Mouth, bleeding in

Bleeding in the mouth is generally caused by mouth sores, gum (periodontal) disease, or by a low platelet count (cells that help the blood to clot). Low platelet counts can be a side effect of chemo or radiation treatment. This is usually a short-term problem. Cancers that affect the blood-forming system, such as leukemia, can also cause a drop in platelets. A person with low platelets may bleed easily. Everyday actions such as brushing or flossing teeth can cause bleeding (if platelet count is low, see the section called "Blood counts"). Side effects of chemo or radiation can include dryness in the mouth or small mouth ulcers, which can bleed.

What to look for

• Blood or bruises in mouth (from or on the gums, tongue, etc.)
• Rash or bright red pinpoint-sized dots on tongue, under tongue, on roof of mouth, and/or on inside of cheeks
• Oozing of blood from mouth

What the patient can do

• Rinse your mouth gently with ice water every 2 hours.
• Have ice chips on hand to suck on. (Avoid hard candies if your mouth is bleeding.)
• Rinse your mouth or brush your teeth with a soft toothbrush after eating. Rinse the toothbrush in warm water to soften the bristles even more.
• Use soft foam mouth swabs or gauze wrapped around a Popsicle stick or tongue depressor to brush teeth if a soft toothbrush causes bleeding.
• Avoid store-bought mouthwash. See the section called "Mouth dryness" to learn how to make a gentle mouth rinse.
• Eat foods that are soft and smooth in consistency and high in calories and protein. Refrigerated soft foods, such as ice cream, applesauce, puddings, and yogurt, are helpful because cold helps to control bleeding.
• Put hard foods, such as apples, pears, etc., in the blender.
• Avoid hot drinks, such as coffee and tea. Heat enlarges blood vessels and can worsen bleeding.
• Apply cream or salve to lips to prevent dryness.
• If you wear dentures, keep them out of your mouth, especially if they do not fit well.
• Avoid aspirin products. Check labels of over-the-counter drugs to be sure they don’t contain aspirin, or check with your pharmacist.

What caregivers can do

• Offer the patient cold water mouth rinses before each meal. Keep ice water nearby.
• If the mouth is oozing blood, keep a bowl nearby for spitting out mouth rinses.
• Make milkshakes or smoothies in the blender, and offer other soft frozen treats. Avoid nuts, caramel, and hard coatings.
• Freeze a few wet tea bags, and have the patient press one on any area of bleeding.

Call the doctor if the patient:

• Is bleeding from the mouth for the first time
• Has bleeding that lasts for more than a half hour
• Vomits blood or material that looks like coffee grounds
• Feels light-headed or dizzy