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Mucositis: Treatment and prevention

What is oral mucositis?

Mucositis is when there is cell damage to the lining of the gastrointestinal (GI) tract. This affects the gums and lining of the mouth and throat. Mouth sores or ulcers may appear when your child’s white blood cell counts decrease during cancer treatment.

Mucositis may cause redness, swelling, sores, or bleeding. It may cause pain or an infection in your child’s mouth and throat and it can hurt when your child swallows.

Some children will need to be admitted to the hospital for pain medicines and IV fluids if they are unable eat, drink, or if there are signs of infection.

Why is oral care important?

Chemotherapy affects rapidly dividing cells. These cells include the lining of your mouth, GI tract, bone marrow cells, and hair cells.

Chemotherapy cannot tell the difference between cancer cells and normal cells and sometimes damages both of them. When these cells are damaged, you are at increased risk for infection.

What can be done to help prevent mucositis?

Brush teeth, gums, and tongue at least 2 times a day for 2 minutes each time. Be sure to clean your teeth after meals and before bed.

Use a soft toothbrush. Soaking your toothbrush in warm water for 1 to 3 minutes will make the bristles softer. Use fluoride toothpaste. Do not use whitening, brightening, tartar control or flavors that are irritating. Air dry toothbrush in between uses, covering a toothbrush increases bacterial growth. Change your toothbrush every 3 months or sooner if you have an infection or if bristles are worn.

Flossing teeth should be avoided when platelets are below 50,000 and ANC below 1,000 due to increased risk of infection and trauma.

Infants without teeth should have their gums and tongue cleaned using a clean cloth or sponge with water 2-3 times per day.

Rinse mouth 2-4 times a day for 15-30 seconds with a bland rinse. This helps clean and hydrate your mouth.

  • Mix 1 teaspoon of baking soda to 2 cups of water.  Pour in a cup and rinse. Change this mixture daily.
  • Mix 1 teaspoon salt to 2 cups of water. Pour in cup and rinse. Change this mixture daily.

Rinses should not take the place of brushing teeth. Rinsing alone will not remove bacteria from the teeth.

Your oncology team may prescribe an antiseptic mouth rinse made of 0.12% Chlorhexidine gluconate (Peridex). Use as directed.

Do not use mouthwashes that contain alcohol. These can irritate the mouth and decrease wound healing.

Apply water or a lanoline based lip moisturizer after all mouth cares. Avoid petroleum based lip products because these can harbor bacteria.

Continue to have regular dental visits.  Remember to check with your oncology team before scheduling any appointments.

Oral cares during mucositis:

If brushing teeth is painful, use wet gauze or sponge swabs to clean your teeth. If using sponge swabs, use 3 swabs each time, 1 for each cheek and 1 for the tongue.

Due to mucositis there is an increased amount of germs in your mouth and cares need to be done more often. Use the bland rinses 4-6 times a day and use the mouth rinses as often as prescribed by your oncology team. These prescribed rinses may include:

  • Peridex: you may dilute 1:1 with sterile water
  • Magic Mouthwash: may be used to numb the mouth and makes it less sensitive

Continue to use water or lanoline based lip products to prevent dry and cracked lips.

Do not use dental floss if your child has low counts or mouth sores.

What foods are helpful when your child has mucositis?

  • Cold foods such as popsicles and ice cream may be soothing for your child
  • Liquids should be encouraged even when your child refuses to eat foods
  • Boost or Ensure are high calorie options
  • Drinking out of a straw may be more comfortable
  • Soft foods may be easier to eat

Try to avoid dry, hard, seasoned, salty, and spicy foods as these may cause pain. Citrus juices and foods should also be avoided.

If your child has a dry mouth, chewing sugarless gum or sucking on a tart candy may help.

When should I call the provider?

Call the provider if:

  • Not urinating 4-5 times per day
  • Dark colored urine
  • Dry skin, lips, or mouth
  • Crying without any tears
  • Call 911 for all emergencies

Questions?

This is not specific to your child but provides general information. If you have any questions, please call the oncology clinic.

Reviewed by Hem/Onc 8/2015 ©Copyright

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Family Resource Center library, or visit www.childrensmn.org/educationmaterials.

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