Majd Al Mardini DDS, FRCD(C)
Cert. Maxillofacial Prosthodontist
883 Upper Wentworth, Suite 209
Hamilton, Ontario, L9A 4Y6
Mouth Care for Chemotherapy Patients
Chemotherapy treatment may cause side effects in the mouth. These side effects may include mouth or throat soreness and/or ulcers; problems with your teeth and gums; or problems with the glands that make your saliva (spit). These side effects can be painful, and can make it difficult for you to eat, talk, and swallow. In addition, chemotherapy increases one's risk of getting an infection. Mouth sores can become infected by the many germs that live in the mouth, and this can lead to serious problems. It is important to take every possible step to prevent these problems from occurring.
Mouth Problems That May Be Caused By Chemotherapy
Sores in the mouth or throat (ulcers)
Painful mouth and/or gums
Burning, peeling, or swelling of the tongue
Changes in saliva consistency or dry mouth
Changes in taste
How to Keep Your Mouth From Getting Sore:
Take Good Care of Your Mouth
If you have ever experienced a mouth or dental problem (i.e., bleeding gums when brushing teeth, broken teeth or fillings, teeth that are sensitive/painful to temperature changes, irritation or gum swelling from wisdom teeth, pyorrhea (periodontal disease), loose teeth, or persistent irritation from dentures, inform your oncology doctor and/or his or her nurse of this condition. They may recommend a consultation with an oncologic dentists.
If possible, try to visit your dentist at least 2 weeks before starting your chemotherapy. Make sure to tell your dentist about your blood values, chemotherapy medicines, and treatment schedule. Make sure to give your dentist the name of your medical oncologist so that the two of them can communicate with one another about providing you with safe dental care. A visit to your dentist can help to prevent serious mouth problems and may lessen the amount of side effects you experience.
Use a soft-bristled toothbrush and regular- flavored fluoride toothpaste without tartar control. Try to brush your teeth, gums, and tongue after each meal and always at bedtime. After brushing your teeth, rinse your mouth with a baking soda solution. Do not use a mouthwash you can buy in a store. Such mouthwashes contain alcohol and may irritate your mouth. You can make your own mouthwash at home. To make your own mouthwash at home, mix 3/4 teaspoon baking soda in a 16-ounce container of water or 1/2 teaspoon baking soda in an 8-ounce container of water.
If you can't brush your teeth after meals, rinse your mouth with water. If you are flossing on a very regular basis (i.e., daily), floss your teeth with waxed dental floss. If flossing is not one of your routine hygiene habits, speak to your doctor before beginning to floss. Flossing must be done in respect to your blood counts. When your platelets drop below 50,000 (50 k/ul), you can modify your flossing to keep the floss above your gums when removing the food from between your teeth.
Be careful when putting in or taking out dentures or partials or plates. If your dentures/partials are poor fitting, you may want to leave them out completely since they may injure your oral tissues during chemotherapy, causing a disruption in your treatment. At bedtime, soak your dentures in a store-bought denture soak. Remove your dentures on the days you will get chemotherapy. Dentures have been known to increase nausea and vomiting with chemotherapy. If your dentures do not fit well, leave them out until after your chemotherapy ends. Leave your dentures out if your blood counts are low. Your doctor or nurse will talk to you about your blood counts and tell you when you should leave your dentures out.
Special Instructions If Your Platelet Count Is Below 50,000 (50 K/Ul)
After eating and at bedtime, brush your teeth using a very soft toothbrush with toothpaste. Because the bristles on soft toothbrushes are softer, your brushing motion must be slower to allow the bristles to flow along the gumline and clean off the food and plaque deposits.
After brushing, rinse your mouth with the baking soda solution. (See recipe for mouthwash above.)
If you notice sores, bleeding, white patches, or a white coating on your tongue, notify your doctor or nurse.
It is very important to keep your diet soft and non-irritating during low blood counts. (Do not eat crunchy, abrasive foods such as chips, popcorn, granola bars, etc.)
If you have any questions, please contact your doctor or nurse.
How to Keep Your Mouth and Lips Moist
Your lips and the inside of your mouth may start to dry out because of fever or medicine. You can do the following things to keep your mouth moist:
Rinse your mouth with water and/or baking soda solution very frequently.
Drink 8 to 12 eight-ounce glasses (2 to 3 liters) of non-alcoholic, non-caffeinated fluids each day.
Suck (do not chew) on ice chips or popsicles. You can also chew sugarless gum.
Lubricate your lips and corners of your mouth with an unflavored lip balm (NOT petroleum jelly or Vaseline®). Ask your dentist or pharmacist for suggestions on particular brands.
Tell your doctor or nurse if your mouth continues to feel dry.
How to Promote Mouth Care with What You Eat
To prevent soreness, eat only those things that feel good in your mouth. Eat foods like broth, gelatin, puddings, milkshakes, cooked cereals and frozen juice bars on a stick. Eat warm or cool foods. Try not to go from eating a food that is very hot to eating a food that is very cold. Try taking smaller bites of food, chewing slowly, and sipping liquids with your meals. Drink 8 to 12 eight-ounce glasses (2 to 3 liters) of nonalcoholic, noncaffeinated fluids each day (including nonacidic juices and/or sports drinks.)
How to Care For A Sore Mouth
If your mouth becomes too sore to brush your teeth, there are some things you can do to help your mouth feel better. If your mouth continues to stay sore, tell your doctor or nurse.
Rinse your mouth well with water after every meal. Also, rinse your mouth with a prescription mouthwash or with mouthwash you make at home. (See instructions on first page). Rinse every 2 to 3 hours while awake. Do not eat acidic or spicy foods, like oranges and hot peppers, which may burn and sting.
Do not eat hard foods such as potato chips or toast. If you have questions about what foods to eat, ask your nurse, doctor, or dietitian.
What To Do If You Develop Mouth Ulcers
If you develop sores (ulcers) in your mouth, tell your doctor or nurse. If the sores are painful or keep you from eating, you may also want to ask your doctor to tell you about a nonprescription product you may apply to the sores to help relieve the pain. Eat foods that are cold or at lukewarm temperature; choose soft, liquid, blended, or moist foods; avoid irritating acidic, salty, spicy and highly seasoned foods. If the ulcers are severe, you may need to eat finely ground or pureed foods.
If you have any problems or questions about the care of your mouth or teeth, please call:
Monday through Thursday, 9 a.m. to 5 p.m.
Adapted in part from the, “Mouth Care for Chemotherapy Patients”, The University of Texas M. D. Anderson Cancer Center Patient Education Office.
Maxillofacial Rehabilitation, John Beumer III, 1996.