Oral mucositis is a common and painful complication of chemotherapy, manifesting as inflammation, redness, and open sores within the mouth and throat. This condition occurs because chemotherapy drugs target and damage rapidly dividing cells throughout the body, including the epithelial cells that line the gastrointestinal tract. The oral mucosa has a high rate of cell turnover, making it particularly susceptible to this effect. When cell renewal is disrupted, the tissue thins and breaks down, leading to painful ulcers. These ulcers can significantly impair a patient’s ability to eat, drink, and speak.
Prevention Strategies Before and During Treatment
A proactive approach to oral health minimizes the risk and severity of mucositis. Patients should undergo a thorough dental evaluation, including necessary extractions or repairs, at least two weeks before starting chemotherapy. Eliminating existing dental issues and infections reduces the risk of serious complications during periods of low white blood cell counts.
Maintaining gentle oral hygiene must begin immediately prior to treatment. This regimen involves using an ultra-soft bristle toothbrush and a non-irritating, mild-tasting toothpaste, preferably without strong foaming agents or whitening components. Regular, gentle brushing of the teeth, gums, and tongue, along with careful flossing, prevents the build-up of bacteria and debris that could lead to secondary infection. If the platelet count is low, flossing should be avoided to prevent bleeding.
A highly effective preventative measure for certain chemotherapy regimens is oral cryotherapy, which involves sucking on ice chips or ice lollies during the infusion. The cold temperature causes vasoconstriction (a narrowing of the blood vessels) in the oral cavity. This reduces the amount of the chemotherapy agent delivered to the mouth’s lining. This technique is recommended for patients receiving bolus infusions of drugs like 5-fluorouracil (5-FU) or melphalan. The ice chips should be held in the mouth for approximately 30 minutes before and throughout the entire duration of the infusion.
Immediate Symptom Relief and Pain Management
Once mouth sores appear, the primary focus shifts to managing pain and discomfort, which interferes with nutrition and hydration. A simple, effective measure is frequent rinsing with a bland, non-irritating solution. A homemade rinse can be prepared by mixing a teaspoon of salt and a teaspoon of baking soda in a quart of warm water, which cleanses and soothes the inflamed mucosa.
Topical agents provide immediate, localized pain relief by temporarily numbing the ulcers. Gels or mouthwashes containing topical anesthetics like lidocaine or benzocaine can be applied directly to the sores or used as a swish-and-spit solution. These are often used 15 to 20 minutes before meals to facilitate eating. The solutions should be held in the mouth for a few minutes to maximize the numbing effect.
A common prescription pain-relieving preparation is often referred to as “Magic Mouthwash,” though components vary widely. A typical formulation combines an anesthetic, such as viscous lidocaine, an antihistamine like diphenhydramine for inflammation, and an antacid like Maalox or Kaopectate to coat the oral lining. These ingredients provide a soothing, temporary coating and localized numbness. Mucosal coating agents, such as sucralfate, are also sometimes used to form a protective layer over the ulcerated tissue. This shields the nerve endings from irritation, though clinical evidence for this compound is not entirely consistent.
Clinical and Prescription Treatments
For patients experiencing moderate to severe oral mucositis, prescription interventions can reduce the duration and intensity of the condition. One treatment involves specific growth factors designed to stimulate cell repair in the oral lining. Palifermin, a synthetic form of keratinocyte growth factor (KGF), is approved for mucositis prevention, particularly in patients undergoing high-dose chemotherapy followed by transplant. This drug promotes the growth and development of epithelial cells, helping the tissue heal faster and reducing the severity of the sores.
Another specialized, non-pharmacological approach is Low-Level Laser Therapy (LLLT), also known as photobiomodulation therapy. LLLT involves applying low-energy beams of light to the oral mucosa. This intervention is thought to reduce inflammation and stimulate cellular processes, accelerating the healing of ulcers and offering pain relief. LLLT has shown effectiveness in reducing the severity and duration of chemotherapy-induced mucositis.
When topical pain relief measures are insufficient, systemic pain management becomes necessary, especially if the pain prevents eating or drinking. A physician may prescribe stronger analgesics, including opioid narcotics, to be taken orally or administered through other routes. This systemic approach is reserved for the most painful cases, ensuring the patient maintains adequate nutrition while the tissue heals.
Essential Home Care and Dietary Modifications
Adjusting diet and daily habits is crucial for managing mouth sores and preventing further irritation. The core principle is choosing foods that are soft, bland, and easy to swallow to minimize physical trauma to the delicate oral tissue. Excellent choices include smoothies, mashed potatoes, custards, yogurt, soft-cooked cereals, and pureed soups.
Foods should be served lukewarm or cool, as extreme temperatures can exacerbate pain in the exposed tissue. Avoid all foods and beverages that are acidic, spicy, salty, or have rough, sharp textures, as these cause immediate discomfort. This means temporarily eliminating items like citrus fruits, tomatoes, carbonated beverages, chips, crackers, and spicy seasonings.
Maintaining adequate hydration is important for overall health and keeping the mouth moist, which helps soothe the mucosa. Patients should sip on fluids frequently throughout the day; using a straw can sometimes help direct liquids past the most painful areas. Alcohol-containing mouthwashes and tobacco products must be avoided as they dry out and severely irritate the damaged oral lining.