Mouth Sores (Mucositis) in Childhood Cancer

oral infection

Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

Mucositis is swelling inside the mouth and throat that can lead to painful ulcers and mouth sores. Mucositisis generally a short-term side effect of cancer treatment and although painful, it usually disappears soon after treatment ends

Mucositis happens when cells that line the digestive tract become inflamed as  result of damage caused by cancer treatment. The digestive tract starts at the mouth, runs through the body, and ends at the rectum. With mucositis, painful sores can form anywhere inside the digestive tract.

 

Causes

There are several possible causes of mouth sores related to cancer and cancer treatment. Understanding the cause may help you and your health care team manage this side effect.

  • Chemotherapy. Up to 40% of people receiving chemotherapy experience mouth sores.
  • Radiation therapy to the head and neck area
  • Bone marrow/stem cell transplant. Mouth sores are a possible sign of graft-versus-host disease, which is a side effect of these procedures.

Anyone undergoing cancer treatment, especially chemotherapy, can be affected by mucositis.

The condition generally occurs around 7 – 10 days after the last day of treatment and typically lasts about 5 – 7 days. whereafter the cells begin to heal and the mucositis disappears.

 

Symptoms

Oral mucositis is inflammation of the mucosa of the mouth which ranges from redness to severe ulceration. Symptoms of mucositis vary from pain and discomfort to an inability to tolerate food or fluids. Mucositis may also limit the patient’s ability to tolerate either chemotherapy or radiotherapy.

Symptoms of mucositis include:

  • Pain in mouth, throat, or stomach
  • Redness, swelling, or wounds in the mouth, throat, or rectum
  • Sores in the mouth or genital area
  • Drooling
  • Refusal to eat or drink
  • Diarrhoea

 

Management/Treatment

Mucositis can be very painful, so your child may not want to eat or drink, but it is vital that your child does eat and stay hydrated. Your child’s doctor will probably prescribe pain medication and may also prescribe medication to fight the infection.

Take your child to visit an oncologic dentist before starting treatment if they will be receiving radiation therapy to the head and neck. An oncologic dentist is experienced in treating people with head and neck cancer.

The best way to manage mouth sores is to prevent them or treat them early. Here are some suggestions and options for preventing and treating mouth sores:

 

Keeping Your Child’s Mouth Clean

  • Your child’s healthcare provider can give some advice as to the best way to brush their teeth – make sure your child follows instructions carefully and fully. If mucositis gets worse, the healthcare provider may suggest that teeth and mouth cleaning should be done more often.
  • Give your child a soft-bristle toothbrush to brush with and make sure that the toothbrush is replaced often.
  • Make sure your child brushes gently
  • If your child’s mouth is too sensitive for a toothbrush,  they can use a special sponge to clean their teeth
  • Have your child rinse his or her mouth with non-alcoholic rinses, antibacterial rinses, salt water, or plain sterile water. These products will help to remove particles and bacteria, prevent the crusting of sores, and soothe sore gums and mouth lining. Ask your child’s health care team for suggestions

 

Manage Pain and Infection

  • Give any pain medication prescribed for your child as instructed.
  • Don’t give your child over-the-counter medications, such as aspirin, ibuprofen, or acetaminophen, unless you are told to do so by your child’s health care provider. These medications can mask a fever, which is an important sign that there is a problem with your child’s health. They can also make it harder for the blood to clot. This raises your child’s risk of bleeding.
  • Have your child use a prescription mouthwash as instructed by the health care provider. These mouthwashes can help to numb the area and prevent infection because they often contain numbing agents and anti-fungal agents. They are sometimes called “magic mouthwashes.” A home-made solution of saltwater and baking soda ( 1/2 teaspoon of salt plus 1/2 teaspoon of baking soda in a glass of water) works well
  • Antibiotics may be prescribed to treat infection of sores. Make sure your child takes these as instructed.
  • Encourage your child to brush and floss gently and regularly to clear away bacteria.

 

Maintain Good Nutrition

If your child has mucositis, he or she will get either intravenous (IV) treatments, IV fluids or nutrition at the hospital if eating or drinking is a problem.

If your child is able to eat and drink, do the following:

  • Encourage your child to drink milk shakes and other cool foods
  • Purée food with a blender if necessary
  • Serve foods cool or at room temperature
  • Make sure foods are cooked until tender and cut into small pieces that require little or no chewing

 

Other Tips

  • Talk to your child’s health care provider about getting dental work done before treatment begins.
  • Moisturise your child’s lips with petroleum jelly or balm, such as lanolin
  • It is best if your child avoids citrus or spicy or acidic foods, but it’is okay to allow them if your child wants them; the most important thing is that your child eats
  • Have an overnight bag ready in case you need to take your child to the hospital
  • If you do go to the hospital, take your child’s medication and any  information you may have regarding their chemotherapy treatments

 

It is important that you DO NOT give your child aspirin during cancer treatment unless your doctor tells says it is alright.

Read more about dental and oral health during cancer treatment.

 

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