Oral Mucositis

Oral mucositis is a mouth condition that may develop from treatment used to cure cancer. With this condition, sores may appear on your lips, gums, tongue, and the roof or floor of your mouth. 

CAUSES

Oral mucositis can happen to anyone who is being treated with cancer therapies, including:

  • Cancer drugs (chemotherapy).

  • Radiation (X-ray or other high-energy rays) for head or neck cancer.

  • Bone marrow transplants and stem cell transplants. 

Oral mucositis is not caused by infection. However, the sores can become infected after they form. Infection can make oral mucositis worse.

The following factors increase your risk of oral mucositis:

  • Poor oral hygiene.

  • Dental problems or oral diseases.

  • Smoking.

  • Chewing tobacco.

  • Drinking alcohol.

  • Having other diseases such as diabetes, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), or kidney disease.

  • Not drinking enough water.

  • Having dentures that do not fit right.

  • Being a child. Children are more likely than adults to develop oral mucositis, but children usually heal more quickly.

  • Being elderly. Elderly adults are more likely to develop oral mucositis. 

SYMPTOMS

Symptoms vary. They may be mild or severe. Symptoms usually show up 7 to 10 days after starting treatment. Symptoms may include:

  • Sores in the mouth that bleed.

  • Color changes inside the mouth. Red, shiny areas appear.

  • White patches or pus in the mouth.

  • Pain in the mouth and throat.

  • Pain when talking.

  • Dryness and a burning feeling in the mouth.

  • Saliva that is dry and thick.

  • Trouble eating, drinking, and swallowing.

  • Weight loss and malnutrition. This happens because eating is a problem.

DIAGNOSIS

A caregiver will check your mouth. Then, the condition is given a grade. This grading system will help your caregiver treat your condition:

  • Grade 1: The inside of the mouth is sore and red.

  • Grade 2: There is redness in the mouth. Open sores are present. Swallowing food might be uncomfortable.

  • Grade 3: There are open sores. The mouth is very red. It is very hard to swallow food.

  • Grade 4: No food or drink can be swallowed.

TREATMENT

Oral mucositis usually heals on its own. Sometimes, changes in the cancer treatment can help. Keeping the mouth as clean and germ free as possible is very important.

  • Medicine may ease the condition. Different types of medicine may be needed, such as:

  • An antibiotic to fight infection, if present.

  • Medicine to help mucosal cells heal more quickly.

  • A water-based moisturizer for your lips, if they are affected.

  • Methods to control pain may include:

  • Keeping your mouth moist. You may suck on ice chips or sugar-free frozen ice pops.

  • Pain relievers that are swished around in the mouth. They will make the mouth numb to ease the pain (topical anesthetics).

  • Specific mouth rinses.

  • Prescribed, medicated gels. The gel coats the mouth. This protects nerve endings and lowers pain.

  • Narcotic pain medicines. These are strong drugs. They may be used if pain is very bad.

  • Mouth care can keep the mouth as healthy as possible and help to prevent infection. Mouth care includes:

  • A dental checkup. Your dental caregiver will make sure you have no teeth problems that could cause infection. Try to have the dental checkup before you begin your treatment for cancer.

  • Brushing your teeth several times a day. Use a soft toothbrush. Change to a new brush often. Use only gentle toothpastes. Ask your caregiver what product would be best for you. Make sure that you also floss your teeth.

  • Rinsing your mouth after every meal. Rinse again at bedtime. Do not use mouthwash that contains alcohol. Ask your caregiver what would be best for you.

HOME CARE INSTRUCTIONS

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver. Follow the directions carefully.

  • Do not smoke.

  • Do not drink alcohol.

  • Eat only bland, soft foods until your mouth sores heal. Avoid sugary and acidic foods and drinks.

  • Ask your caregiver if you should add high-protein shakes to your diet to avoid malnutrition and weight loss.

  • Drink enough fluids to keep your urine clear or pale yellow.

  • If you have dentures, take them out often.

  • Continue to check your mouth every day for any signs of oral mucositis.

  • Keep all follow-up appointments.

SEEK MEDICAL CARE IF:

  • You notice redness, soreness, or dryness in your mouth.

  • You have mouth or throat pain that makes it hard to swallow or speak.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your pain in your mouth or throat gets worse and does not improve with pain medicine.

  • You have a lot of bleeding in your mouth.

  • You develop new, open sores in your mouth.

  • You notice patches of pus forming in your mouth.

  • You cannot swallow solid food or liquids.

  • You have a fever.