Sore Mouth, Gums and Throat  

Sore mouth, gums and throat is commonly experienced by cancer patients undergoing chemotherapy; it is a frequent chemotherapy side effect. The reason is because chemo drugs tend to interfere with the cells of the body that divide and reproduce themselves, including cells of the oral cavity. When the healthy cells in the lining of the mouth are damaged and unable to reproduce, the body reacts by producing a number of side effects, which severity varies from patient to another.  The good news is that these sores may clear up by themselves in a few days.  

The mouth and throat (including other organs of the digestive tract) are composed of a tissue (a group cells) called mucosa. They protect the digestive tract. But they are sensitive to chemotherapy however. Thus, once the chemo drugs start attacking cancer cells, cancer patients may experience mouth problems, which may include dry mouth, ulcers and dental problems. In some patients, the treatment can inflame the buccal mucosa (protective lining of the mouth), a condition called stomatitis or mucositis. Mucositis is characterized by redness, inflammation, sores (ulcerations) as well as discomfort and pain.  The medications can also lead to esophagitis, inflammation of esophagus. 

It is important to note that these mouth problems are not always the result of chemotherapy drugs; they can be due to other medications or the cancer itself. In fact, most patients complain of burning sensation and ulcers in the mouth 3 to 10 days following chemotherapy due to low white blood cell count. Treatment may require supportive care until the cells regenerate themselves, which takes about 7 to 14 days. A healthy diet is the key to increase the white blood cell count, and thus minimize these effects. 

What You Can Do? 

During chemo treatment, it is extremely important to keep the mouth clean and free from the oral foci of infection and pain to minimize local infection and bacteremia. All cancer patients need to adopt a good oral hygiene program: dental cleaning and scaling, daily brushing and careful flossing to reduce plaque and other oral problems including tooth decay and bad breath. Cancer patients should brush their teeth 3 to 4 times a day or after each meal with a soft toothbrush and use floss with care to prevent cut or injure to the gums. 

It is recommended for scaling, cleaning, tooth extractions or repair of cavities to be done before the chemotherapy begin. Because chemotherapy agents reduce the property of the body to heal, to prevent risk of infection and/or ulcers, any tooth extraction should be done at least two weeks before the chemo therapy.  It is also recommended for patients to rinse their mouths frequently with salt water, baking soda or chlorhexidine (Peridex® or Periogard®) during and after chemotherapy. Flossing and use of electric toothbrushes and Waterpic® should be avoided in case the gums are swollen, sore or tend to bleed. 

In addition, you can take the following daily steps to help your mouth stay healthy: 

• First of all, let your doctor know if you have ulcers so that you may be prescribed medications to help heal the ulcers and prevent infection 
• Keep your toothbrush in a toothbrush case, and replace it frequently to prevent infection  problems  
• Clean your teeth or dentures gently every morning and evening or after each meal 
• Use a soft-bristle toothbrush to brush your; you may soften it more by soaking it in warm water if you have mouth sores. Use non-irritating toothpaste that contains natural salivary enzymes that help control bacteria. 
• Depending on the sores, the brushing may be painful, in this case, use either a cotton swab or toothettes 
• You can dip a Q-tip in 3% hydrogen peroxide followed by a warm water rinse to get rid of debris from around the teeth, and increase oxygen level in your mouth. 
• Avoid acidic drinks, such as orange and grapefruit juice 
• Avoid mouthwashes alcohol that can irritate your mouth and/or worsen the sores 
• If you have vomited, rinse out your mouth before cleaning your teeth as the acid in the vomit may damage your teeth  
• Keep your lips moist by using Vaseline® or a lip balm  
• Keep your mouth by drinking plenty of fluids 
• Avoid irritating foods: hot spices, garlic, onion, vinegar and salty foods 
• Avoid tobacco and all alcohol beverage that can irritate your mouth 
• If you have sores in your mouth and/or throat, add gravies and sauces to your food to help swallowing. 

 What You Can Do If You Have Sores and/or Infections? 

During chemotherapy, the mucositis is usually caused by low white blood cell count, cells of the immune system involved in defending the body. When this occurs, the immune system becomes weak, putting you at increased risk of infectionand other serious medical conditions. For patients who also receive radiotherapy to the head and neck, the radiation can also cause sores in the mouth, gums and throat due to the necrotic and inflammatory effect of radiation energy on oral mucosa. 

Mouth infections during cancer treatment can be dangerous. Examine your mouth regularly searching for abnormal appearances or feelings. If the soreness or abnormalities are found in your mouth, and they are severe, it is important to have a complete mouth evaluation by a professional. Therefore, report any oral change to your dentist. All infection should be diagnosed and treated promptly to prevent complications. The diagnosis can be made based on clinical characteristics, or using medical tests: smear or cultures for instance. 

To enhance the healing process of your mouth, you can:  

• Apply black seed oil on the affected area 
• Apply Vitamin E on the sores 
• Apply Orabase^®, Ulcerase^® (and others) to irritated areas in mouth or on lips.