Oral Mucositis

Oral mucositis is the condition when the lining of the mouth is inflamed and sore. It is commonly experienced by patients receiving anti-cancer treatments such as chemotherapy, targeted therapy, immunotherapy, bone marrow transplant and radiotherapy to the head and neck region since the cells lining the mouth are susceptible to be attacked by these cancer treatments.

Risk factors of mucositis include

• Smoking
• Drinking alcohol
• Dehydration
• Low body mass index (BMI)
• Protein deficiency
• Having dental implants or dentures
• Poor dental hygiene
• Having kidney disease
• Having diabetes
• Being immunocompromised, e.g. HIV

What are the symptoms of oral mucositis?

• Red, shiny, swollen, painful mouth and gums
• Ulcers in your mouth or on your tongue
• Dry mouth
• Thick saliva or sticky feeling in your mouth
• Troubles with swallowing, chewing, talking or wearing dentures
• Change of taste
• Sensitive to hot, cold, salty, spicy or acidic foods and drinks
• Bleeding in the mouth
• White patches or thrush, which indicate infection

If you have symptoms of mucositis, tell your health care team. Your doctor or nurse will check for any changes on the surface of your tongue, roof of your mouth and insides of your cheeks.

Doctors may give you medications, such as:

• Alcohol-free mouthwash: Rinse your mouth every 4 hourly.
• Mouthwash containing local anaesthetics: e.g. lidocaine, benzocaine, dyclonine hydrochloride and Ulcerease.
• Oral painkillers: e.g. paracetamol, tramadol drops, codeine or morphine drops
• Anti-inflammatory drugs: e.g. Your doctor may prescribe steroid mouthwash if you are on specific type of targeted agent.
• Anti-fungal treatment: If you have oral thrush, your doctor may prescribe you with anti-fungal treatment, e.g. anti-fungal mouth drops or a course of anti-fungal tablets. Treating the infection will reduce the pain and bad smell of your mouth. If you don’t know how to use it, please ask your health care team.

How should I manage oral mucositis at home? 

1.  Maintain good oral hygiene

• Rinse your mouth several times a day:
  • You can rinse your mouth with salt or bicarbonate soda water or alcohol-free mouthwash.
  • Rinse every morning, evening and after each meal.
• Clean your mouth and teeth gently:
  • Clean your mouth and teeth with a soft bristled or electric toothbrush. If the mouth is too sore, you can use an oral sponge to clean the mouth.
  • Choose a gentle fluoride toothpaste. If you find the toothpaste irritating to your mouth, use salt or bicarbonate soda water to rinse the mouth. Avoid whitening toothpastes, which may irritate your mouth and gums.
• Floss gently:
  • Floss gently as it may damage the gums. You can consider alternatives, such as inter dental toothpicks or rubber tips.
  • If your platelet count is too low, your doctor may suggest you not to floss.
• Use your denture when necessary and clean it regularly:
  • Make sure your denture fit properly.
  • Only wear the denture when you eat. Take it off after eating.
  • Clean your denture after use and at least twice a day.

2. Mind your diet

• Don’t smoke.
• Avoid alcohol.
• Choose foods that are soft, moist and easy to swallow, such as rice, congee, mashed potatoes, soup, scrambled eggs etc.
• Eat foods at room temperature. Avoid very hot or very cold foods or drinks.
• Avoid sugary, acidic, spicy, oily and fried
• Avoid rough, crunchy or dry foods, e.g. crackers, nuts, chips etc.
• Avoid alcohol.
• Eat small meals frequently
• Protein shakes may help you obtain more nutrients and fluids.
• Use a straw if you have mouth sores. Paper or plastic straws may be better than metal straws which can give you a metallic taste.
• Have a well-balanced diet rich in citrus and protein.

3. Keep hydrated

• Drink 6-8 glasses of water or other fluids a day.
• Limit your caffeine intake (e.g. coffee, tea or soft drinks).
• Suck on ice chips or use sugar-free chewing gums to ke your mouth moist.
• Use lip balms.

How can I prevent mucositis?

• Check your mouth, tongue and teeth daily during treatment.
• Tell your health care team if you find any changes in your mouth.
• Have dental check-up regularly.
• Brush your teeth and rinse your mouth several times a day.
• Stop smoking and drinking.
• Eat a balanced diet with lots of fruits and vegetables.
• Keep hydrated with 6-8 glasses of water or fluid.
• Keep your mouth moist.

American Cancer Society: Mouth Soreness and Pain

Cleveland Clinic: Mucositis

Cancer Research UK: Mouth problems and cancer treatment

Special thanks to Ms. Ka-Wing Lau (Class M27), medical student of Li Ka Shing Faculty of Medicine, the University of Hong Kong, and Dr. Wendy Wing-Lok Chan, Department of Clinical Oncology, the University of Hong Kong for authoring and editing this article.