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Mouth sores are like little cuts or ulcers in the mouth. The
sores may be very red, or may have small white patches in the middle.
They may bleed or become infected. They can appear 1 to 2 weeks after
some kinds of chemo. They can also be caused by radiation treatments to
the head and neck area, infection, dehydration, poor mouth care, oxygen
therapy, alcohol or tobacco, not enough vitamins, or lack of protein.
Healing may take 2 to 4 weeks. Mouth sores can be very painful and lead
to dehydration, poor eating, and weight loss (see section on fluids and
dehydration).
What to look for
- Inside of mouth and gums look red, shiny, or
swollen
- Blood in mouth
- Small ulcers or sores in mouth, on
gums, or on or under tongue
- A white or yellow film in the mouth or
on the tongue
- Soreness or pain in mouth or throat
- Feeling of dryness, mild burning, or
pain when eating hot and cold foods
- Soft whitish patches or pus in the
mouth
- Increased mucus in the mouth
What the patient can do
- Check mouth twice a day using a small flashlight and padded
popsicle stick. If you wear dentures, take them out before you inspect
your mouth. Tell your doctor or nurse if your mouth looks or feels
different or if you notice changes in how things taste.
- Follow this plan for mouth care 30 minutes after eating and
every 4 hours while awake, or at least twice a day unless your doctor
or nurse gives you other instructions:
Brush your teeth using a
soft nylon bristle toothbrush. To
soften the bristles even more, soak the brush in hot water before
brushing and rinse brush with hot water during brushing. If the
toothbrush hurts, use a popsicle stick with gauze wrapped around it or
a cotton swab instead. Or you can get soft foam mouth swabs from the
drugstore.
Rinse toothbrush well in
hot water after use and store in a cool, dry
place.
Use non-abrasive toothpaste that contains fluoride. Note that whitening
toothpastes may contain hydrogen peroxide which can irritate sore
mouths.
Remove and clean dentures
between meals on a regular time schedule. If
you have sores under your dentures, leave dentures out between meals
and at night. Clean dentures well between uses, and store in an
anti-bacterial soak. If dentures fit poorly, do not use them during
treatment.
- Gently rinse mouth before and after meals and at bed time
with one of the following solutions (stir or shake solution well, swish
around in mouth and gently gargle, then spit out):
1 teaspoon baking soda
2 cups water
Or
1 teaspoon salt
1 teaspoon baking soda
1 quart water
- If you normally floss, keep flossing at least once a day
unless you are told not to do so. Tell your doctor if this causes
bleeding or other problems. If you do not usually floss, talk with your
doctor before you start.
- Avoid store-bought mouthwashes, which often
contain alcohol
or other irritants.
- Keep lips moist with petroleum jelly, mild lip
balm, or
cocoa butter.
- Drink at least 2 to 3 quarts of fluids each
day if your doctor approves.
- If mouth pain is severe or
makes it hard to eat, ask your doctor about medicine that can be
swished 15-20 minutes before meals or painted on each painful sore with
a cotton swab before meals. If this does not work, you may need
stronger pain medicines.
- To promote healing, ask your doctor about using
Maalox® or Milk of Magnesia®.
(Allow this to settle and
separate, pour the liquid off the top of the solution, and swab the
pasty part onto the sore area with a cotton swab. Rinse with water
after 15-20 minutes.)
- Sip warm tea slowly
- Eat
chilled foods and fluids (for instance, popsicles, ice cubes, frozen
yogurt, sherbet, ice cream).
- Eat soft foods that are moist
and easy to swallow.
- Eat small, frequent meals of bland, moist,
non-spicy foods.
Avoid raw vegetable and fruits, and other hard, dry, or crusty foods
such as chips or pretzels.
- Avoid very salty or high-sugar
foods.
- Avoid acid fruits and juices, such as tomato,
orange,
grapefruit, lime, or lemon.
- Avoid fizzy drinks, alcohol, and tobacco.
- Create a pleasant mealtime atmosphere.
What caregivers can do
- Use a flashlight to check the
patient's mouth for red areas or white patches, which often
become sores. If patient wears dentures, remove them before looking.
- Offer liquids with a straw, which may help bypass the sore
area in the mouth.
- Mash or puree hard foods in a blender to make them easier
to
eat.
- Try coating mouth sores with Anbesol®
before meals,
to numb them during eating.
- Offer pain medicines a half hour before mealtime.
Call the doctor if the patient:
- has redness or shininess in mouth that lasts for
more than 48 hours
- has bleeding gums
- first
notices any type of "cut" or sore in the mouth
- has a
temperature of 100.5° F or higher, taken in the mouth
- has white patches on the tongue or inside the mouth
- has taken little food or fluid for 2 days
- cannot take medicines due to sores in mouth
Go to a list of symptoms to find
other problems in Caring for the
Patient with Cancer at Home: A Guide for Patients and Families.
Revised: 04/07/08
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