Also called:
- oral mucositis
- stomatitis
People with cancer can develop mouth (oral) problems from their cancer treatments. Mouth problems are often a result of inflammation and destruction of normal cells and glands in the mouth.
Painful sores and inflammation can develop in the mouth, including the tongue, gums, back of the throat and the lips. This is because cancer treatments can affect the cells lining the mouth, causing dryness and irritation.
Mucositis and stomatitis are often used interchangeably:
- Mucositis is a general term used to describe an inflammation of the mucous membranes that line the mouth, throat, esophagus and intestines. It's called oral mucositis when the inflammation is in the mouth.
- Stomatitis is an inflammation of tissues inside the mouth, including the gums, tongue, cheeks and lips.
If sore mouth as a result of cancer treatment is severe enough, it can interfere with treatment and a person's ability to maintain good nutrition. Sometimes treatment doses have to be reduced or treatments may have to be stopped temporarily. There are steps the healthcare team takes to check for, prevent and control a sore mouth. A registered dietitian can also give suggestions on how to cope with a sore mouth when it affects eating and how to maintain nutrition.
Causes
Cancer treatments, such as chemotherapy and radiation therapy to the head and neck area, can damage the rapidly dividing mucosal cells that line the mouth and many of the organs throughout the body and prevent them from reproducing. This makes it difficult for the cells lining the mouth to repair themselves.
- Many chemotherapy drugs can cause a sore mouth (oral mucositis or stomatitis). This happens more often when higher doses are used.
- Radiation therapy to the head and neck can cause a sore mouth (oral mucositis or stomatitis), throat (pharyngitis) and esophagus (esophagitis).
- Drinking alcohol and smoking dries the mucous membranes lining the mouth and can increase the risk of a sore mouth.
- Poor dental health and poorly fitting dentures can also increase the risk of mouth problems, including sore mouth.
Symptoms
The first symptoms usually occur in the lining of the mouth, then the gums and throat:
- dry, cracked or blistered tongue
- burning sensation in the mouth
- redness in the mouth – a sign of inflammation
- pain and discomfort in the mouth
- sores or ulcers in the mouth
- bleeding
These symptoms usually develop shortly after treatment is started (anywhere from 5 to 14 days). They are usually temporary and often go away a few weeks after treatment is finished.
Prevention
Good nutrition and regular mouth care can help prevent a sore mouth. Maintaining proper nutrition habits can also help a sore mouth heal faster. The following tips may also be helpful to relieve a sore mouth:
- Ask your dentist to contact your healthcare team before any dental work is done. There may be an increased risk for infection and bleeding during and right after treatment.
- Clean the teeth and mouth after every meal and at bedtime. The healthcare team or dentist can suggest gentle ways of cleaning teeth and gums, such as using a very soft (such as supersoft) toothbrush. Ask your healthcare team about flossing. Plaque build-up can cause problems, so routine flossing may be encouraged. It may not be recommended while the mouth is very sore or if blood counts are low.
- The healthcare team will give instructions about cleaning and rinsing the mouth often and what to use. They may suggest using salt or baking soda mixed with water or club soda to rinse the mouth. Check with the healthcare team to see what they suggest and to find out the amounts of salt or baking soda to use (these can vary among cancer treatment centres).
- Talk to the healthcare team or pharmacist about mouthwashes that are alcohol-free or ones that are good to use while experiencing a sore mouth. Salt, baking soda or club soda are cheaper than store-bought mouthwashes and work well.
- Rinse toothbrushes well after each use and store them in a clean, dry place.
- Do not use lemon glycerine swabs. These can dry and irritate the mouth.
- Remove dentures frequently to give gums a rest or only wear them for meals.
- Try drinking fruit nectars, such as pear, peach or apricot.
- Drink fluids through a straw if the mouth is sore.
- Limit tart, salty or acidic fruits and juices (such as orange, grapefruit and tomatoes). These fruits and juices can be eaten again when the mouth is no longer sore.
- Limit spices and spicy foods that can irritate the mouth.
- Limit rough, coarse or dry foods, such as raw vegetables, potato chips, pretzels or nuts.
- Eat soft, bland foods that are lukewarm or cool in temperature. Hot foods or fluids can irritate a sore mouth. Foods such as cream soups, mashed potatoes, yogurt, eggs, custards, puddings, cooked cereals, ice cream, casseroles, milkshakes and commercial nutritional supplements may help. Use a blender to soften or puree foods when chewing and/or swallowing becomes difficult.
- Sucking on ice chips or sugar-free popsicles just before and during treatment may be helpful for people receiving certain types of chemotherapy, such as 5-fluorouracil (5-FU, Adrucil).
- Don't use toothpicks. These can cut the mouth.
- Avoid alcohol and tobacco.
Management
Report any swelling, sores, bleeding, a sticky, white coating in the mouth or any pain to the doctor or healthcare team. Tell them if pain is making it difficult to eat or drink. They may recommend special mouth rinses or medication to reduce the pain. Pain or changes in the appearance of your mouth may be signs of an infection.
Bleeding
The mouth or gums can bleed when they become irritated because of eating, brushing or flossing. When platelet counts are low (thrombocytopenia), it can cause a person to bleed more easily. The healthcare team will tell you how to treat bleeding and safely keep the mouth clean when platelet counts are low. They may prescribe medicine to decrease bleeding and help clots form. Be sure to rinse the mouth carefully so clots are not disturbed.
Infections
Infections in the mouth can occur because of damage to the lining of the mouth and a weakened immune system when white blood cell counts are lowered (leukopenia or neutropenia). Infections can become serious problems. Dry mouth (xerostomia) may also increase the risk of mouth infections. There are a number of ways to help prevent or treat these infections, depending on what is causing them: bacteria, fungi or a virus.
Bacterial infections
Treatment for bacterial infections may include:
- antibacterial rinses (used in the mouth or for cleaning dentures and dental appliances)
- medicated mouth rinses
- antibiotic therapy
Fungal infections
Candida albicans (thrush) is a common fungal infection that often causes white patches in the mouth. Treatment for fungal infections may include:
- medicines to prevent fungal infections
- special antifungal mouthwashes or lozenges
- antifungal drugs may need to be taken by mouth (orally) or given intravenously
Viral infections
Herpes virus can cause infections, such as cold sores. Medications can be used to prevent or treat viral infections. These may be taken by mouth, applied to sores as a cream or given intravenously.
Pain relief
- The healthcare team may prescribe topical medications for pain or special "swish and swallow" rinses to coat and soothe the mouth. Rinse the mouth before applying the medication or clean it gently by wiping the mouth and teeth with wet gauze dipped in saltwater.
- Do not take any over-the-counter medications, such as pain relievers, without checking with the doctor or healthcare team first. These medications may contain aspirin or other drugs that can weaken the platelets and make bleeding problems worse. The healthcare team will recommend or prescribe suitable pain-relieving medications.
- Sometimes teeth become more sensitive weeks or months after treatment has ended. Toothpaste or treatments for sensitive teeth may help.