From: "Lillian" <firstname.lastname@example.org>
Date: Sun, 24 Sep 2000 22:29:35 -0700
To: "MOL" <email@example.com>
Subject: [MOL] Mouth Sores
. 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.
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