The Family Care Research Program

Information for Patients and Caregivers

Cancer and Treatment-related Mucositis (Mouth Sores)

What are mouth sores?

Mouth sores can be any alteration in the lining of your mouth, usually consisting of a sore or ulcers and swelling that can be very painful. Mouth sores can be associated with a dry mouth.

How do people describe mouth sores?

Most people describe mouth sores as painful and make eating, chewing, talking and/or swallowing and communicating difficult.

Warning signs of mucositis usually begin within one to two weeks after chemotherapy. The discomfort can range from mild, easily treated and quick healing, to more severe problems and very painful.

These can include:

Small ulcers or sores in the mouth, on gums and tongue; the sores may be reddish and may have white centers. They may feel like a lump or bump in the mouth. Whitish patches inside the mouth may also be apparent.
A burning, tingling feeling inside the mouth
Inside of mouth looks red, shiny and swollen. They may be located on the cheek, gums, on top of or underneath the tongue.
Unusual sensitivity to very hot and very cold foods may be present.
Unusual mouth dryness may occur.
Fever

What causes mouth sores?

Almost half of all cancer patients on chemotherapy, and almost all who have radiation to the head or neck experience mouth discomfort as a side effect of treatment. Chemotherapy medications work on rapidly-dividing cells, like cancer cells – but also attack other cells in the body, including those forming the lining of the mouth. Cancer chemotherapy treatments such as Bleomycin, Adriamycin, Daunorubicin, 5-FU and Methotrexate can cause a disruption in the lining of the mouth, leading to mouth sores. Radiation to the head and neck can also cause mouth sores, as well as a decreased immune function and dehydration. People with a preexisting dental disease such as dental caries or periodontal disease and are taking chemotherapy or radiation to the head and neck are at greater risk.

How do people cope with mouth sores?

There are things you can do to help prevent sores.

To prevent mouth sores:

Before you begin chemotherapy or radiation, schedule a complete dental examination, and inform your dentist that you will be undergoing cancer treatment.
Suck on hard candy or crushed ice.
Avoid very hot food; try eating most of your food just warm or at room temperature if your mouth is tender.
Some people find that cold foods, like ices or popsicles ease a sore mouth, while others find it painful. Try this and see what works for you.
Highly seasoned foods sometimes aggravate mouth soreness.
Avoid alcohol and tobacco; both can irritate an already-sore mouth.
Citrus fruits and tomatoes are uncomfortable for some people with mucositis, as are salty foods. Consider eliminating these items from your diet.
In general, carbonated drinks, including sparkling water, can be irritating to a tender mouth.
Foods with sharp edges, such as chips or crackers, may prove irritating.
In general, soft, bland foods are probably the best choice for people with sore mouths.
Get professional help: many cancer treatment centers have registered dieticians who can help you shape a diet that works for you during the treatment.
Maintain adequate fluid intake of 8-10 glasses of fluids such as water, caffeine-free beverages such as Gatorade, but avoid acid-containing fruit juices such as orange juice and lemonade.
Avoid using lemon or glycerin mouth swabs or mouthwash containing alcohol as they are drying and irritating to your mouth.
Use a water-based mouth moisturizer to help improve mouth moisture.
Keep your lips moist with cocoa butter, petroleum jelly, balm or lipstick.
Brush your teeth after every meal and at bedtime using a soft brush and a mild, non-abrasive toothpaste.
Don’t forget to gently brush your tongue as well as teeth and gums to help reduce the risk of a fungus infection.
Change your toothbrush very frequently – every week or so.
Special appliances like WaterPiks and electric toothbrushes may further irritate sensitive mouth tissues and gums.
Use artificial over-the-counter saliva to keep mouth moist. (Salivant, Oral Balance, Moist Plus)
If your toothbrush causes pain, consider using a Toothette, a sponge-tipped swab containing a dental cleaner.

When you already have mouth sores:

There are anesthetic and protective medications than can be used on a short-term basis that can ease pain. These include gels and ointments such as viscous (gel) Xylocaine, Zilactin film, and a variety of other antifungal agents like Nystatin. There are special mouthwashes and rinses combining several ingredients that can be very helpful.

Try a straw for drinking fluids
Eat bland foods high in protein.
Use unwaxed dental floss
Try using a waterpik for rinsing to increase comfort.
Let hot food cool before eating it.
Avoid spicy, acidic and peppery foods, and irritants such as tobacco or alcohol
Remove dentures to avoid further sores or irritations, wear only during mealtime.
Before meals and as needed for comfort, apply a numbing agent such as benzocaine or xylocaine to sore areas of your mouth with a cotton-tipped applicator.
Ask your doctor to prescribe a medication for your sore mouth.
Use pain medication to control the mouth pain 1 ½ hours before meals at around-the-clock (4-6 hour intervals) if the mouth pain is constant.
Rinse your mouth after meals and at bedtime with warm salt water or sodium bicarbonate for 1-2 minutes.
Careful and routine brushing of teeth, gums and tongue with an extra-soft toothbrush.

What can family members and friends do to help me with mouth sores?

Ask family members or friends to prepare meals high in protein to promote healing.
Have family members and friends remind you to perform mouth care after meals and at bedtime.
Ask family members of friends to prepare bland, soft foods that will be more tolerable.
Ask family members or friends to buy toothpaste with sodium bicarbonate or synthetic saliva products.

How can I talk to my family members about mouth sores?

Be open with your family members about how you feel having mouth sores.
Ask them for ideas on how to deal with your mouth sores.
Tell your family members how your mouth sores are affecting your emotions.
Ask your family members how your mouth sores are affecting them.

What should I report to my doctor or nurse?

Fever over 100.7 for 24 hours.
Excessive bleeding from gums or mouth sores.
New red or white patches or sores in your mouth.
Weight loss of more than 5 pounds in one week.
Blisters or ulcers in the mouth or painful redness.
Inability to eat any food for 24 hours.

Where can I get more information?

Consult your family dentist.
Contact your health care providers
Contact the National Cancer Institute at 1-800-4-CANCER or through the Internet at: http://www.cancer.gov/cancer_information/coping/
Contact the American Cancer Society at 1-800-ACS-2345 or through the Internet at: http://www.cancer.org/docroot/MBC/MBC_2x_OtherEffects.asp?sitearea=MBC
Visit the Family Care Research Program at : http://www.cancercare.msu.edu/
Contact Cancer Source over the Internet at: http://www.cancersource.com
Contact The National Coalition for Cancer Survivorship on the internet at: http://www.cansearch.org/resources/essential, go to Side Effects, and look up Mouth Soreness.

References:

Beck, S.L. Mucositis. In Yarbro, CH, Frogge, MH, Goodman, M & Groenwald, S L. eds. Cancer Symptom Management, Sudbury MA: Jones and Bartlett Publishers, 1999: 308-322.
Goodman, M., Hiderley, L.J. & Purl, S. Integumentary and Mucous Membrane Alterations. In Yarbro, CH, Frogge, MH, Goodman, M & Groenwald, S L. (4^th Ed.) Cancer Nursing: Principles and Practice, Sudbury MA: Jones and Bartlett Publishers, 1997: 789-803.
Shih, A., Miaskowski, C., Dodd, MJ, Stotts, NA & McPhail, L. (2002). A research review of the current treatments for radiation-induced oral mucositis in patients with head and neck cancer. Oncology Nursing Forum, 29(7):1063-80.