. Mouth Sores
The mouth and digestive tract are
composed of cells (mucosa) that are more sensitive to chemotherapy. During or
after chemotherapy or radiation therapy, a cancer patient may have some sort of
mouth problem, ranging from dryness to ulcers. These mouth problems may be
related to the cancer itself, but more are often due to chemotherapy or other
medication. Three to ten days following chemotherapy, patients may experience a
burning sensation, followed by ulcers. When ulceration develops, treatment is
mostly supportive until the cells regenerate themselves, which takes about 7 to
14 days. This can impact on oral comfort and nutrition, but adequate care can
minimize these effects.
Prevention:
Basic mouth hygiene is of primary importance, and should be initiated before
chemotherapy starts. Patients should brush their teeth 3 to 4 times a day with a
soft toothbrush or sponge and use floss. Patients at high risk (those receiving
5-FU or methotrexate) should rinse their mouth frequently with salt water,
baking soda or chlorhexidine following chemotherapy.
Treatment: Once
mouth sores developed, analgesics and anesthetics can be employed. Xylocaine is
a local anesthetic available as a gel or spray used to decrease pain, but has a
short duration of action. It should not be used prior
to meals, as it can cause choking. Protective agents
(sucralfate, kaopectate) are also used to cover ulcers and decrease irritation.
It is important not to use irritant substances like peroxide as they way worsen
the ulcers. Topical steroids should not be used as they may facilitate
infections. In addition, patients should not eat
spicy, hot, acidic or coarse foods or juice. Preference should be put on soft
moist foods.
| Drug name |
Usual dose |
Side Effects |
| Saline mouthwash |
10-30 mL swish and swallow every 2 to 6 hours |
Few |
| Baking soda mouthwash |
1/2 tsp. salt plus 1/2 tsp. baking soda in a cup of warm water,
rinse every 3 or 4 hours |
Few |
| Chlorhexidine (Peridex) |
Rinse every 4 hours |
Taste, color, teeth staining |
| Betadine mouthwash |
Diluted with water 50-50 10 cc 3 times a day and as needed applied
locally or swish |
Iodine allergy, color, teeth staining |
| Xylocaine |
GEL: 5 to 15 mL every 4 hours SPRAY: 1 spray every 4
hours |
Possible systemic effect Choking if taken before meals
|
| Sucralfate or kaopectate |
10 to 30 mL every 2 to 6 hours, swish and spit |
Taste |
Damage to the mucosa can facilitate
some infections, such as candida or herpes simplex virus infections. Appropriate
treatment should be started. Thrush can be treated with topical antifungals,
such as clotrimazole or nystatin. When infection is more severe, oral
ketoconazole, fluconazole, or intravenous amphotericin may be used.
| Drug
Name |
Usual dose |
Side
effects |
| Clotrimazole troches (Mycelex) |
Place
troche in mouth 4 to 5 times a day, for 7 to 14 days |
Well
tolerated, taste |
| Nystatin suspension |
1
teaspoonful every 4 to 6 hours, swish and swallow |
Well
tolerated, irritation |
| Fluconazole (Diflucan) |
100mg
every day |
Nausea,
vomiting, itching |
| Amphotericin B |
Intravenous dose varies |
Headache, fever, chills. |
| Amphotericin B mouthwash |
10mg
swish and swallow every day |
Taste |
Dry mouth (xerostomia) can occur
in certain patients and can be easily treated with drinking fluids, sodas,
sucking ice chips, eating fresh fruits or chewing gum. Preparation containing alcohol or glycerin should not be used
because they may irritate or aggravate dryness.
Artificial saliva (MoiStir, Artisial) is commercially available and can be
useful in some patients. Dryness should not be overlooked, as it may predispose
to ulcers and infections.
