" are often used in place of each other, but they are different.
- Oral mucositis is an inflammation of mucous membranes in the mouth. It usually appears as red, burn-like sores or as ulcer -like sores in the mouth.
- Stomatitis is an inflammation of mucous membranes and other tissues in the mouth. These include the gums, tongue, roof and floor of the mouth, and the inside of the lips and cheeks.
Mucositis may be caused by either radiation therapy or chemotherapy.
- Mucositis caused by chemotherapy will heal by itself, usually in 2 to 4 weeks if there is no infection.
- Mucositis caused by radiation therapy usually lasts 6 to 8 weeks, depending on how long the treatment was.
- In patients receiving high-dose chemotherapy or chemoradiation for stem cell transplant: Mucositis usually begins 7 to 10 days after treatment begins, and lasts for about 2 weeks after treatment ends.
Swishing ice chips in the mouth for 30 minutes, beginning 5 minutes before patients receive fluorouracil, may help prevent mucositis. Patients who receive high-dose chemotherapy and stem cell transplant may be given medicine to help prevent mucositis or keep it from lasting as long.
Mucositis may cause the following problems:
- Pain.
- Infection.
- Bleeding, in patients receiving chemotherapy. Patients receiving radiation therapy usually do not have bleeding.
- Trouble breathing and eating.
Care of mucositis during chemotherapy and radiation therapy includes cleaning the mouth and relieving pain.
Treatment of mucositis caused by either radiation therapy or chemotherapy is about the same. Treatment depends on your white blood cell count and how severe the mucositis is. The following are ways to treat mucositis during chemotherapy, stem cell transplant, or radiation therapy:
Cleaning the mouth
- Clean your teeth and mouth every 4 hours and at bedtime. Do this more often if the mucositis becomes worse.
- Use a soft-bristle toothbrush.
- Replace your toothbrush often.
- Use lubricating jelly that is water-soluble, to help keep your mouth moist.
- Use mild rinses or plain water. Frequent rinsing removes pieces of food and bacteria from the mouth, prevents crusting of sores, and moistens and soothes sore gums and the lining of the mouth.
- If mouth sores begin to crust over, the following rinse may be used:
- Three percent hydrogen peroxide mixed with an equal amount of water or saltwater. To make a saltwater mixture, put 1/4 teaspoon of salt in 1 cup of water.
This should not be used for more than 2 days because it will keep mucositis from healing.
Relieving mucositis pain
- Try topical medicines for pain. Rinse your mouth before putting the medicine on the gums or lining of the mouth. Wipe mouth and teeth gently with wet gauze dipped in saltwater to remove pieces of food.
- Painkillers may help when topical medicines do not. Nonsteroidal anti-inflammatory drugs (NSAIDS, aspirin -type painkillers) should not be used by patients receiving chemotherapy because they increase the risk of bleeding.
- Zinc supplements taken during radiation therapy may help treat pain caused by mucositis as well as dermatitis (inflammation of the skin).
- Povidone-iodine mouthwash that does not contain alcohol may help delay or decrease mucositis caused by radiation therapy.
See the Pain section of this summary for more information on pain control.
There can be many causes of oral pain in cancer patients.
A cancer patient's pain may come from the following:
- The cancer.
- Side effects of cancer treatments.
- Other medical conditions not related to the cancer.
Because there can be many causes of oral pain, a careful diagnosis is important. This may include:
- A medical history.
- Physical and dental exams.
- X-rays of the teeth.
Oral pain in cancer patients may be caused by the cancer.
Cancer can cause pain in different ways:
- The tumor presses on nearby areas as it grows and affects nerves and causes inflammation.
- Leukemias and lymphomas, which spread through the body and may affect sensitive areas in the mouth. Multiple myeloma can affect the teeth.
- Brain tumors may cause headaches.
- Cancer may spread to the head and neck from other parts of the body and cause oral pain.
- With some cancers, pain may be felt in parts of the body not near the cancer. This is called referred pain. Tumors of the nose, throat, and lungs can cause referred pain in the mouth or jaw.
Oral pain may be a side effect of treatments.
Oral mucositis is the most common side effect of radiation therapy and chemotherapy. Pain in the mucous membranes often continues for a while even after the mucositis is healed.
Surgery may damage bone, nerves, or tissue and may cause pain. Bisphosphonates, drugs taken to treat bone pain, sometimes cause bone to break down. This is most common after a dental procedure such as having a tooth pulled. (See the Oral Complications Not Related to Chemotherapy or Radiation Therapy section of this summary for more information.)
Patients who have transplants may develop graft-versus-host-disease (GVHD). This can cause inflammation of the mucous membranes and joint pain. (See the Managing Oral Complications of High-Dose Chemotherapy and/or Stem Cell Transplant section of this summary for more information).
Certain anticancer drugs can cause oral pain.
If an anticancer drug is causing pain, stopping the drug usually stops the pain. Because there may be many causes of oral pain during cancer treatment, a careful diagnosis is important. This may include a medical history, physical and dental exams, and x-rays of the teeth.
Some patients may have sensitive teeth weeks or months after chemotherapy has ended. Fluoride treatments or toothpaste for sensitive teeth may relieve the discomfort.
Teeth grinding may cause pain in the teeth or jaw muscles.
Pain in the teeth or jaw muscles may occur in patients who grind their teeth or clench their jaws, often because of stress or not being able to sleep. Treatment may include muscle relaxers, drugs to treat anxiety, physical therapy (moist heat, massage, and stretching), and mouth guards to wear while sleeping.
Pain control helps improve the patient's quality of life.
Oral and facial pain can affect eating, talking, and many other activities that involve the head, neck, mouth, and throat. Most patients with head and neck cancers have pain. The doctor may ask the patient to rate the pain using a rating system. This may be on a scale from 0 to 10, with 10 being the worst. The level of pain felt is affected by many different things. It's important for patients to talk with their doctors about pain.
Pain that is not controlled can affect all areas of the patient's life. Pain may cause feelings of anxiety and depression, and may prevent the patient from working or enjoying everyday life with friends and family. Pain may also slow the recovery from cancer or lead to new physical problems. Controlling cancer pain can help the patient enjoy normal routines and a better quality of life.
For oral mucositis pain, topical treatments are usually used. See the Oral Mucositis section of this summary for information on relieving oral mucositis pain.
Other pain medicines may be also be used. Sometimes, more than one pain medicine is needed. Muscle relaxers and medicines for anxiety or depression or to prevent seizures may help some patients. For severe pain, opioids may be prescribed.
Non-drug treatments may also help, including the following:
- Physical therapy.
- TENS (transcutaneous electrical nerve stimulation).
- Applying cold or heat.
- Hypnosis.
- Acupuncture. (See the PDQ summary on Acupuncture.)
- Distraction.
- Relaxation therapy or imagery.
- Cognitive behavioral therapy.
- Music or drama therapy.
- Counseling.
Damage to the lining of the mouth and a weakened immune system make it easier for infection to occur.
Oral mucositis breaks down the lining of the mouth, which lets bacteria and viruses get into the blood. When the immune system is weakened by chemotherapy, even good bacteria in the mouth can cause infections. Germs picked up from the hospital or other places may also cause infections.
As the white blood cell count gets lower, infections may occur more often and become more serious. Patients who have low white blood cell counts for a long time have a higher risk of serious infections. Dry mouth, which is common during radiation therapy to the head and neck, may also raise the risk of infections in the mouth.
Dental care given before chemotherapy and radiation therapy are started can lower the risk of infections in the mouth, teeth, or gums.
Infections may be caused by bacteria, a fungus, or a virus.
Bacterial infections
Treatment of bacterial infections in patients who have gum disease and receive high-dose chemotherapy may include the following:
- Using medicated and peroxide mouth rinses.
- Brushing and flossing.
- Wearing dentures as little as possible.
Fungal infections
The mouth normally contains fungi that can live on or in the oral cavity without causing any problems. However, an overgrowth (too much fungi) in the mouth can be serious and should be treated.
Antibiotics and steroid drugs are often used when a patient receiving chemotherapy has a low white blood cell count. These drugs change the balance of bacteria in the mouth, making it easier for a fungal overgrowth to occur. Also, fungal infections are common in patients treated with radiation therapy. Patients receiving cancer treatment may be given drugs to help prevent fungal infections from occurring.
Candidiasis is a type of fungal infection that is common in patients receiving both chemotherapy and radiation therapy. Symptoms may include a burning pain and taste changes. Treatment of fungal infections in the lining of the mouth only may include mouthwashes and lozenges that contain antifungal drugs. An antifungal rinse should be used to soak dentures and dental devices and to rinse the mouth. Drugs may be used to when rinses and lozenges do not get rid of the fungal infection. Drugs are sometimes used to prevent fungal infections.
Viral infections
Patients receiving chemotherapy, especially those with immune systems weakened by stem cell transplant, have an increased risk of viral infections. Herpesvirus infections and other viruses that are latent (present in the body but not active or causing symptoms) may flare up. Finding and treating the infections early is important. Giving antiviral drugs before treatment starts can lower the risk of viral infections.
Bleeding may occur when anticancer drugs make the blood less able to clot.
High-dose chemotherapy and stem cell transplants can cause a lower-than-normal number of platelets in the blood. This can cause problems with the body's blood clotting process. Bleeding may be mild (small red spots on the lips, soft palate, or bottom of the mouth) or severe, especially at the gum line and from ulcers in the mouth. Areas of gum disease may bleed on their own or when irritated by eating, brushing, or flossing. When platelet counts are very low, blood may ooze from the gums.
Most patients can safely brush and floss while blood counts are low.
Continuing regular oral care will help prevent infections that can make bleeding problems worse. Your dentist or medical doctor can explain how to treat bleeding and safely keep your mouth clean when platelet counts are low.
Treatment for bleeding during chemotherapy may include the following:
- Medicines to reduce blood flow and help clots form.
- Topical products that cover and seal bleeding areas.
- Rinsing with a mixture of saltwater and 3% hydrogen peroxide. (The mixture should have 2 or 3 times the amount of saltwater than hydrogen peroxide.) To make the saltwater mixture, put 1/4 teaspoon of salt in 1 cup of water. This helps clean wounds in the mouth. Rinse carefully so clots are not disturbed.
Dry Mouth
Dry mouth (xerostomia) occurs when the salivary glands don't make enough saliva.
Saliva is made by salivary glands. Saliva is needed for taste, swallowing, and speech. It helps prevent infection and tooth decay by cleaning off the teeth and gums and preventing too much acid in the mouth.
Radiation therapy can damage salivary glands and cause them to make too little saliva. Some types of chemotherapy used for stem cell transplant may also damage salivary glands.
When there is not enough saliva, the mouth gets dry and uncomfortable. This condition is called dry mouth (xerostomia). The risk of tooth decay, gum disease, and infection increases, and your quality of life suffers.
Symptoms of dry mouth include the following:
- Thick, stringy saliva.
- Increased thirst.
- Changes in taste, swallowing, or speech.
- A sore or burning feeling (especially on the tongue).
- Cuts or cracks in the lips or at the corners of the mouth.
- Changes in the surface of the tongue.
- Problems wearing dentures.
Salivary glands usually return to normal after chemotherapy ends.
Dry mouth caused by chemotherapy for stem cell transplant is usually temporary. The salivary glands often recover 2 to 3 months after chemotherapy ends.
Salivary glands may not recover completely after radiation therapy ends.
The amount of saliva made by the salivary glands usually starts to decrease within 1 week after starting radiation therapy to the head or neck. It continues to decrease as treatment goes on. How severe the dryness is depends on the dose of radiation and the number of salivary glands that receive radiation.
Salivary glands may partly recover during the first year after radiation therapy. However, recovery is usually not complete, especially if the salivary glands received direct radiation. Salivary glands that did not receive radiation may start making more saliva to make up for the loss of saliva from the damaged glands.
Careful oral hygiene can help prevent mouth sores, gum disease, and tooth decay caused by dry mouth.
Care of dry mouth may include the following:
- Clean the mouth and teeth at least 4 times a day.
- Floss once a day.
- Brush with a fluoride toothpaste.
- Apply fluoride gel once a day at bedtime, after cleaning the teeth.
- Rinse 4 to 6 times a day with a mixture of salt and baking soda (mix ½ teaspoon salt and ½ teaspoon baking soda in 1 cup of warm water).
- Avoid foods and liquids that have a lot of sugar in them.
- Sip water often to relieve mouth dryness.
A dentist may give the following treatments:
- Rinses to replace minerals in the teeth.
- Rinses to fight infection in the mouth.
- Saliva substitutes or medicines that help the salivary glands make more saliva.
- Fluoride treatments to prevent tooth decay.
Acupuncture may also help relieve dry mouth.
Tooth Decay
Dry mouth and changes in the balance of bacteria in the mouth increase the risk of tooth decay (cavities). Careful oral hygiene and regular care by a dentist can help prevent cavities. See the Regular Oral Care section of this summary for more information.
Taste Changes
Changes in taste (dysguesia) are common during chemotherapy and radiation therapy.
Changes in the sense of taste is a common side effect of both chemotherapy and head or neck radiation therapy. Taste changes can be caused by damage to the taste buds, dry mouth, infection, or dental problems. Foods may seem to have no taste or may not taste the way they did before cancer treatment. Radiation may cause a change in sweet, sour, bitter, and salty tastes. Chemotherapy drugs may cause an unpleasant taste.
In most patients receiving chemotherapy and in some patients receiving radiation therapy, taste returns to normal a few months after treatment ends. However, for many radiation therapy patients, the change is permanent. In others, the taste buds may recover 6 to 8 weeks or more after radiation therapy ends. Zinc sulfate supplements may help some patients recover their sense of taste.
Cancer patients who are receiving high-dose chemotherapy or radiation therapy often feel fatigue (a lack of energy). This can be caused by either the cancer or its treatment. Some patients may have problems sleeping. Patients may feel too tired for regular oral care, which may further increase the risk for mouth ulcers, infection, and pain. (See the PDQ summary on Fatigue for more information.)
Loss of appetite can lead to malnutrition.
Patients treated for head and neck cancers have a high risk of malnutrition. The cancer itself, poor diet before diagnosis, and complications from surgery, radiation therapy, and chemotherapy can lead to nutrition problems. Patients may lose the desire to eat because of nausea, vomiting, trouble swallowing, sores in the mouth, or dry mouth. When eating causes discomfort or pain, the patient's quality of life and nutritional well-being suffer. The following may help patients with cancer meet their nutrition needs:
- Serve food chopped, ground, or blended, to shorten the amount of time it needs to stay in the mouth before being swallowed.
- Eat between-meal snacks to add calories and nutrients.
- Eat foods high in calories and protein.
- Take supplements to get vitamins, minerals, and calories.
Meeting with a nutrition counselor may help during and after treatment.
Nutrition support may include liquid diets and tube feeding.
Many patients treated for head and neck cancers who receive radiation therapy only are able to eat soft foods. As treatment continues, most patients will add or switch to high-calorie, high-protein liquids to meet their nutrition needs. Some patients may need to receive the liquids through a tube that is inserted into the stomach or small intestine. Almost all patients who receive chemotherapy and head or neck radiation therapy at the same time will need tube feedings within 3 to 4 weeks. Studies show that patients do better if they begin these feedings at the start of treatment, before weight loss occurs.
Normal eating by mouth can begin again when treatment is finished and the area that received radiation is healed. A team that includes a speech and swallowing therapist can help the patients with the return to normal eating. Tube feedings are decreased as eating by mouth increases, and are stopped when you are able to get enough nutrients by mouth. Although most patients will once again be able to eat solid foods, many will have lasting complications such as taste changes, dry mouth, and trouble swallowing.
Mouth and Jaw Stiffness
Treatment for head and neck cancers may affect the ability to move the jaws, mouth, neck, and tongue. There may be problems with swallowing. Stiffness may be caused by:
- Oral surgery.
- Late effects of radiation therapy. An overgrowth of fibrous tissue (fibrosis) in the skin, mucous membranes, muscle, and joints of the jaw may occur after radiation therapy has ended.
- Stress caused by the cancer and its treatment.
Jaw stiffness may lead to serious health problems, including:
- Malnutrition and weight loss from being unable to eat normally.
- Slower healing and recovery from poor nutrition.
- Dental problems from being unable to clean the teeth and gums well and have dental treatments.
- Weakened jaw muscles from not using them.
- Emotional problems from avoiding social contact with others because of trouble speaking and eating.
The risk of having jaw stiffness from radiation therapy increases with higher doses of radiation and with repeated radiation treatments. The stiffness usually begins around the time the radiation treatments end. It may get worse over time, stay the same, or get somewhat better on its own. Treatment should begin as soon as possible to keep the condition from getting worse or becoming permanent. Treatment may include the following
- Medical devices for the mouth.
- Pain treatments.
- Medicine to relax muscles.
- Jaw exercises.
- Medicine to treat depression.
Swallowing Problems
Pain during swallowing and being unable to swallow (dysphagia) are common in cancer patients before, during, and after treatment.
Swallowing problems are common in patients who have head and neck cancers. Cancer treatment side effects such as oral mucositis, dry mouth, skin damage from radiation, infections, and graft-versus-host-disease (GVHD) may all cause problems with swallowing.
Trouble swallowing increases the risk of other complications.
Other complications can develop from being unable to swallow and these can further decrease the patient's quality of life:
- Pneumonia and other respiratory problems: Patients who have trouble swallowing may aspirate (inhale food or liquids into the lung) when trying to eat or drink. Aspiration can lead to serious conditions, including pneumonia and respiratory failure.
- Poor nutrition: Being unable to swallow normally makes it hard to eat well. Malnutrition occurs when the body doesn't get all the nutrients needed for health. Wounds heal slowly and the body is less able to fight off infections.
- Need for tube feeding: A patient who is not able to take in enough food by mouth may be fed through a tube. The healthcare team and a registered dietitian can explain the benefits and risks of tube feeding for patients who have swallowing problems.
- Side effects of pain medicine: Opioids used to treat painful swallowing may cause dry mouth and constipation.
- Emotional problems: Being unable to eat, drink, and speak normally may cause depression and the desire to avoid other people.
Whether radiation therapy will affect swallowing depends on several factors.
The following may affect the risk of swallowing problems after radiation therapy:
- Total dose and schedule of radiation therapy. Higher doses over a shorter time often have more side effects.
- The way the radiation is given. Some types of radiation cause less damage to healthy tissue.
- Whether chemotherapy is given at the same time. The risk of side effects is increased if both are given.
- The patient's genetic makeup.
- Whether the patient is taking any food by mouth or only by tube feeding.
- Whether the patient smokes.
- How well the patient copes with problems.
Swallowing problems sometimes go away after treatment
Some side effects go away within 3 months after the end of treatment, and patients are able to swallow normally again. However, some treatments can cause permanent damage or late effects. Late effects are health problems that occur long after treatment has ended. Conditions that may cause permanent swallowing problems or late effects include:
- Damaged blood vessels.
- Wasting away of tissue in the treated areas.
- Lymphedema (buildup of lymph in the body).
- Overgrowth of fibrous tissue in head or neck areas, which may lead to jaw stiffness.
- Chronic dry mouth.
- Infections.
Swallowing problems are managed by a team of experts.
The oncologist works with other health care experts who specialize in treating head and neck cancers and the oral complications of cancer treatment. These specialists may include the following:
- Speech therapist: A speech therapist can assess how well the patient is swallowing and give the patient swallowing therapy and information to better understand the problem.
- Dietitian: A dietitian can help plan a safe way for the patient to receive the nutrition needed for health while swallowing is a problem.
- Dental specialist: Replace missing teeth and damaged area of the mouth with artificial devices to help swallowing.
- Psychologist: For patients who are having a hard time adjusting to being unable to swallow and eat normally, psychological counseling may help.
Tissue and Bone Loss
Radiation therapy can destroy very small blood vessels within the bone. This can kill bone tissue and lead to bone fractures or infection. Radiation can also kill tissue in the mouth. Ulcers may form, grow, and cause pain, loss of feeling, or infection.
Preventive care can make tissue and bone loss less severe.
The following may help prevent and treat tissue and bone loss:
- Eat a well-balanced diet.
- Wear removable dentures or devices as little as possible.
- Don't smoke.
- Don't drink alcohol.
- Use topical antibiotics.
- Use painkillers as prescribed.
- Surgery to remove dead bone or to rebuild bones of the mouth and jaw.
- Hyperbaric oxygen therapy (a method that uses oxygen under pressure to help wounds heal).
See the PDQ summary on Nutrition in Cancer Care for more information about managing mouth sores, dry mouth, and taste changes.
Managing Oral Complications of High-Dose Chemotherapy and / or Stem Cell Transplant
Patients who receive transplants have an increased risk of graft-versus-host disease.
Graft-versus-host disease (GVHD) occurs when your tissue reacts to bone marrow or stem cells that come from a donor. Symptoms of oral GVHD include the following:
- Sores that are red and have ulcers, which appear in the mouth 2 to 3 weeks after the transplant.
- Dry mouth.
- Pain from spices, alcohol, or flavoring (such as mint in toothpaste).
- Swallowing problems.
- A feeling of tightness in the skin or in the lining of the mouth.
- Taste changes.
It's important to have these symptoms treated because they can lead to weight loss or malnutrition. Treatment of oral GVHD may include the following:
- Topical rinses, gels, creams, or powders.
- Antifungal drugs taken by mouth or injection.
- Psoralen and ultraviolet A (PUVA) therapy.
- Drugs that help the salivary glands make more saliva.
- Fluoride treatments.
- Treatments to replace minerals lost from teeth by acids in the mouth.
Oral devices need special care during high-dose chemotherapy and/or stem cell transplant.
The following can help in the care and use of dentures, braces, and other oral devices during high-dose chemotherapy or stem cell transplant:
- Have brackets, wires, and retainers removed before high-dose chemotherapy begins.
- Wear dentures only when eating during the first 3 to 4 weeks after the transplant.
- Brush dentures twice a day and rinsing them well.
- Soak dentures in an antibacterial solution when they are not being worn.
- Clean denture soaking cups and changing denture soaking solution every day.
- Remove dentures or other oral devices when cleaning your mouth.
- Continue your regular oral care 3 or 4 times a day with dentures or other devices out of the mouth.
- If you have mouth sores, avoid using removable oral devices until the sores have healed.
Care of the teeth and gums is important during chemotherapy or stem cell transplant.
Talk to your medical doctor or dentist about the best way to take care of your mouth during high-dose chemotherapy and stem cell transplant. Careful brushing and flossing may help prevent infection of oral tissues. The following may help prevent infection and relieve discomfort of oral in tissues:
- Brush teeth with a soft-bristle brush 2 to 3 times a day. Be sure to brush the area where the teeth meet the gums.
- Rinse the toothbrush in hot water every 15 to 30 seconds to keep the bristles soft.
- Rinse your mouth 3 or 4 times while brushing.
- Avoid rinses that have alcohol in them.
- Use a mild-tasting toothpaste.
- Let the toothbrush air-dry between uses.
- Floss according to your medical doctor's or dentist's directions.
- Clean the mouth after meals.
- Use foam swabs to clean the tongue and roof of the mouth.
- Avoid the following:
- Foods that are spicy or acidic.
- "Hard" foods that could irritate or break the skin in your mouth, such as chips.
- Hot foods and drinks.
Medicines and ice may be used to prevent and treat mucositis from stem cell transplant.
Medicines may be given to help prevent mouth sores or help the mouth heal faster if it is damaged by chemotherapy or radiation therapy. Also, holding ice chips in the mouth during high-dose chemotherapy, may help prevent mouth sores.
Dental treatments may be put off until the patient's immune system returns to normal.
Regular dental treatments, including cleaning and polishing, should wait until the transplant patient's immune system returns to normal. The immune system can take 6 to 12 months to recover after high-dose chemotherapy and stem cell transplant. During this time, the risk of oral complications is high. If dental treatments are needed, antibiotics and supportive care are given.
Supportive care before oral procedures may include giving antibiotics or immunoglobulin G, adjusting steroid doses, and/or platelet transfusion.
Oral Complications in Second Cancers
Cancer survivors who received chemotherapy or a transplant or who underwent radiation therapy are at risk of developing a second cancer later in life. Oral squamous cell cancer is the most common second oral cancer in transplant patients. The lips and tongue are the areas that are affected most often.
Second cancers are more common in patients treated for leukemia or lymphoma, Multiple myeloma patients who received a stem cell transplant using their own stem cells sometimes develop an oral plasmacytoma.
Patients who received a transplant should see a doctor if they have swollen lymph nodes or lumps in soft tissue areas. This could be a sign of a second cancer.
Oral Complications Not Related to Chemotherapy or Radiation Therapy
Certain drugs used to treat cancer and other bone problems are linked to bone loss in the mouth.
Some drugs break down bone tissue in the mouth. This is called osteonecrosis of the jaw (ONJ). ONJ can also cause infection. Symptoms include pain and inflamed lesions in the mouth, where areas of damaged bone may show.
Drugs that may cause ONJ include the following:
- Bisphosphonates: Drugs given to some patients whose cancer has spread to the bones. They are used to decrease pain and the risk of broken bones. Bisphosphonates are also used to treat hypercalcemia (too much calcium in the blood). Bisphosphonates commonly used include zoledronic acid, pamidronate, and alendronate.
- Denosumab: A drug used to prevent or treat certain bone problems. Denosumab is a type of monoclonal antibody.
- Angiogenesis inhibitors: Drugs or substances that keep new blood vessels from forming. In cancer treatment, angiogenesis inhibitors may prevent the growth of new blood vessels that tumors need to grow. Some of the angiogenesis inhibitors that may cause ONJ are bevacizumab, sunitinib, and sorafenib.
It's important for the health care team to know if a patient has been treated with these drugs. Cancer that has spread to the jawbone can look like ONJ. A biopsy may be needed to find out the cause of the ONJ.
ONJ is not a common condition. It occurs more often in patients who receive bisphosphonates or denosumab by injection than in patients who take them by mouth. Taking bisphosphonates, denosumab, or angiogenesis inhibitors increases the risk of ONJ. The risk of ONJ is much greater when angiogenesis inhibitors and bisphosphonates are used together.
The following may also increase the risk of ONJ:
- Having teeth removed.
- Wearing dentures that do not fit well.
- Having multiple myeloma.
Patients with bone metastases may decrease their risk of ONJ by getting screened and treated for dental problems before bisphosphonate or denosumab therapy is started.
Treatment of ONJ usually includes treating the infection and good dental hygiene.
Treatment of ONJ may include the following:
- Removing the infected tissue, which may include bone. Laser surgery may be used.
- Smoothing sharp edges of exposed bone.
- Using antibiotics to fight infection.
- Using medicated mouth rinses.
- Using pain medicine.
During treatment for ONJ, you should continue to brush and floss after meals to keep your mouth very clean. It is best to avoid tobacco use while ONJ is healing.
You and your doctor can decide whether you should stop using medicines that cause ONJ, based on the effect it would have on your general health.
Oral Complications and Social Problems
The social problems related to oral complications can be the hardest problems for cancer patients to cope with. Oral complications affect eating and speaking and may make you unable or unwilling to take part in mealtimes or to dine out. Patients may become frustrated, withdrawn, or depressed, and they may avoid other people. Some drugs that are used to treat depression cannot be used because they can make oral complications worse. See the following PDQ summaries for more information:
- Adjustment to Cancer: Anxiety and Distress
- Depression
Education, supportive care, and the treatment of symptoms are important for patients who have mouth problems that are related to cancer treatment. Patients are watched closely for pain, ability to cope, and response to treatment. Supportive care from health care providers and family can help the patient cope with cancer and its complications.
Oral Complications of Chemotherapy and Radiation Therapy in Children
Children who received high-dose chemotherapy or radiation therapy to the head and neck may not have normal dental growth and development. New teeth may appear late or not at all, and tooth size may be smaller than normal. The head and face may not develop fully. The changes are usually the same on both sides of the head and are not always noticeable.
Orthodontic treatment for patients with these dental growth and development side effects is being studied.
Changes to This Summary (04 / 26 / 2019)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
About This PDQ Summary
About PDQ
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government's center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.
Purpose of This Summary
This PDQ cancer information summary has current information about the causes and treatment of oral complications of chemotherapy and head/neck radiation. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Reviewers and Updates
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.
Clinical Trial Information
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
Permission to Use This Summary
PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary]."
The best way to cite this PDQ summary is:
PDQ® Supportive and Palliative Care Editorial Board. PDQ Oral Complications of Chemotherapy and Head/Neck Radiation. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389169]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.
The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
Contact Us
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website's E-mail Us.
Last Revised: 2019-04-26
If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.
Topic Contents
- General Information About Oral Complications
- Oral Complications and Their Causes
- Preventing and Treating Oral Complications Before Chemotherapy or Radiation Therapy Begins
- Managing Oral Complications During and After Chemotherapy or Radiation Therapy
- Managing Oral Complications of High-Dose Chemotherapy and / or Stem Cell Transplant
- Oral Complications in Second Cancers
- Oral Complications Not Related to Chemotherapy or Radiation Therapy
- Oral Complications and Social Problems
- Oral Complications of Chemotherapy and Radiation Therapy in Children
- Changes to This Summary (04 / 26 / 2019)
- About This PDQ Summary
This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.


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Ticket Information
ADULT: $20 (persons 13 and older)
CHILD: up to 2 Children FREE with EACH Paid Adult (persons age 3 to 12)
EXTRA CHILD: $3 (persons 3 to 12)
INFANT: are FREE and do not need a ticket (persons under 2yrs of age)
STUDENT: $10 (persons 13-17) — This ticket is only for children, NOT young adults attending university/college.
Free Children's Tickets may have been distributed throughout your area in Fast Food Restaurants, Convenience Stores, Businesses, Schools and Retail stores. These may be used to admit ONE child for EACH paid adult. The Free Children's Tickets may not be used in combination with the Family Package.
Children under 2 are free and do not need a ticket. Age 3 to 12 must have a Child's ticket (Free or Paid). All Persons, Ages 13 and up must have an Adult ticket to enter the Circus. All Children must be accompanied by an adult. Children may not be left unattended at the Circus.
After your purchase is complete, you will be sent an email with a summary of your purchase and a barcode to be scanned at the entrance. This is ONE barcode for your entire purchase. You do NOT have to print this email, we prefer you to display it on your mobile device at the entrance to the Circus.
Tickets are NOT refundable. If you are unable to attend, you may pass your tickets along to a friend or family member.
Special needs adults with support caregivers are free! Please present identification at arrival; however, caregivers must purchase an adult ticket.
If you have difficulty purchasing tickets online or if you would prefer not to buy online, you may purchase tickets at the show's on-site box office one the hour before each performance.
For further assistance with Ticket Purchases
Use the LIVE CHAT below or
Call (941) 870 – 7444
Show time:
Friday, April 12, 2024 4:30 pm
Online sales have ended for this performance.All Muncie, IN Showtimes
- No events found.

subset: commoncrawl


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Does My Child Have a Food Allergy?
posted: Feb. 28, 2017.
Especially during the younger years, adequate food and nutrition is vital for a child's growth and development. But for some children, a snack or meal as simple as a peanut butter sandwich or a cup of milk can cause serious health problems. So, what's a parent to do when they suspect their child is allergic to a certain food?
A food allergy is the abnormal response of the immune system to a food. It's possible to be allergic to any food, but these particular foods are responsible for the majority of allergies: milk, eggs, wheat, soy, tree nuts, fish, shellfish, and peanuts. Food allergies should not be confused with food intolerance, or food sensitivity, which is more common and less severe.
Symptoms of an allergic reaction typically occur within just moments to an hour after the child ingests a food. They can range from uncomfortable to life-threatening, so it's important for parents to understand what to do if they suspect their child is having an allergic reaction to food. Symptoms will vary for each child, but the most common telltale signs include:
- Vomiting
- Diarrhea
- Hives
- Eczema
- Trouble breathing
- Itching or swelling of the lips, tongue, mouth or throat
- Sneezing
- Wheezing
- Light-headedness or loss of consciousness
Food allergy symptoms often resemble other medical conditions, so always contact your pediatrician for a proper diagnosis. If you suspect your child has a food allergy, remove that particular food from your child's diet immediately. If the allergic reaction is severe, seek medical care right away.
The good news is that food allergies are often outgrown during early childhood. Your pediatrician or allergist can perform tests to pinpoint and track your child's food allergies They can also work with you to modify and manage your child's diet to ensure they are receiving adequate nutrition for growth and development without putting them at risk for additional allergic reactions.


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GRETA | Nautical Wedding Invitation Template
If you're looking for a unique and memorable way to announce your upcoming nuptials, look no further than our beach wedding invitation template! This elegant wedding invitation is perfect for a destination or beach wedding and will surely excite your guests for your big day.
Please read below for what's included and how it works!
You will receive an email from Corjl.com 15 minutes after the purchase with the link to self-edit your template. Edit any wording, change typography and text colour and add your own photo. Print at home on your own printer or take it to a local print shop. No software is required. This is a digital product, and no physical item will be shipped.
Shop more stationery from the Beach Collection
▶ Free Demo: https://www.corjl.com/d/H5BG3/s
Access the DEMO version and see exactly what can be edited.
1. Purchase your template. You will receive an email with a link to create an account in Corjl and access your template.
After creating your Corjl account, you need to log in with the email and password provided from the following page: https://www.corjl.com/orders/login.
2. Edit the text, add your own image and proofread each template. Save and download your design as a JPG, PNG or PDF.
3. Print at home, send to a local printer or order online through our partner Prints of Love.
✅ Make any changes to your text. Add or remove blocks of text, adjust the font type, and edit the color, size, and position of your text.
✅ Add your own images and graphics.
Templates are available for editing 365 days after purchase—no Download Limit.
🚫 Cannot change template size, orientation or graphics.
❗ If you use a mobile device or tablet, you can only edit text, add an image, and download the edited version. For the best editing experience, we recommend using a desktop or laptop computer with the Google Chrome browser.
For the best quality, we recommend printing with a professional service.
Our shop has partnered with PRINTS OF LOVE to offer fast, high-quality yet affordable printing. Plus free 2-3 day U.S. shipping and free envelopes!
> Save your files as PDF with slow bleeds selected, so the quality is very high and the text will remain perfectly sharp.
Simply visit this link to send your file to PRINTS OF LOVE.
Get 10% OFF with code: CREATIVETHINGS10
Or you can send your PDF to a print center like Vistaprint, COSTCO, Office Max, Office Depot, Walgreens, Staples, FedEx Office and many more. Please check with them what format they prefer.
If you are looking for a special place to print your wedding stationery in the UK we recommend PRINTED.COM. They offers a wide range of paper quality and foil finish options, so you'll be sure to find the perfect combination for your special day.
> Save your files as PDF with slow bleeds selected.
Print your templates with Vistaprint, they can print and deliver to 45 countries, or with a local print center.
You can also print at home (with options to print multiple cards per US Letter or A4 sheet). Choose the download option PDF + "Show Bleed and "Show Trim Marks". Select the option "Print Multiples Per Page if Possible" this will print multiple copies per page. Recommended to print on high-quality stock paper. Select a stock of at least 100lb or more.
Welcome to Creative Things Studio. When you choose to access and use our templates, you are agreeing to and are bound by the following terms and conditions. Please read them carefully.
• PERSONAL USE: All templates provided by Creative Things Studio are for personal use only. You are granted permission to access, save, and use the templates, but any commercial use, including selling, distributing, or repurposing for commercial endeavours, is strictly prohibited.
• ONE-TIME USE: The acquisition of a template implies it's for a singular application. While you are free to modify, save, and download your chosen template for proofing, creating varied editions for multiple events is not allowed.
• RETURN & EXCHANGE: We do not offer refunds or exchanges for digital products. Please feel free to contact us before purchasing if you have any questions!
• CONTENT USAGE: The content, graphics, or templates from Creative Things Studio is available to you solely for personal endeavours. Any form of republication, distribution, resale, or other unauthorized uses are prohibited. Reproduction of any part of the content, description, or template in any medium is not allowed.
• RIGHTS: Creative Things Studio retains the full authority to withdraw access to any template for users who do not adhere to these terms and conditions.
• COPYRIGHT: All items, descriptions, and other materials in the shop are under the copyright of Creative Things Studio. It is strictly forbidden to replicate or reproduce them in any way. Invitations and templates available for purchase are solely for personal use and must not be resold under any circumstances. All designs, graphics, and other intellectual properties belong exclusively to Creative Things Studio unless otherwise noted. For any graphics or assets that are not the original work of Creative Things Studio, appropriate licenses have been secured for their presentation in the file preview.
© Creative Things Studio. All rights reserved.
- What is Corjl? Corjl is an online editor where you can edit your templates easily. Corjl also gives you a chance to try your wording on a Demo of the product itself. You can find the Demo Link next to every item in the product description.
- Can I edit from my phone or tablet?Yes, you can edit your template right from your phone or tablet, but please note that if you are personalizing an item on a mobile/ tablet device, you are limited to only replacing the text and images.
- You will need to use a desktop or laptop computer to access additional features.
- Also, please note that Google Chrome is the recommended browser for using Corjl. Some features may not show up or be available in other browsers.
- Do I have to download fonts or software? No, you don't have to download any fonts or software.
- The template editing tool, Corjl, is web-based, and fonts are included.
- You will only download your print-ready file at the end!
- What Can I change? With Corjl, you can edit all the texts, font type and colour, size and position, add and remove text boxes. Add your own images. Once you're happy, you can save your creation as a high-resolution JPG, PNG and PDF.
- What can not I change? You cannot change size and orientation. The sizes are standard US / EU sizes to fit envelopes. Please note the size of each template is in the product description. You cannot change the colours of the graphics.
- Test the FREE DEMO to see what you can customize!
- Where can I print? For details on suitable printing options, please consult the "Where to Print" section provided above in this FAQ.
- Why do certain colours look different after they print? We always try to match on-screen colours (RGB) to printed colours (CMYK) as close as possible, although sometimes slight color variation may occur based on the calibration of your monitor.
- I recommend doing test prints before printing in bulk.
- What is a good paper weight to print wedding invitations? Recommended to print on high-quality stock paper. Select a stock of at least 100lb or more. Though most consumer-grade home printers can handle 80lb (216gsm) to 100lb (270gsm) cardstock, not all can. All printers are different, so be sure to do your research and consult your printer manual for card stock printing information and recommendations.
Printable Templates
Easily personalize after purchase using the Corjl online editor from your desktop computer.
Here's how it works:
MAKE IT YOURS - As soon as you buy your template, you can start customizing it! Just head over to Corjl.com using a browser on your desktop computer, and you'll be able to change the wording, typography and text and background colours and even add your own picture.
DOWNLOAD - Once you're happy with your creation, save and download your design as a high-quality PDF, PNG, or JPG. Files are available for editing 365 days after purchase—no Download Limit.
PRINT - Print at home, send to a local printer or order online through our partner Prints of Love.


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Privacy policy
General information
Welcome to our Privacy Policy page! When you use our store services, you trust us with your information. This Privacy Policy is meant to help you understand what data we collect, why we collect it, and what we do with it. When you share information with us, we can make our services even better for you. For instance, we can show you more relevant search results and ads, help you connect with people or to make sharing with others quicker and easier. As you use our services, we want you to be clear how we're using information and the ways in which you can protect your privacy. This is important; we hope you will take time to read it carefully. Remember, you can find controls to manage your information and protect your privacy and security. We've tried to keep it as simple as possible.
Right to access, correct and delete data and to object to data processing
Our customers have the right to access, correct and delete personal data relating to them, and to object to the processing of such data, by addressing a written request, at any time. The Company makes every effort to put in place suitable precautions to safeguard the security and privacy of personal data, and to prevent it from being altered, corrupted, destroyed or accessed by unauthorized third parties. However, the Company does not control each and every risk related to the use of the Internet, and therefore warns the Site users of the potential risks involved in the functioning and use of the Internet. The Site may include links to other web sites or other internet sources. As the Company cannot control these web sites and external sources, the Company cannot be held responsible for the provision or display of these web sites and external sources, and may not be held liable for the content, advertising, products, services or any other material available on or from these web sites or external sources.
Management of personal data
You can view or edit your personal data online for many of our services. You can also make choices about our collection and use of your data. How you can access or control your personal data will depend on which services you use. You can choose whether you wish to receive promotional communications from our store by email, SMS, physical mail, and telephone. If you receive promotional email or SMS messages from us and would like to opt out, you can do so by following the directions in that message. You can also make choices about the receipt of promotional email, telephone calls, and postal mail by visiting and signing into Company Promotional Communications Manager, which allows you to update contact information, manage contact preferences, opt out of email subscriptions, and choose whether to share your contact information with our partners. These choices do not apply to mandatory service communications that are part of certain store services.
Information We Collect
Our store collects data to operate effectively and provide you the best experiences with our services. You provide some of this data directly, such as when you create a personal account. We get some of it by recording how you interact with our services by, for example, using technologies like cookies, and receiving error reports or usage data from software running on your device. We also obtain data from third parties (including other companies). For example, we supplement the data we collect by purchasing demographic data from other companies. We also use services from other companies to help us determine a location based on your IP address in order to customize certain services to your location. The data we collect depends on the services and features you use.
How We Use Your Information
Our store uses the data we collect for three basic purposes: to operate our business and provide (including improving and personalizing) the services we offer, to send communications, including promotional communications, and to display advertising. In carrying out these purposes, we combine data we collect through the various store services you use to give you a more seamless, consistent and personalized experience. However, to enhance privacy, we have built in technological and procedural safeguards designed to prevent certain data combinations. For example, we store data we collect from you when you are unauthenticated (not signed in) separately from any account information that directly identifies you, such as your name, email address or phone number.
Sharing Your Information
We share your personal data with your consent or as necessary to complete any transaction or provide any service you have requested or authorized. For example, we share your content with third parties when you tell us to do so. When you provide payment data to make a purchase, we will share payment data with banks and other entities that process payment transactions or provide other financial services, and for fraud prevention and credit risk reduction. In addition, we share personal data among our controlled affiliates and subsidiaries. We also share personal data with vendors or agents working on our behalf for the purposes described in this statement. For example, companies we've hired to provide customer service support or assist in protecting and securing our systems and services may need access to personal data in order to provide those functions. In such cases, these companies must abide by our data privacy and security requirements and are not allowed to use personal data they receive from us for any other purpose. We may also disclose personal data as part of a corporate transaction such as a merger or sale of assets.


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Health Issue: Sleep Apnea
Overview and Facts
Sleep apnea, a disruption of breathing while asleep, is a deceiving sleep disorder – 90% of people who have sleep apnea don't know that they have it! Although episodes of choking or gasping for air might occur hundreds of times throughout the night, you may not have any recollection of struggling for breath.
Usually it is the bed partner who first notices that the person is struggling to breathe. If left untreated, this common disorder can be life-threatening.
What happens when you have an episode of sleep apnea?
When you stop breathing during sleep due to sleep apnea, the balance of oxygen and carbon dioxide in the blood is upset. This imbalance stimulates the brain to restart the breathing process. The brain signals you to wake up so that the muscles of the tongue and throat can increase the size of the airway. Then, carbon dioxide can escape, and oxygen can enter the airway. These waking episodes are necessary to restart breathing (and to save your life), and you may not remember them, but they do disrupt your sleep and cause daytime exhaustion.
Obstructive Sleep Apnea (OSA)
OSA is the most common type of sleep apnea. It is caused by a breathing obstruction, which stops the air flow in the nose and mouth. The rest of this article discusses the causes, symptoms and treatments for OSA.
Central Sleep Apnea (CSA)
Central sleep apnea (CSA), less common than OSA, is a central nervous system disorder that occurs when the brain signal telling the body to breathe is delayed. CSA can be caused by disease or injury involving the brainstem, such as a stroke, a brain tumor, a viral brain infection, or a chronic respiratory disease. People with CSA seldom snore. However, while the causes of apnea are different in CSA and OSA, the symptoms and results are much the same – a deprivation of oxygen and poor sleep. The treatments for CSA include medications that stimulate the need to breathe and administration of oxygen.


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Privacy Policy
1. An overview of data protection
General information
The following information will provide you with an easy to navigate overview of what will happen with your personal data when you visit our website. The term "personal data" comprises all data that can be used to personally identify you. For detailed information about the subject matter of data protection, please consult our Data Protection Declaration, which we have included beneath this copy.
Data recording on our website
Who is the responsible party for the recording of data on this website (i.e. the "controller")?
The data on this website is processed by the operator of the website, whose contact information is available under section "Information Required by Law" on this website.
How do we record your data?
We collect your data as a result of your sharing of your data with us. This may, for instance be information you enter into our contact form.
Our IT systems automatically record other data when you visit our website. This data comprises primarily technical information (e.g. web browser, operating system or time the site was accessed). This information is recorded automatically when you access our website.
What are the purposes we use your data for?
A portion of the information is generated to guarantee the error free provision of the website. Other data may be used to analyse your user patterns.
What rights do you have as far as your information is concerned?
You have the right to receive information about the source, recipients and purposes of your archived personal data at any time without having to pay a fee for such disclosures. You also have the right to demand that your data are rectified, blocked or eradicated. Please do not hesitate to contact us at any time under the address disclosed in section "Information Required by Law" on this website if you have questions about this or any other data protection related issues. You also have the right to log a complaint with the competent supervising agency.
Moreover, under certain circumstances, you have the right to demand the restriction of the processing of your personal data. For details, please consult the Data Protection Declaration under section "Right to Restriction of Data Processing."
Analysis tools and tools provided by third parties
There is a possibility that your browsing patterns will be statistically analysed when your visit our website. Such analyses are performed primarily with cookies and with what we refer to as analysis programmes. As a rule, the analyses of your browsing patterns are conducted anonymously; i.e. the browsing patterns cannot be traced back to you.
You have the option to object to such analyses or you can prevent their performance by not using certain tools. For detailed information about the tools and about your options to object, please consult our Data Protection Declaration below.
2. General information and mandatory information
Data protection
The operators of this website and its pages take the protection of your personal data very seriously. Hence, we handle your personal data as confidential information and in compliance with the statutory data protection regulations and this Data Protection Declaration.
Whenever you use this website, a variety of personal information will be collected. Personal data comprises data that can be used to personally identify you. This Data Protection Declaration explains which data we collect as well as the purposes we use this data for. It also explains how, and for which purpose the information is collected.
We herewith advise you that the transmission of data via the Internet (i.e. through e-mail communications) may be prone to security gaps. It is not possible to completely protect data against third party access.
Information about the responsible party (referred to as the "controller" in the GDPR)
The data processing controller on this website is:
Peick FörderSysteme GmbH
Zeppelinstraße 26
71672 Marbach am Neckar
Phone: +49 7144 91046 – 0
E-mail: email@example.com
The controller is the natural person or legal entity that single-handedly or jointly with others makes decisions as to the purposes of and resources for the processing of personal data (e.g. names, e-mail addresses, etc.).
Designation of a data protection officer as mandated by law
We have appointed a data protection officer for our company.
Nicole Dienstl
Zeppelinstraße 26
71672 Marbach am Neckar
Phone: +49 7144 91046 – 0
E-mail: firstname.lastname@example.com
Revocation of your consent to the processing of data
A wide range of data processing transactions are possible only subject to your express consent. You can also revoke at any time any consent you have already given us. To do so, all you are required to do is sent us an informal notification via e-mail. This shall be without prejudice to the lawfulness of any data collection that occurred prior to your revocation.
Right to object to the collection of data in special cases; right to object to direct advertising (Art. 21 GDPR)
In the event that data are processed on the basis of Art. 6 Sect. 1 lit. e or f GDPR, you have the right to at any time object to the processing of your personal data based on grounds arising from your unique situation. This also applies to any profiling based on these provisions. To determine the legal basis, on which any processing of data is based, please consult this Data Protection Declaration. If you log an objection, we will no longer process your affected personal data, unless we are in a position to present compelling protection worthy grounds for the processing of your data, that outweigh your interests, rights and freedoms or if the purpose of the processing is the claiming, exercising or defence of legal entitlements (objection pursuant to Art. 21 Sect. 1 GDPR).
If your personal data is being processed in order to engage in direct advertising, you have the right to at any time object to the processing of your affected personal data for the purposes of such advertising. This also applies to profiling to the extent that it is affiliated with such direct advertising. If you object, your personal data will subsequently no longer be used for direct advertising purposes (objection pursuant to Art. 21 Sect. 2 GDPR).
Right to log a complaint with the competent supervisory agency
In the event of violations of the GDPR, data subjects are entitled to log a complaint with a supervisory agency, in particular in the member state where they usually maintain their domicile, place of work or at the place where the alleged violation occurred. The right to log a complaint is in effect regardless of any other administrative or court proceedings available as legal recourses.
Right to data portability
You have the right to demand that we hand over any data we automatically process on the basis of your consent or in order to fulfil a contract be handed over to you or a third party in a commonly used, machine readable format. If you should demand the direct transfer of the data to another controller, this will be done only if it is technically feasible.
SSL and/or TLS encryption
For security reasons and to protect the transmission of confidential content, such as purchase orders or inquiries you submit to us as the website operator, this website uses either an SSL or a TLS encryption programme. You can recognise an encrypted connection by checking whether the address line of the browser switches from "http://" to "https://" and also by the appearance of the lock icon in the browser line.
If the SSL or TLS encryption is activated, data you transmit to us cannot be read by third parties.
Information about, blockage, rectification and eradication of data
Within the scope of the applicable statutory provisions, you have the right to at any time demand information about your archived personal data, their source and recipients as well as the purpose of the processing of your data. You may also have a right to have your data rectified, blocked or eradicated. If you have questions about this subject matter or any other questions about personal data, please do not hesitate to contact us at any time at the address provided in section "Information Required by Law."
Right to demand processing restrictions
You have the right to demand the imposition of restrictions as far as the processing of your personal data is concerned. To do so, you may contact us at any time at the address provided in section "Information Required by Law." The right to demand restriction of processing applies in the following cases:
- In the event that you should dispute the correctness of your data archived by us, we will usually need some time to verify this claim. During the time that this investigation is ongoing, you have the right to demand that we restrict the processing of your personal data.
- If the processing of your personal data was/is conducted in an unlawful manner, you have the option to demand the restriction of the processing of your data in lieu of demanding the eradication of this data.
- If we do not need your personal data any longer and you need it to exercise, defend or claim legal entitlements, you have the right to demand the restriction of the processing of your personal data instead of its eradication.
- If you have raised an objection pursuant to Art. 21 Sect. 1 GDPR, your rights and our rights will have to be weighed against each other. As long as it has not been determined whose interests prevail, you have the right to demand a restriction of the processing of your personal data.
If you have restricted the processing of your personal data, these data – with the exception of their archiving – may be processed only subject to your consent or to claim, exercise or defend legal entitlements or to protect the rights of other natural persons or legal entities or for important public interest reasons cited by the European Union or a member state of the EU.
Rejection of unsolicited e-mails
We herewith object to the use of contact information published in conjunction with the mandatory information to be provided in section "Information Required by Law" to send us promotional and information material that we have not expressly requested. The operators of this website and its pages reserve the express right to take legal action in the event of the unsolicited sending of promotional information, for instance via SPAM messages.
3. Recording of data on our website
In some instances, our website and its pages use so-called cookies. Cookies do not cause any damage to your computer and do not contain viruses. The purpose of cookies is to make our website more user friendly, effective and more secure. Cookies are small text files that are placed on your computer and stored by your browser.
Most of the cookies we use are so-called "session cookies." They are automatically deleted after your leave our site. Other cookies will remain archived on your device until you delete them. These cookies enable us to recognise your browser the next time you visit our website.
You can adjust the settings of your browser to make sure that you are notified every time cookies are placed and to enable you to accept cookies only in specific cases or to exclude the acceptance of cookies for specific situations or in general and to activate the automatic deletion of cookies when you close your browser. If you deactivate cookies, the functions of this website may be limited.
Cookies that are required for the performance of the electronic communications transaction or to provide certain functions you want to use (e.g. the shopping cart function), are stored on the basis of Art. 6 Sect. 1 lit. f GDPR. The website operator has a legitimate interest in storing cookies to ensure the technically error free and optimised provision of the operator's services. If other cookies (e.g. cookies for the analysis of your browsing patterns) should be stored, they are addressed separately in this Data Protection Declaration.
Server log files
The provider of this website and its pages automatically collects and stores information in so-called server log files, which your browser communicates to us automatically. The information comprises:
- The type and version of browser used
- The used operating system
- Referrer URL
- The hostname of the accessing computer
- The time of the server inquiry
- The IP address
This data is not merged with other data sources.
This data is recorded on the basis of Art. 6 Sect. 1 lit. f GDPR. The operator of the website has a legitimate interest in the technically error free depiction and the optimization of the operator's website. In order to achieve this, server log files must be recorded.
Contact form
If you submit inquiries to us via our contact form, the information provided in the contact form as well as any contact information provided therein will be stored by us in order to handle your inquiry and in the event that we have further questions. We will not share this information without your consent.
Hence, the processing of the data entered into the contact form occurs exclusively based on your consent (Art. 6 Sect. 1 lit. a GDPR). You have the right to revoke at any time any consent you have already given us. To do so, all you are required to do is sent us an informal notification via e-mail. This shall be without prejudice to the lawfulness of any data collection that occurred prior to your revocation.
The information you have entered into the contact form shall remain with us until you ask us to eradicate the data, revoke your consent to the archiving of data or if the purpose for which the information is being archived no longer exists (e.g. after we have concluded our response to your inquiry). This shall be without prejudice to any mandatory legal provisions – in particular retention periods.
Request by e-mail, telephone or fax
If you contact us by e-mail, telephone or fax, your request, including all resulting personal data (name, request) will be stored and processed by us for the purpose of processing your request. We do not pass these data on without your consent.
The processing of these data is based on Art. 6 para. 1 lit. b GDPR, if your request is related to the execution of a contract or if it is necessary to carry out pre-contractual measures. In all other cases, the processing is based on your consent (Article 6 (1) a GDPR) and/or on our legitimate interests (Article 6 (1) (f) GDPR), since we have a legitimate interest in the effective processing of requests addressed to us.
The data sent by you to us via contact requests remain with us until you request us to delete, revoke your consent to the storage or the purpose for the data storage lapses (e.g. after completion of your request). Mandatory statutory provisions – in particular statutory retention periods – remain unaffected.
4. Analysis tools and advertising
Google Analytics
This website uses functions of the web analysis service Google Analytics. The provider of this service is Google Ireland Limited ("Google"), Gordon House, Barrow Street, Dublin 4, Ireland.
Google Analytics uses so-called cookies. Cookies are text files, which are stored on your computer and that enable an analysis of the use of the website by users. The information generated by cookies on your use of this website is usually transferred to a Google server in the United States, where it is stored.
The storage of Google Analytics cookies and the utilization of this analysis tool are based on Art. 6 Sect. 1 lit. f GDPR. The operator of this website has a legitimate interest in the analysis of user patterns to optimize both, the services offered online and the operator's advertising activities.
IP anonymization
On this website, we have activated the IP anonymization function. As a result, your IP address will be abbreviated by Google within the member states of the European Union or in other states that have ratified the Convention on the European Economic Area prior to its transmission to the United States. The full IP address will be transmitted to one of Google's servers in the United States and abbreviated there only in exceptional cases. On behalf of the operator of this website, Google shall use this information to analyse your use of this website to generate reports on website activities and to render other services to the operator of this website that are related to the use of the website and the Internet. The IP address transmitted in conjunction with Google Analytics from your browser shall not be merged with other data in Google's possession.
Browser plug-in
You do have the option to prevent the archiving of cookies by making pertinent changes to the settings of your browser software. However, we have to point out that in this case you may not be able to use all of the functions of this website to their fullest extent. Moreover, you have the option prevent the recording of the data generated by the cookie and affiliated with your use of the website (including your IP address) by Google as well as the processing of this data by Google by downloading and installing the browser plug-in available under the following link: https://tools.google.com/dlpage/gaoptout?hl=en.
Objection to the recording of data
You have the option to prevent the recording of your data by Google Analytics by clicking on the following link. This will result in the placement of an opt out cookie, which prevents the recording of your data during future visits to this website: Google Analytics deactivation.
For more information about the handling of user data by Google Analytics, please consult Google's Data Privacy Declaration at: https://support.google.com/analytics/answer/6004245?hl=en.
Contract data processing
We have executed a contract data processing agreement with Google and are implementing the stringent provisions of the German data protection agencies to the fullest when using Google Analytics.
Demographic parameters provided by Google Analytics
This website uses the function "demographic parameters" provided by Google Analytics. It makes it possible to generate reports providing information on the age, gender and interests of website visitors. The sources of this information are interest-related advertising by Google as well as visitor data obtained from third party providers. This data cannot be allocated to a specific individual. You have the option to deactivate this function at any time by making pertinent settings changes for advertising in your Google account or you can generally prohibit the recording of your data by Google Analytics as explained in section "Objection to the recording of data."
Archiving period
Data on the user or incident level stored by Google linked to cookies, user IDs or advertising IDs (e.g. DoubleClick cookies, Android advertising ID) will be anonymized or deleted after 14 month. For details please click the following link: https://support.google.com/analytics/answer/7667196?hl=en
5. Plug-ins and Tools
YouTube with expanded data protection integration
Our website uses plug-ins of the YouTube platform, which is being operated by Google Ireland Limited ("Google"), Gordon House, Barrow Street, Dublin 4, Ireland.
We use YouTube in the expanded data protection mode. According to YouTube, this mode ensures that YouTube does not store any information about visitors to this website before they watch the video. Nevertheless, this does not necessarily mean that the sharing of data with YouTube partners can be ruled out as a result of the expanded data protection mode. For instance, regardless of whether you are watching a video, YouTube will always establish a connection with the Google DoubleClick network.
As soon as you start to play a YouTube video on our website, a connection to YouTube's servers will be established. As a result, the YouTube server will be notified, which of our pages you have visited. If you are logged into your YouTube account while you visit our site, you enable YouTube to directly allocate your browsing patterns to your personal profile. You have the option to prevent this by logging out of your YouTube account.
Furthermore, after you have started to play a video, YouTube will be able to place various cookies on your device. With the assistance of these cookies, YouTube will be able to obtain information about our website visitor. Among other things, this information will be used to generate video statistics with the aim of improving the user friendliness of the site and to prevent attempts to commit fraud. These cookies will stay on your device until you delete them.
Under certain circumstances, additional data processing transactions may be triggered after you have started to play a YouTube video, which are beyond our control.
The use of YouTube is based on our interest in presenting our online content in an appealing manner. Pursuant to Art. 6 Sect. 1 lit. f GDPR, this is a legitimate interest.
For more information on how YouTube handles user data, please consult the YouTube Data Privacy Policy under: https://policies.google.com/privacy?hl=en.
Google Web Fonts
To ensure that fonts used on this website are uniform, this website uses so-called Web Fonts provided by Google. When you access a page on our website, your browser will load the required web fonts into your browser cache to correctly display text and fonts.
To do this, the browser you use will have to establish a connection with Google's servers. As a result, Google will learn that your IP address was used to access our website. The use of Google Web Fonts is based on our interest in presenting our online content in a uniform and appealing way. According to Art. 6 Sect. 1 lit. f GDPR, this is a legitimate interest.
If your browser should not support Web Fonts, a standard font installed on your computer will be used.
For more information on Google Web Fonts, please follow this link: https://developers.google.com/fonts/faq and consult Google's Data Privacy Declaration under: https://policies.google.com/privacy?hl=en.
Google Maps
Via an API, this website uses the mapping service Google Maps. The provider is Google Ireland Limited ("Google"), Gordon House, Barrow Street, Dublin 4, Ireland.
To enable the use of the Google Maps features, your IP address must be stored. As a rule, this information is transferred to one of Google's servers in the United States, where it is archived. The operator of this website has no control over the data transfer.
We use Google Maps to present our online content in an appealing manner and to make the locations disclosed on our website easy to find. This constitutes a legitimate interest as defined in Art. 6 Sect. 1 lit. f GDPR.
For more information on the handling of user data, please review Google's Data Privacy Declaration under: https://policies.google.com/privacy?hl=en.


text:
We have tracked, from Department of Justice, Bureau of Justice Assistance, over 2 funding programs and $26,263,951 allocated funding to date.
Recent published funding opportunities:
Funding Opportunity |
BJA FY 22 Edward Byrne Memorial Justice Assistance Grant Program - State Solicitation Apply for O BJA 2022 171322 Funding Number: O BJA 2022 171322 Agency: Department of Justice, Bureau of Justice Assistance Category: Law, Justice and Legal Services Funding Amount: $19,663,951 |
BJA FY 19 National Sexual Assault Kit Initiative (SAKI) Training and Technical Assistance Apply for BJA 2019 15229 Funding Number: BJA 2019 15229 Agency: Department of Justice, Bureau of Justice Assistance Category: Employment, Labor and Training, Humanities (see Cultural Affairs in CFDA), Information and Statistics, Law, Justice and Legal Services Funding Amount: $6,600,000 |
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