Mouth Sores

What is it?

Mucositis - all mucous linings; stomatitis - inflammation of the mouth and esophagitis - inflammation of the esophagus, all refer to very painful sores or ulceration in the oral cavity. These conditions are a direct side effect of chemotherapy drugs. Chemo seeks out and attacks all fast reproducing cells in your body. After the cancer itself, the inside of your mouth/nose/throat is a prime target. There is no real prevention of this occurrence other than being very meticulous with your oral hygiene and following a careful diet.

Not only is the chemo active within the cells in your mouth, but the drugs themselves are excreted through the salivary glands - as much as 35% - as one of the routes of exiting your body. If you can imagine the size of the infusion bag – then re-swallowing the chemo and the potential harm it can cause, you will be extremely motivated to follow the cardinal rule of drinking at least 2 - 3 litres (8 – 12 cups) of liquids a day - which significantly aids in the dilution and ultimate dispersion of the drugs. As well, the drugs may slow down the production of saliva and/or result in very thick saliva. This too underlines the necessity of drinking copious amounts of liquids.

Conventional Wisdom:

Chemo-related mouth sores are very painful and diligence is required to prevent the severity of their occurrence and potential infections. The following basics must be followed:

1. See your dentist for a thorough evaluation and any required dental treatment before beginning chemo. The resultant sensitivity within the oral cavity combined with periodic, expected low blood counts prevents any invasive procedure once your treatment begins.
2. Switch to a very soft toothbrush and a mild, non-abrasive toothpaste. You may or may not be able to use extremely gentle dental floss - depending on your platelet count.
3. Use a solution of ½ tsp baking soda per 8 ounces of water as a mouthwash avoiding all mouthwashes containing alcohol.
4. Your dentist may suggest applying a sealant or fluoride treatment to your teeth to prevent acid etching and enamel erosion.

Drugs may be needed to control a severe outbreak of mouth sores. These include antifungals, antibacterials and antivirals. You may also be prescribed liquid suspensions and analgesics for the pain. Diet may need to be modified to include liquid high protein/ high calorie meal replacements when chewing and swallowing become difficult.

Self Help:

Adherence to the abovementioned basic oral hygiene and following these simple avoidances will help minimize the occurrence and severity of mouth sores:

• Avoid highly spiced foods
• Avoid alcoholic beverages and tobacco products
• Avoid all highly citric fruits and drinks
• Avoid very cold and very hot beverages
• Avoid all liquid medication containing alcohol (if possible)
• Do not use toothpicks
• Do not use harsh dental floss
• Avoid any mouthwashes containing alcohol
• Avoid all teeth whitening products

Natural aids to comfort when dealing with mouth sores include:

• Preparing a tincture of very strong chamomile and mint tea - use two chamomile tea bags infused for a minimum 15 minutes with a couple of sprigs of fresh or dried mint. Let cool to room temperature. Swish and hold in your mouth for 5 seconds - use every ½ hour or as needed.
• Another home remedy includes making an infusion of coriander seeds (1 tsp) in 1 cup of warm water.
• You can also try a mixture of coconut cream - 2 tbsps and 2 tsps of honey. Rub this mixture on the sore area.

When dealing with very thick saliva try sucking on a sugarless lemon lozenge - lemon is a saliva stimulant but you need to carefully rinse your mouth afterwards as lemon causes erosion of the tooth enamel.

While undergoing chemo, it’s a very good practice to rinse your mouth after eating or drinking anything.

Similar in origin to issues in the oral cavity, minor nosebleeds can be frequent when undergoing chemo. The nasal passage contains fast reproducing cells and is very sensitive. Take care when blowing your nose and use a gentle skin moisturizer to soften the accessible area.

Also needing to be mentioned is sores in the recto-vaginal area. Although normally associated with the herpes virus, these outbreaks can be brought on by chemo drugs and be very similar in nature to mouth sores. Very careful hygiene must be followed after urinating and having a bowel movement. The majority of chemo is dispelled through the urine and feces so cleaning oneself with a gentle wet wipe - front to back - is a good habit to follow. If you have a bidet, cleansing yourself at least twice a day is also helpful - being careful not to use harsh soap or hot water. Prescription drugs may be needed to control outbreaks.

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