Dealing With Mouth Problems

By Nancy Symonds, RDH (Registered Dental Hygienist)

If you have been taking care of your mouth as suggested in Preventing and Relieving Mouth Problems, Mouth Care During Treatment, and Special Needs of Chemotherapy & Head & Neck Radiation Patients, you won't have as much need for this article. Nevertheless, mouth problems can even happen to patients who are doing their best to prevent them.

That is why we have this special article, because every oral infection is important, as the infection can spread to your body. Due to the change in your immune system, the infections can look different and be in different areas than where you may have had sores (cold sores, herpes, etc.) before treatment. Remove any dentures or partials and examine your mouth daily under a strong light with a plastic dental mirror you can purchase at a pharmacy. See if you are getting any red or whitish yellow sores, bleeding, or painful areas. Alert your doctor about these symptoms and get medication. Early treatment of infections gives you a better chance of keeping them under control and spreading into your body.

So you might want to print this article so you can refer to it if needed. Here we discuss the following topics:

Dry, Peeling Lips with Cracks or Sores at the Corners of the Mouth

Drink plenty of fluids

Avoid wetting lips with your tongue which increases dryness

Avoid petroleum based lip balms such as Vaseline as they are drying

Use hydrous lanolin, cocoa butter, vegetable oil based products or aloe vera. Warning: do not use if you are on oxygen. Radiation patients should not use any oils or moisturizers before radiation treatments. Consult with your radiation oncologist. Cracks at the corners of your mouth may be infections, alert your doctor to see if you need medication.

Dry Mouth

Increase your fluids. Many patients carry a water bottle with water and ice chips.

Rinse with the baking soda/salt rinse (see Rinses in Mouth Care During Treatment) often, swish, don't swallow, and then rinse out with water. This will moisturize and lubricate your mouth.

Use artificial salivas recommended by your doctor or dentist. You can make your own with 1/4 teaspoon glycerin in 1 cup water, swish for a few seconds and then spit out. These are helpful when you are telephoning, traveling, or just before eating.

Suck on sugarless hard candy or chew sugarless gum. Avoid sugar and sweets as they can dry your mouth and cause tooth decay.

Use a mild flavored baking soda or children's toothpaste if regular toothpaste is too irritating.

See section on Foods to Eat and Foods to Avoid to prevent dryness and irritation to your mouth.

Head and neck radiation patients use fluoride treatments daily. See instructions for Fluoride Trays.

Thick Saliva

Swish, then swallow papaya juice from a glass, not metal, container to cut thick saliva.

Mix 1 teaspoon unflavored Adolph's meat tenderizer in 1 cup of water, swish and gargle, but do not swallow.

Mouth and Throat Soreness (Mucositis)

Mouth sores may begin 1 to 2 weeks after cancer treatments have begun and take 2 to 4 weeks to heal. Keeping your mouth immaculately clean and moist and avoiding foods that irritate your mouth can help you get through these problems. Daily examination of your mouth to detect mouth sores and alerting your doctor immediately will also lessen the severity of the sores.

Use the baking soda/salt rinse (see Rinses in Mouth Care During Treatment) as often as needed. This reduces acidity and bacteria in the mouth. Chemotherapy patients may use a chlorhexidine rinse unless this irritates the mouth.

Coating agents such as Kaopectate, Milk of Magnesia, and Maalox can ease the pain. If your whole mouth is sore, hold and swish the coating agent through your mouth and then spit out. Do this before meals so you will have less discomfort while eating. If you only have a few isolated sores, let the coating agent foam in a spoon and then paint it over the sores with a Q-tip. Rinse with water after a few minutes. Medicated gels can also be used for isolated sores to soothe and coat the sores.

Your doctor may prescribe a slurry of Carafate to swish and spit out.

A combination of topical anesthetics and coating agents can be combined to help you eat.

Topical anesthetics such as viscous Lidocaine, Xylocaine, or Benzocaine may be swished 20 to 30 minutes before meals. These will numb your mouth so do not eat anything too hot and eat small bites to prevent gagging.

Denture Sore Mouth

Do not wear your dentures or partials until your mouth sores are gone. Your dentures or partials may need to be adjusted to fit properly as you may have lost weight.

Many of these sores are yeast (fungal) infections and your doctor or dentist needs to know what kind of infection (bacterial, viral, or fungal) is causing the soreness. The denture or partial may be the source of the infection and needs to be sterilized.

Yeast (candidiasis) Infection

This is a common infection in patients who have a dry mouth. These are whitish yellow patches that usually appear on the tongue and inside cheeks of the mouth.

It must be determined if the infection is localized in the mouth where it can be treated with a prescription from your doctor or dentist for anti fungal lozenges or mouth rinses. Ask your pharmacist for the medication with the lowest sugar content.

If the infection has spread, your doctor will prescribe a systemic anti fungal medication.

Fever Blisters or Cold Sores (Herpes) Infection

Fever blisters look like clusters of blisters and are painful. Over the counter medicated cream or a prescription from your doctor should be used immediately. If the blisters continue to spread, you will need a systemic anti viral prescription from your doctor. Get help from your doctor right away as these sores can lead to a bacterial infection.

Bacterial Infections (Sores)

See your doctor to get the right medication for your specific infection.

Bleeding in the Mouth

Bleeding can come from decreased platelets in the blood due to therapy, sores, coarse food, hard toothbrushes, improper flossing, or a dry mouth which makes the lining of the mouth more susceptible to sores and cuts.

Do not use aspirin or hot beverages as they may cause more bleeding.

Keep dentures or partials out of your mouth, especially if they are ill fitting. Keep your mouth cold with soft, bland, cold foods, rinsing with ice water or sucking on ice chips.

You may have to stop flossing and brushing your teeth and rely on your finger wrapped in gauze and dipped in the baking soda/salt solution (see Rinses in Mouth Care

During Treatment) to clean your teeth in a very gentle way or just use the rinse. Your doctor will tell you when you can resume regular flossing and brushing.

See your doctor if you have bleeding coming from cuts, sores, or your gums and the bleeding increases or does not stop after 48 hours or if you have a fever.

Altered or Loss of Taste

This metallic or salty taste may come from less saliva or the chemotherapy treatments. Normal taste usually comes back a few months after treatment.

Follow the instructions for dry mouth, foods to eat and avoid.

Eat several small meals a day, add nutritional supplements in powdered or liquid form such as instant breakfast powders to keep from losing weight.

If food is too sweet add salt, or if food is too salty, sweeten with a sugar substitute.

Nausea and Vomiting

You may be like many others and not have any nausea during chemotherapy. However, if this unpleasant side-effect does occur, ask your doctor to help you because there are medications that can relieve the symptoms. In addition, here are just three of the things you can do and, because this is a mouth care article, we want to especially emphasize the last one.

Sucking on a sugarless lozenge while receiving chemotherapy can mask the taste of the chemotherapy drugs, a taste which comes through the whole system even though the drug isn't being taken by mouth. If an upset stomach does happen to occur, even if mild and not necessarily caused by the chemo, the mind can pair the taste with the unpleasant sensations in the stomach. Then, the next time chemo begins, the body thinks it's supposed to have an upset stomach and guess what, it does. Lozenges that cover over the taste may prevent this not uncommon problem.

Eat cool or room temperature foods to cut down on tastes or smells that can cause nausea.

Rinse immediately after vomiting with the baking soda/salt rinse (see Rinses in Mouth Care During Treatment) to neutralize the gastric acids in your mouth before you brush your teeth. This will help prevent damage to the enamel on your teeth.

Hard to Open Mouth (Trismus)

This is usually seen in head and neck radiation patient where the jaw muscles tighten and it is difficult to open your mouth.

Before meals, open and close your mouth as wide as you can 20 times, 3 times a day.

© Copyright 1998, Nancy Symonds, RDH