Childhood Cancers
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Mouth Problems
Mouth Care Overview
Chemotherapy drugs are a group of strong drugs that are used to treat cancers. As well as killing cancer cells, chemotherapy can have other effects, which are called side effects. This may include effects on the mouth, gums, back of the throat and the teeth.
How Mouth Problems Happen
Problems with your mouth can be caused by two side effects of chemotherapy. Firstly Chemotherapy affects all cells that divide rapidly. Cancer Cells divide rapidly and this means that chemotherapy can destroy them. However the cells that line the mouth also divide rapidly and can be affected by chemotherapy. This will make the mouth lining slower to grow and heal properly.
Secondly, you may be at risk of infection because of the drop in your white blood cell count as a result of having had chemotherapy. Your mouth is one area where infection can develop.
If you have a problem with infection or a sore/red area on the lining of your mouth the nurses or doctors may call it mucositis. They may also say you have got mouth ulcers.
Mouth problems can make it very painful to eat and drink. For many patients mouth pain can be the most painful problem.
How to Prevent Mouth Problems
While you are having chemotherapy, it is essential to continue with good oral hygiene. Good oral hygiene means that the mouth should be cleaned, all debris removed and the lips kept soft and moist.
The nurses or doctors will advise you about mouth care during your first visit to hospital but the things that will help are:
- You will need to use a soft bristled toothbrush and fluoride toothpaste in the morning and, more importantly, at bedtime.
- Continue having regular visits to the dentist at least every six months. You should mention to your nurse or doctor that you are going to visit the dentist. You should also tell your dentist that you are having chemotherapy.
- Some specific chemotherapy treatments will leave you more at risk of developing mouth problems. If you are receiving one of these treatment protocols, you will be advised to use antibacterial chlorhexidine (Corsodyl) mouthwash four times a day in addition to the twice-daily teeth cleaning.
- When your blood count is low (neutopaenic), anti-fungal drugs will be prescribed for you that will continue until your blood count recovers.
How to Detect Mouth Problems
Of course, despite the measures you are taking to prevent your mouth becoming sore, some people will inevitably develop problems. Each day it is a good idea to look at the whole of your mouth including the lips and the tongue. You can do this in the mirror or ask another person at home or in hospital to have a look.
If you see or experience any of the following problems at home, you or your parent must telephone your local children's unit for advice.
- Sores or raw areas in the mouth
- White spots or patches in the mouth
- Pain in the mouth or throat
- Unusual bleeding in the mouth.
If you do have any of these symptoms, you MAY have to be admitted to hospital to treat and manage the symptoms. A telephone call earlier rather than later may prevent an admission to hospital if the mouth problems are not too bad.
Treating Mouth Problems
If you develop a mouth problem after chemotherapy treatment, you may need to change how you do your mouthcare. If you were not using them already, you will need to start using an antibacterial and anti-fungal mouthwash such as Corsodyl (chlorhexidine) or Nystatin.
If you are already using mouthwashes and develop a mouth problem, you may need to be given different medication to try to treat your mouth problem. You may experience pain and feel unable to eat the food you normally like.
If your mouth is very sore or you have an infection you may need to be admitted to hospital. You may need antibiotics or antiviral drugs to control the infection. The Doctors and Nurses may suggest that you take painkillers either by mouth or intravenously. In some cases, painkillers by mouth are enough to control the pain and food can be taken in the normal way. If you are unable to eat or drink because your mouth is too sore you may need some help with your nutrition in the form of an intravenous drip known as Total Parental Nutrition or TPN. This will be for as long as it takes for your mouth to improve, usually when your blood count returns.
If you have experienced mouth problems with your earlier chemotherapy treatments, it does not mean you will experience a sore mouth with every course of chemotherapy. Specific treatments for your mouth will usually be continued during the whole time that you are having chemotherapy if you have had a problem. This will help to prevent problems in the future.
Some patients with sore mouths have said that they find fizzy drinks like Lucozade are easier to drink. Fizzy drinks can dissolve the enamel on your teeth, especially when they are sipped over a long period of time. This is because of the bubbling and the slight acidity of the drink. Try not to drink fizzy drinks for too long a period to help protect your teeth.
