Mucositis
Methods of managing mucositis

You should be sure to get excellent oral care by a knowledgeable dental professional before cancer treatment begins. Your health care provider may assist you with informing your dental professional about what you will need done.

Having good oral health

• Reduces the risk and severity of oral problems
• Allows for prompt identification and treatment of existing infections or other problems
• Improves the chance that you will tolerate the best schedule and doses of cancer treatment for your disease
• Prevents, eliminates, or reduces oral pain
• Minimizes oral infections that could lead to very serious whole-body infections
• Prevents or minimizes problems that can affect nutrition
• Prevents or reduces the chances of problems with the bones in your jaw later
• Preserves or improves oral health
• Provides an opportunity for patient education about oral hygiene during cancer therapy
• Improves your quality of life ⁴

Routine oral care

Doing oral care on a frequent basis daily plays an important role in oral health during cancer therapy. You may not be able to prevent all problems, but it will decrease the severity of the problems.

• Promote cleansing
• Prevent infections
• Moisturize the oral cavity
• Maintain mucosal health

Clean your teeth after eating and at bedtime using a soft bristled toothbrush. Always use non-irritating toothpaste. Avoid using toothpastes with strong whiteners which may cause irritation. Rinsing your toothbrush in warm water will help to soften the bristles. If you still experience pain with brushing, you may need to use soft foam swabs.

Daily flossing is also an important part of good oral care. However if you have not routinely flossed, speak with your health care practitioner about starting. Stop flossing if you experience spontaneous or uncontrolled bleeding. Your health care provider may also give you some guidelines about flossing.

In addition to brushing your teeth, you will want to pay close attention to the soft tissues in your oral cavity. These include the inside of your cheeks, the roof of your mouth, and under your tongue. Rinse your mouth regularly with a non-irritating solution.

Oral Care Solutions

Various types of "magic solutions" have been tried for mouth care. These solutions are often made up of several types of solutions, in hopes of finding a combination that works very well for mucositis symptoms. Unfortunately there is limited research on these solutions and some have actually been found to worsen the problems rather than prevent them. Be sure to get your healthcare provider's okay before trying any of these "magic" solutions.

Three simple options that are recommended include:

Normal saline solution (salt water): You can obtain bottled normal saline, or you can prepare this at home by adding one teaspoon of table salt to one quart or four cups of plain water. Shake or stir the solution. Keep it with you for regular use. If you make more than enough solution that you will use in one day, keep the remainder in the refrigerator. Note: if your tap water contains germs you should obtain another source of water to use. If you are not sure about the safety of your water supply, check it out with your local health department.

Baking soda solution: You can prepare this at home by adding 1 teaspoon of baking soda to 8 ounces of water.

Salt and soda solution: You can prepare this at home by adding ½ teaspoon of table salt and 2 teaspoons of baking soda to one quart or four cups of plain water. Shake or stir the solution. Keep it with you for regular use. If you make more than enough solution that you will use in one day, keep the remainder in the refrigerator

**Note: You may hear different recommendations regarding the amount of salt and soda added to the water to make the rinse. Check to see what your provider prefers.

Keep the solution you are going to use for the day at a temperature that is comfortable for you, and always keep any solution you are not going to use in a day in your refrigerator. Avoid mixing up extremely large amounts that will take more than several days to use. Salt water provides a non-irritating solution to clean the mouth and provide moisture for the membranes. Sodium bicarbonate (or baking soda) helps to dissolve mucus, making it possible for saliva to do a better job of cleaning the oral cavity.

Additional Tips for Better Oral Care

It is important to have your mouth in the best condition possible prior to starting your cancer therapy. The frequency of rinsing is probably more important than the specific solution as long as it is a non-irritating solution. This rinsing helps to rinse out any of the chemicals that may be building up in your saliva from the chemotherapy and helps to keep your mouth clean.

Avoid using mouth rinse products that have glycerin or alcohol as they can cause drying in your mouth. The alcohol can be irritating to your mucous membranes.

Drink plenty of fluids to avoid dehydration. Keeping fluids close by you will help you to accomplish this. Avoid acidic drinks such as orange or grapefruit juice if sores are present in your mouth. Avoid drinking anything that is extremely hot or cold, as extremes in temperature can also be painful to the sensitive tissues in your mouth.

Apply lip moisturizer or non-drying lip balm to keep your lips moist and avoid cracking. Do not bite or chew on your lips.

If your healthcare team tells you that you are likely to develop sores or ulcers in your mouth, you will benefit from using a soft foam swab dipped in a small amount of mouth rinse to cleanse the soft tissues in your mouth. This includes your cheeks, the roof of your mouth, your gums, tongue and under your tongue. Pour a small amount of the rinsing solution into a small cup for use with the foam swabs. Do not dip a swab that has been in your mouth into your bottle of rinse solution. Initially do this cleansing four times a day. If you develop sores increase the frequency to every two hours while you are awake. If you get up to the bathroom during the night do oral care at that time also.

Remember, even if routine oral care is not successful in preventing all mouth sores, it does help to decrease the severity of the problem.

A word about dentures: If you have dentures or other dental appliances be alert to special concerns. The fit of these devices may change during your cancer therapy and they need to be adjusted. If you have sores in your mouth you should limit the amount of time you have the devices in your mouth. Keep these devices as clean as possible so that they do not cause infections in your mouth. Brush them several times a day with a cleansing solution. Soaking your dental appliance in an antimicrobial solution will also help to prevent infections. Always remove these devices during oral care so that you clean all areas of your mouth.