Chemotherapy and radiation therapy, as well as dehydration, protein malnutrition, and infection, can cause sores and inflammation of the soft tissues within the mouth (stomatitis) and the mucous membranes (mucositis). They can progress to include painful ulceration, hemorrhage, and secondary infection, causing sufficient pain to make eating very difficult and sometimes leading to discontinuation of cancer treatment. Fortunately these conditions can sometimes be prevented, or at least minimized, by a careful daily regimen of oral care.
Careful daily mouth care is the key to minimizing the development of sores in the mouth and esophagus. Patients should check the mouth daily and report changes in sensation, appearance, or taste. During and after each course of chemotherapy, they should practice oral hygiene every four hours while awake and within a half hour after eating.
- Brushing the teeth, using a soft nylon bristle toothbrush. Soaking the brush in hot water before brushing and rinsing it with hot water during brushing increases the softness of the bristles. The toothbrush should be rinsed well after use and stored in a cool, dry place. To brush, the patient should place the brush at a 45-degree angle between the gums and the teeth and move it in short, circular strokes.
- Using a nonirritating dentifrice such as a baking soda solution. Lemon and glycerin should never be used. Although in the past this combination was frequently used in hospitals for mouth care, it has been found to irritate the oral tissues.
- Flossing between the teeth twice daily with unwaxed dental floss unless advised otherwise. (In cases where the platelet count is low or there are bleeding problems, flossing should be avoided.)
- Rinsing the mouth thoroughly with half-strength hydrogen peroxide (never full-strength) or baking soda and water solution. Commercial mouthwash containing alcohol may be irritating or drying and should be avoided. A mouthwash can be made with one part 3 percent hydrogen peroxide and one or two parts water, plus a pinch of salt.
- Cleaning dentures, if they are worn, in the same way and according to the same schedule.
- Among other steps to minimize mouth sores are:
- Lubricate the lips with a water-based lubricant such as K-Y Jelly, or with cocoa butter or a lip balm such as Chap Stick.
- If possible, include in each meal some food that needs to be chewed, since chewing will promote circulation in the gum tissues. Gently massaging the gums with a finger or the rubber tip on a toothbrush is also helpful.
- Avoid irritating foods: those that are very hot, either in temperature or in flavor, very acidic, such as vinegar, or crunchy or rough, such as toast, pretzels, crackers, or popcorn.
- Refrain from smoking or chewing tobacco or drinking alcoholic beverages.
- Make sure that if dentures are worn, they fit properly, since they can be a major source of irritation if they are too loose. If it is not possible to improve their fit, dentures should be worn only for eating.
If a mild irritation develops, rinse between brushings with one of the solutions suggested above. Flossing should be discontinued if it causes pain. A child’s soft toothbrush may be less irritating. If the pain makes eating a problem, the doctor may prescribe a topical analgesic, as well as a topical protective agent to promote healing.
Sipping lukewarm tea may help healing, as may a substrate of antacid, which can be made by allowing an antacid such as Maalox or Gelusil to settle, pouring off the liquid and applying the remaining paste to the sore with a cotton-tipped applicator. After fifteen to twenty minutes the mouth can be rinsed with a saline solution or water.
A high-protein diet with vitamin supplements is important to promote cell repair and replacement. People with cancer may find room temperature foods and beverages more soothing than warm or cold foods. Some persons may find it easier to eat if they have their favorite foods. They can have friends or family bring fruits, ethnic treats, or desserts to the hospital and ask the nurses whether there is a refrigerator to store snacks and a stove or oven to warm up food.
If the inflammation becomes severe, the oral hygiene routine should be increased to every two hours while awake and twice during the night. Topical protective agents and analgesics can also be used more frequently, and antifungal agents and antibiotics may also be ordered. The person should discontinue using a toothbrush, floss, and dentures. The teeth can be cleaned instead with a sponge-tipped applicator, a Water Pik set on the lowest setting, or even sterile gauze wrapped around a finger.