Taking Care of Dental Conditions while Undergoing Chemo: Mouth Sores

In a previous article, I wrote about the importance of addressing dry mouth (xerostomia) and gave some suggestions for how the problem can be treated. Here, the discussion of oral health continues and provides ways you can help keep your mouth in good shape and pain-free while undergoing chemotherapy and/or radiation.

What are mouth sores?

Oral mucositis is the technical term for mouth sores. This problem is especially prevalent among the young and the elderly, but anyone, especially those undergoing chemotherapy, can suffer from it. In fact, an article on OncoLink says that over 40% of patients who receive chemotherapy will develop some degree of mucositis during the course of their treatment.¹

Mucositis can cause mouth blisters, sore mouth and/or gums, or may even result in open sores so painful that you cannot eat. Its symptoms include:^1,2

• Red or swollen mouth and gums
• Bloody mouth
• Painful mouth and/or throat
• Difficulty swallowing or talking
• Burning dry mouth that makes it difficult to eat
• Soft, whitish spots or pus in the mouth or on the tongue
• Increased or thicker saliva

Why do mouth sores form?

The reason we often develop mouth sores during chemo has to do with the fact that the lining of our entire gastrointestinal tract (mouth, throat, stomach, and bowel) is made up of epithelial cells. These cells, under most circumstances, rapidly regenerate. However, since chemotherapy and radiation are non-discriminatory when it comes to killing fast-growing cells (they kill good and bad cells), the epithelial cells often die. The result is damaged, unrepaired tissue that hurts.

Preventing mouth sores

It is important that we address oral mucositis as soon as possible because it can lead to:

• Pain,
• Nutritional problems,
• Increased risk of infections,
• Reduced quality of life, and/or
• Potentially requiring a reduction in chemotherapy doses.

While there are currently only a few interventions that will reduce the severity of mucositis, you can help prevent the problem by maintaining a good oral care routine. Using mouth rinses and brushing your teeth with a soft-bristled brush after meals and at bedtime will help keep your mouth healthy.

Mouth rinses that have proven most effective are:^1,2

• Normal saline (1 tsp of table salt in 32 ounces of water) or
• Salt and Soda (1 tsp of table salt plus 1 tsp of baking soda in 32 ounces of water

Other prevention methods you can try include:^1,2

• Use a non-abrasive toothpaste (try mixing 1 tsp baking soda in 2 cups of water). Avoid all toothpaste that has whiteners in it.
• Keep lips moist (Try applying coconut oil or olive oil. Avoid products that use petroleum.)
• Avoid commercial mouthwashes that have alcohol in them.
• Avoid lemon or glycerin swabs. Use only a small, soft-bristled toothbrush.
• Stay hydrated.
• Eat high protein foods.
• Avoid alcohol, smoking, and chewing tobacco which will all irritate the tissues in your mouth.
• Avoid hot, spicy, or acidic foods and stay away from hard/coarse foods, such as crackers, chips, and crusty bread.

Additional methods against mucositis

Some studies have shown that cryotherapy, a fancy name for sucking on ice cubes during the administration of chemotherapy, is effective against mucositis. In addition, there are mucosal protectants that help control pain by coating the mucosa and forming a protective barrier around exposed nerve endings. In clinical trials, two protectants that demonstrated their ability to control pain are Gelclair and Zilactin.¹

A product often prescribed by oncologists is Magic Mouthwash. This mouthwash varies some in its composition but generally contains some percentages of lidocaine, diphenhydramine, and Maalox. Despite its popularity, it is not a good choice to treat mouth sores. Maalox dries the tissue, which can actually complicate issues rather than resolve them. Rather than use Magic Mouthwash, consider simply using lidocaine alone in a “swish and spit method.”^1,2

There is currently no magic cure for mucositis, but you may be able to reduce its severity by following some of the tips here. Research continues and hopefully, in the near future, there will be more reliable ways of addressing this painful, dangerous condition.