Cancer and Your Mouth
Managing Oral Mucositis
by Debra Harris, RN, MSN, OCN, and Malinda Burt, RN, BSN, OCN
Mucositis is a general term that describes inflammation of mucosal cells that line the gastrointestinal tract from the mouth to the rectum. This inflammation most commonly affects the mouth and esophagus (throat), but may be present throughout the gastrointestinal tract.
Mucositis may begin with painless redness and swelling, but it frequently progresses to more painful ulcers or lesions that are often described as burning or aching. These lesions commonly occur on the tongue, lips, and inside of cheeks. Pain is frequently worse with swallowing. Sensitivity to certain foods, especially spicy ones, may be increased. Other taste changes may also occur. In more severe cases, eating, drinking, and talking become difficult.
What causes mucositis?
Chemotherapy and radiation work by directly damaging and destroying cancer cells in the body. These treatments target abnormal cancer cells by their rapid growth. Unfortunately, we also have many normal rapidly growing cells in the body that can be affected by chemotherapy. The cells that line the surface of the gastrointestinal tract are this type of cell. When chemotherapy damages these cells, inflammation, irritation, and severe swelling can occur. This can lead to eventual tissue breakdown and ulceration of the mouth and throat.
When chemotherapy damages these cells, inflammation, irritation, and severe swelling can occur.
How do people cope with mucositis?
The timeline for developing mucositis varies depending on the type of treatment received. There are many steps you can take prior to and during treatment to minimize the severity of mucositis. Unfortunately, however, symptoms are often not preventable. Here are some tips to help you cope with oral mucositis:
- Have a dental evaluation prior to treatment.
- Maintain good oral care prior to and throughout treatment.
- Receive and follow instructions related to brushing, flossing, and mouth rinsing.
- Lubricate lips with lip balm or ointment.
- Keep your mouth moist with frequent rinses.
- Stay hydrated, drinking at least two liters of fluid a day if tolerated.
- Take pain medicine as ordered.
- Eat mild, easy-to-swallow foods.
- Use nutritional supplements if necessary.
- Chew non-irritating sugar-free gum or hard candy to stimulate saliva.
- Avoid alcohol and mouthwashes that contain alcohol.
- Avoid acid-containing fruits and juices (orange, grapefruit, lemon, tomato).
- Avoid tobacco.
What can family members and
friends do to help me with mucositis?
Ask family members and friends to encourage you to continue oral care, to prepare foods that are mild and easy to swallow, and to help you stay hydrated. When talking to family and friends about oral mucositis, tell them about how the mucositis is affecting how you feel about treatment, as well as how it is affecting your ability to eat, drink, swallow, and talk. Write notes if necessary. Let them know what is working and encourage their participation at the level that makes you comfortable.
What should I report to my
You should report the following symptoms to your healthcare provider:
- large amounts of bleeding or bleeding that does not stop;
- a temperature above 100.4 degrees;
- discomfort, pain, or irritation;
- new sores, ulcers, or lesions in your mouth;
- extremely dry mouth;
- difficulty eating, chewing, or swallowing; and
- difficulty breathing.
Researchers and scientists are working hard to develop new ways to prevent mucositis. It’s important to work with your healthcare team and your dentist to make sure your mouth is in good shape as you prepare for and complete treatment. Know that although mucositis can be distressing, it is temporary and the pain can be minimized.
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Debra Harris is the nurse manager for the Bone Marrow Transplant and Hematological Malignancies Unit at Oregon Health & Science University in Portland, OR. She has served as the Advanced Practice Lead for the creation of evidenced-based practice tools related to oral mucositis for nurses since 2006. Malinda Burt is the staff educator for the Bone Marrow Transplant and Hematological Malignancies Unit at OHSU.
This article was originally published in Coping® with Cancer magazine, September/October 2011.