Oral mucositis, commonly referred to as mouth sores, is a frequent side effect experienced by individuals undergoing chemotherapy. Chemotherapy drugs target and destroy rapidly dividing cells, including the healthy cells lining the mouth and gastrointestinal tract. This disruption leads to painful inflammation and ulcerations that significantly interfere with a patient’s ability to eat, drink, and speak. Managing these lesions is crucial for maintaining comfort and nutrition throughout treatment. This article details the preventative steps, at-home care, and medical interventions available to manage chemotherapy-induced mouth sores effectively.
Proactive Measures and Prevention
The most effective strategy for managing oral mucositis is preventative action and strict oral care throughout the treatment cycle. A pre-treatment dental assessment is highly recommended to address existing issues like sharp teeth, broken fillings, or gum disease, which could cause trauma or infection. Complex dental work, such as extractions, should be completed at least one month before starting chemotherapy to allow for complete healing.
Maintaining rigorous oral hygiene reduces the bacterial load, lowering the risk of infection in damaged tissues. Patients should use a small, soft-bristled toothbrush to gently clean the teeth and gums at least twice daily, and ideally after every meal. The bristles can be softened by running them under warm water before use, and a non-alcoholic, fluoride toothpaste should be used to prevent irritation.
Cryotherapy, or the use of cold, is a preventative tool during the infusion of certain chemotherapy agents, particularly fluorouracil (5-FU). Sucking on ice chips or small ice pops for about 30 minutes before, during, and after the infusion causes vasoconstriction (narrowing of the blood vessels) in the mouth. This localized restriction limits the amount of chemotherapy drug reaching the oral mucosa, reducing cellular damage and the development of sores.
At-Home Care and Symptom Management
For mild to moderate mouth sores, non-prescription remedies and dietary adjustments manage symptoms. Regular rinsing is a primary method for keeping the mouth clean and soothing irritated tissues; a homemade saline and baking soda rinse is often recommended. Preparation involves mixing one teaspoon of salt and one teaspoon of baking soda into four cups of warm water.
This alkaline solution neutralizes acidity and promotes healing by gently cleansing the ulcers. The rinse should be swished gently for 15 to 30 seconds, spit out, and performed several times a day, particularly after meals and before bed. Avoid commercial mouthwashes containing alcohol or peroxide, as these ingredients can dry out and burn the sensitive mucosal lining.
Dietary modifications prevent mechanical and chemical irritation while ensuring adequate nutrition and hydration. Patients should focus on soft, bland, moist foods requiring minimal chewing, such as mashed potatoes, scrambled eggs, or pureed fruits. Foods that are sharp, crunchy, spicy, highly acidic, or very salty (like citrus fruits, tomatoes, and chips) should be avoided entirely.
Food and drink temperature is a significant factor; patients should avoid extremely hot or cold items, opting for room temperature or slightly chilled foods instead. Over-the-counter pain relievers, such as acetaminophen, manage general discomfort, but nonsteroidal anti-inflammatory drugs (NSAIDs) should only be taken with explicit approval from the oncology team due to bleeding risks.
Medical Interventions and Prescription Treatments
When over-the-counter methods fail to control oral mucositis pain, prescription treatments provide targeted relief. The most common approach is a compounded oral rinse, often called “Magic Mouthwash,” though its exact formula varies widely. These custom solutions deliver multiple therapeutic effects simultaneously.
Components often include a local anesthetic (such as lidocaine) to numb the sores, allowing for eating and drinking. An antacid is frequently added to help the solution coat the oral lining, and an antihistamine like diphenhydramine may be included for its mild analgesic and anti-inflammatory effects. Some formulations also contain a corticosteroid to reduce inflammation, plus an antifungal or antibiotic agent to prevent secondary infections.
Patients are instructed to swish the prescribed amount and gargle for up to two minutes to coat the sores, then spit the solution out. They must avoid eating or drinking for at least 30 minutes to maximize contact time. For severe pain, systemic pain management, including prescription narcotics, can improve comfort and quality of life. In high-risk scenarios, such as bone marrow transplants, the intravenous medication palifermin may be used to stimulate cell growth and promote quicker healing.
Recognizing Complications and Seeking Professional Help
While most cases of oral mucositis are manageable, monitor the sores for signs of complications requiring immediate medical attention. Open wounds create a pathway for bacteria to enter the bloodstream, and the compromised immune system increases the risk of serious infection. Signs of infection include a fever of 100.4°F or higher, the presence of pus, or significant swelling and redness extending beyond the ulcerated area.
Unmanageable pain, even with prescribed medications, signals a worsening condition requiring clinical reassessment. Difficulty swallowing or drinking sufficient fluids poses a serious risk of dehydration and malnutrition. If a patient cannot consume enough liquids or if pain prevents eating, they must contact their oncology team immediately. These symptoms may necessitate hospitalization for intravenous hydration, nutritional support, or an adjustment to the treatment plan.