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Mouth Care for Cancer Patients

This information describes what to do if you develop mucositis during your cancer treatment.

What is mucositis?

Mucositis is a term that describes changes in your mouth and throat. Some chemotherapy drugs or radiation therapy to the head and neck may cause these. Mouth changes may begin 3 to 10 days after treatment starts. They usually heal about 3 weeks after treatment ends.

Mucositis may cause the following:

  • Redness or swelling of your gums and lining of your mouth
  • Mouth sores on the lining of your mouth, inside your cheeks and lips, or on your tongue
  • Mouth and throat pain that may cause difficulty swallowing

Do I need special dental care?

Your doctor may tell you to see a dentist before you start cancer treatment. If you need to see your dentist during your treatment, ask him or her to call your cancer doctor first.

How should I care for my mouth?

Brush your teeth and tongue gently after each meal and at bedtime. Use a small, soft-bristle toothbrush. If your mouth is too sore for a regular soft toothbrush, you can get a supersoft one. Some examples of these are:

  • Biotene® Supersoft Toothbrush
  • Sensodyne® Total Care
  • Colgate® Sensitive Extra Soft Compact Head
  • Oral-B® Sensitive Extra Soft Compact Toothbrush #35

Use a fluoride toothpaste or baking soda with fluoride.

If you have a set of dentures, a bridge, or a dental prosthesis, take it out and clean it each time you clean your mouth. You may keep wearing this if it fits well and does not irritate your mouth. Leave it out of your mouth while you sleep. If you develop any irritation, keep it out of your mouth as much as possible.

Floss your teeth with unwaxed dental floss once daily at bedtime. If you have not flossed regularly before treatment, do not start flossing now.

Use one of the following rinses unless your nurse has told you to irrigate your mouth.

Rinse your mouth every 4 to 6 hours or more often for comfort. Swish and gargle well for 15-30 seconds, then spit it out.

  • One quart (4 cups) of water mixed with one teaspoon of salt and one teaspoon of baking soda. This is the same as one quart of normal saline mixed with one teaspoon of bicarbonate
  • One quart of water mixed with one teaspoon of salt
  • One quart of water mixed with one teaspoon of baking soda
  • Water
  • A mouthwash free of alcohol and sugar, e.g., Biotene® or Dentek

Use a lip moisturizer (e.g., Aquaphor®,  A&D® ointment) after mouth care. Do not apply it 4 hours before radiation therapy to the head and neck.

Should I avoid anything?

Avoid:

  • Tobacco
  • Alcohol
  • Commercial mouthwash that has alcohol (e.g., Scope®, Listerine®)
  • Spices (e.g., pepper, chili powder, horseradish, curry powder, Tabasco® sauce)
  • Citrus fruits and juices (e.g., orange, lemon, lime, grapefruit, pineapple)
  • Tomatoes
  • Hard, dry, or coarse foods (e.g., toast, crackers, raw vegetables, potato chips, pretzels)
  • Very hot or cold foods and liquids

What if my mouth feels painful?

Tell your doctor or nurse. If you have just a few small, painful areas, your doctor may prescribe a topical anesthetic. An example of this is viscous lidocaine 2%. You can apply it to the painful areas using a swab or Q-tips®. Apply it every hour as needed.

If you feel pain in most of your mouth and throat, your doctor may prescribe medicine to coat your whole mouth (such as GelClair® or viscous lidocaine 2%). Swish, gargle, and spit 1 tablespoon every 3 to 4 hours, up to 8 times a day. Do not swallow it. Do not eat for 60 minutes afterward.

If you still have mouth pain, tell your doctor or nurse. He or she can prescribe other pain medications.

What if I have trouble swallowing?

These changes will make swallowing easier and help you take in enough protein and calories:

  • If your mouth is dry, rinse it just before eating to moisten it and stimulate your taste buds.
  • Eat soft, moist, bland foods in small bites and chew it well.
  • Use sauces and gravies.
  • Moisten foods with yogurt, milk, soy milk, or water.
  • Dip dry foods in liquids.
  • Blend or puree your food.
  • Alter the temperature and consistency of your food as needed.
  • Avoid irritants such as alcoholic beverages, tart or acidic fruits and juices, spicy foods, pickled foods, and tobacco.
  • Sip plenty of water throughout the day to be sure you have enough liquids. Keep in mind that drinks with sugar (juice, iced tea, soda) may cause tooth decay. You may drink these during meals, but limit them between meals.

What if I do not eat enough?

  • Drink supplements such as Carnation® Instant Breakfast and Ensure®.
  • Add protein powders to broth, soups, cereals, and beverages. Dilute these as needed.
  • Eat multiple small rather than fewer large meals.
  • Tell your doctor and nurse if you do not eat well. They may arrange for you to see a nutritionist.

What should I do if my mouth is dry?

Drink sips of water often throughout the day. These may also help:

  • A spray bottle to squirt water into your mouth
  • Commercial mouth moisturizers, e.g., Biotene® Oral Balance, Salivart®, MouthKote®
  • Artificial saliva
  • Biotene® Gum
  • A humidifier

What should I report to my doctor or nurse?

Tell your doctor or nurse if you have:

  • New redness, sores, or white patches in your mouth.
  • Bleeding of your gums or mouth.
  • Difficulty or pain when you swallow.
  • Pain that does not get better with pain medicine.
  • A fever of 100.4° F (38° C) or higher.
  • Any questions or concerns.