TOPICS
Oral |
Resources | Research News
Oral
Mucositis | Oral Thrush |
Loss
of Taste |
Dry Mouth
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Burning Mouth Syndrome
 Oral
side effects that can result from cancer treatments include
oral mucositis, oral thrush and
loss of taste sensation or smell.
Oral health is
important!
In addition to being painful, a sore mouth can become easily
infected. Every step should be taken to prevent infections, because
they can be hard to fight during chemotherapy and can lead to
serious problems or the interruption of your treatment.
Prevention:
Talk you your doctor about seeing a dentist at least two weeks
before chemotherapy begins. If you've already started
chemotherapy and didn’t go to a dentist, see one as soon as
possible, and notify him
or her that you are receiving treatment.
Tip: If
brushing becomes too painful due to mouth sores, try a finger
toothbrush. Meant for babies, they are very gentle yet are
helpful in keeping the teeth and gums clean. They can be found in
most drugstores and grocery stores.
See Oral complications of cancer radiotherapy.
PMID: 834698
PubMed
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Related
abstracts
TOPIC
SEARCH: Radiotherapy and:
PubMed
Cancer Treatment and Mucositis:
PubMed
 Oral mucositis is
an inflammation of the mucous
membranes in the mouth. It can range from redness to severe ulceration.
This is a side effect associated with many cancer treatments.
The consequences can be mild to severe.
Mucositis "occurs when cancer treatments break
down the continually dividing epithelial cells lining the GI
tract, particularly in the oral cavity, leaving the mucosal
tissue open to ulceration and infection. It can occur anywhere
along the digestive tract from the mouth to the anus."
Stomatitis (mouth and oropharynx),
oesophagitis (oesophagus), gastritis (stomach),
enteritis (small intestine), colitis (colon), proctitis
(anus) and vaginitis (vagina) are all examples of
mucositis.
GONG Cancer Guidelines
Patients have reported
that oral mucositis is a distressing side effect of
standard-dose chemotherapy, occurring in approximately one third
of patients. Source:
professional.cancerconsultants.com
Mucositis is painful and can affect nutrition,
increase risk of infection, and can delay or limit treatment. It can lead to
major complications after or during cancer treatment.
Good oral hygiene practices are thought to
reduce pain, bleeding, infection, and dental complications (Rubenstein
et al 2004).
Potential complications include:
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Infection, such as herpes simplex virus,
candida albicans and other opportunistic agents
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Bleeding from non-intact mucous
membranes |
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Pain, secondary to lesions
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Decreased dietary intake leading to
dehydration and poor nutritional status
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Diarrhea or constipation
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The inability to talk comfortably may
lead some patients
with severe oral mucositis to suffer from depression
Adapted from GONG
Cancer Guidelines |
Treatment for mucositis should be guided
by your doctor.
In general, hydration should be maintained with oral fluid
intake and regular care of mucous membranes, such as regular
mouth care with a soft brush is recommended to reduce incidence
of complications.
In the News
Education on Preventive and Management
Practices, and Related Services:
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Related Services:
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Dietician for dietary education
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Medical Provider education on
assessment, management and prevention of
mucositis
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Dentist for treatment of dental
disease before commencement of treatment for
cancer
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Education on Preventive and
Management Practices
Ask your health care provider:
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How to assess and report changes
in oral mucous membranes at home
including changes to vaginal and rectal mucous
membranes
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Mouth care regime:
Regular cleaning of teeth and gums with a soft
toothbrush or swab as tolerated
Cleaning dentures daily and leaving out when at
rest and whenever a mouthwash is used;
Gums and areas under a denture should be brushed
on a regular basis
Your doctor might recommend rinsing mouth after
all meals with
a warm salt water or sodium bicarbonate mouth
rinse.
(Avoid mouthwashes containing irritants, such as
alcohol, phenol or chlorhexidine).
Sucking on ice cubes may ease discomfort (check
that water source is pure)
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Avoid hot food and drinks, spicy
food, alcohol and smoking
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Lubricate lip and mouth as
necessary
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Discuss use of topical
anesthetics and analgesics if necessary.
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Discuss strategies to prevent
risks associated with sexual activities
Avoid trauma to the genital areas such as the
use of tampons,
suppositories, chemical irritants from
deodorants, and
vaginal or anal intercourse until areas have
recovered.
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Discuss need to maintain good
hygiene, including encouragement of bathing and
cleaning
after each urination and bowel movements.
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Discuss need to report bleeding
from non-intact mucous membranes
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Adapted from GONG
Cancer Guidelines
Resources on Mucositis
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GONG Cancer Guidelines (very clear and concise
recommendations provided here) |
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Updated clinical practice guidelines for the
prevention and treatment of mucositis.
guidelines.gov |
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Cancer Treatment-Induced Mucositis Pain:
Strategies for Assessment and Management
http://www.ncbi.nlm.nih.gov/
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Clinical practice guidelines for the prevention
and treatment of cancer therapy–induced oral and
gastrointestinal mucositis (Rubenstein et al 2004).
http://bit.ly/pwVLVE |
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Tips for Getting Through
Therapy
PAL
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Mucosal damage: a major risk factor for severe complications
after cytotoxic therapy.
Semin Oncol. 2004 Jun;31(3 Suppl 8):35-44. Review.
PMID:
15181607 |
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Preventing Mucositis - discussion of investigational use of
Dehydroascorbic acid
DHA
Medscape
(free login req.) |
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Management of oral mucositis during local radiation and
systemic chemotherapy:
a study of 98 patients.
J Prosthet Dent.
1991 Sep;66(3):361-9.
PMID: 1800734
PubMed
| Related
abstracts |
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FDA Approves Kepivance for Severe Oral
Mucositis in Cancer Patients
Undergoing Bone Marrow Transplant; Pivotal Phase 3 Study
Published in
This Week's New England Journal of Medicine
cancerconsultants.com
Dec 2004
Questions and Answers on Palifermin (Keratinocyte Growth
Factor)
FDA.gov
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The cancer patient with severe mucositis. Curr Rev Pain.
2000;4(3):197-202. Review.
PMID: 10998733
Abstract
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Complementary Medicine:
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Oral glutamine to alleviate radiation-induced oral mucositis:
a pilot randomized trial. Int J Radiat Oncol Biol Phys. 2000 Feb 1;46(3):535-9. PMID:
10701731 abstract
| related
abstracts |
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Prospective evaluation of a chamomile mouthwash for prevention
of 5-FU-induced oral mucositis. Cancer. 1996 Feb 1;77(3):522-5.
PMID: 8630960
PubMed
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Oral
Mucositis
WebMagic Patient Tips:
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It is called magic mouthwash but to tell you the
truth, I used frozen things like popsicles. I was advised to even
start with ice chips during my treatment and continue with very cold
things.
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This is the recipe for "Magic Mouthwash"
that the onc nurse gave me....
Equal parts of hydrogen peroxide and water, mixed together.
Swish around in mouth, DO NOT GARGLE OR SWALLOW.
ALWAYS ASK YOUR ONCOLOGIST BEFORE TRYING THIS OR ANYTHING NEW.
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I used CAPHOSOL®. It tasted almost like a salt
water rinse. I found it worked longer than the magic mouthwash and
didn't have any aftertastes which I was sensitive to at the time.
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Much sympathy to your friend. I got nailed with
sores pretty hard after the first round of chemo and the doctor gave
me a life-time supply of CAPHOSOL®. It did help, and it had some
cool geek cred because its two liquid components come in separate
plastic ampules which have to be mixed.
It did not, however, represent a dramatic improvement over the
saline/baking soda solution. I found that being really diligent
about rinsing regularly, regardless of whether I felt any sores
oncoming or not, was the best routine for me.
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Oral
Mucositis
Research News and Resources
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Chlorhexidine prophylaxis for chemotherapy- and
radiotherapy-induced stomatitis:
a randomized double-blind trial.
Oral Surg Oral Med Oral Pathol. 1990 Mar;69(3):331-8.
PMID: 2179802
PubMed
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A controlled evaluation of chamomile
for preventing stomatitis in patients receiving 5-fluorouracil
based chemotherapy
asco.org |
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Mayo
Clinic on chemo mouth sores: what causes, which days are worst, how to
help prevent, how to cope.
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Preventing / managing oral mucositis
(resources) - common and serious side effect related to high dose
therapy and stem cell transplantation
Abstract
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A prospective, randomized study of cryotherapy ...
[ice chips
and ice-cold water shortly before, during, and for additional 90
min after completion of treatment] ... during administration
of high-dose melphalan to decrease the severity and duration of
oral mucositis in patients with multiple myeloma undergoing
autologous peripheral blood stem cell transplantation.
Bone
Marrow Transplant. 2006 Jun;37(11):1031-5. PMID: 16633359
Compared to the normal saline group, patients using cryotherapy
experienced less grade 3-4 mucositis, 14 vs 74%, P=0.0005. Patients receiving cryotherapy
also had statistically
lower uses of narcotics and TPN, although there were no
differences in length of
hospitalization or weight loss. Patient-reported pain was
significantly lower and
activities were significantly better in the cryotherapy group.
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Oral thrush presents as distinctive
lesions of the mouth, tongue, or cheeks -- caused
by infection of the mouth with the fungus (yeast) Candida albicans..
Lesions are easily brushed away revealing a reddened, tender area that
may bleed slightly." MedlinePlus
Loss of taste
sensation is called
Ageusia.
Anosmia
is the technical name for loss of
smell.
These are expected side effect
of localized radiation treatment, which can improve with time. These
effects can have " devastating physical and psychological consequences for the patient. Oral complications include xerostomia, dental decay, mucositis, taste loss,
osteoradionecrosis, infection, and trismus. In many instances, these
problems can be eradicated or controlled with appropriate
treatment."
"As the
effects of the treatment fade away things return to normal, but it
may take up to a year for your sense of taste to return."
source cancerbacup.org.uk
Consulting a nutritionally oriented
health professional is advised to determine nutritional deficiencies
that may contribute to the problem, as well as nutrients that might
help to rebuild the cells damaged by treatment, such as Zinc,
and vitamin B-12, glutamine.
About oral thrush
CDC
Information from Merck
Manual
"Depending on the cause of the taste disorder, a doctor may
recommend changing or stopping
a suspected drug, keeping the mouth
wet by sucking on candy, or just waiting several weeks to see if
the problem disappears. Zinc supplements, which can be purchased
without a prescription, are claimed to speed recovery, especially
from taste disorders that follow a bout of the flu. The effect,
however, has not been scientifically confirmed."
Taste and smell impairment
CancerSupportiveCare
"The cells comprising taste buds usually
will regenerate
within four months after treatment. However, the degree of
long-term
impairment of taste is quite variable from patient to
patient."
Impaired taste info
MedlinePlus
"Vitamin (Vitamin B-12) or mineral (Zinc in diet)
deficiency"
Disorders of taste and smell
eMedicine.com
Burning Mouth Syndrome
( BMS)
A
burning pain in the tongue or oral mucous membranes, usually without
accompanying clinical and laboratory findings. Candidal infections
are also purported to cause burning mouth syndrome. About
BMS aafp.org
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Burning mouth syndrome
(BMS): double blind controlled study of alpha-lipoic acid (thioctic
acid) therapy.
J Oral Pathol Med. 2002 May;31(5):267-9.
PMID:
12110042
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A reduction in the
production and quality of saliva in the salivary glands is a known
side effect of radiation therapy.
Try to follow these simple
guidelines:
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Perform oral hygiene after
each meal and before bedtime
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Rinse mouth immediately
after meals
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Brush and rinse
dentures after meals
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Use fluoride-based
toothpaste
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Drink clean water to
keep mouth moist at all times
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Ask your doctor about
use of prescription fluoride gel at bedtime
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Rinse often with salt
and baking soda solution
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Limit or avoid
sugar-based liquids and foods
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Avoid alcohol-based
rinses
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Use lip moisturizers
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Ask your doctor about Oral
pilocarpine (Salagen) a drug that stimulates saliva secretion |
Adapted from
thecancerblog.com
Research
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Acupuncture for pilocarpine-resistant xerostomia
following radiotherapy
for head and neck malignancies.
Int J Radiat Oncol Biol Phys. 2001 Jun 1;50(2):353-7.
PMID:
11380221
Acupuncture reduces xerostomia in some patients who are
otherwise
refractory to best current management.
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Related Resources
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Complimentary Medicine: Chemo-protection
PAL | Radio-protection
PAL
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Low blood counts PAL
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Chemotherapy side effects PAL
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xerostomia
