Coping with Mouth Pain and Sores

Many cancer treatments, including chemotherapy, radiation, and targeted drug therapies (Sutent®, Nexavar®, etc), can cause mouth problems. Often, the problems are mild, but more severe issues may occur and your treatment may have to be stopped temporarily.

Types of Mouth Problems

  • Redness or soreness anywhere in your mouth
  • Cracks, ulcers, blisters, white patches, or bleeding in your mouth
  • Dry mouth
  • Problems chewing or swallowing
  • Pain in your teeth, gums, tongue or jaw

Mouth problems can make it hard to eat, drink, or speak, and it may change the way things taste. They also increase your risk of getting an infection. There are some things that can be done to prevent mouth sores. Some problems will go away in time, others require treatment to heal or lessen the symptoms and pain. It is important to take very good care of your mouth and teeth before and during cancer treatment because some mouth problems will require that your treatment be delayed or even stopped.

Preventing Mouth Problems

Here are some suggestions to help you prevent mouth pain and sores.

  • If possible, have a dental checkup before starting treatment. Tooth decay, cavities, and other dental problems can increase your risk of infection.
  • Keep your mouth moist and drink lots of water: 8 – 12 cups every day. Artificial saliva products are available if necessary.
  • Keep your mouth clean – brush your teeth, gums and tongue using a very soft toothbrush moistened with warm water. Use toothpaste that contains fluoride. If you use a water pick, use the weakest setting.
  • Floss daily, but if you have areas of bleeding or sores, avoid these areas until they heal.
  • Use an alcohol-free mouthwash because alcohol can cause mouth dryness and worsen irritation. Biotene® is one example of a mouthwash that you can buy without a prescription. Special toothpastes are also available (Biotene® or one that is baking soda-based). Check the labels to make sure your mouth products do not contain any type of alcohol. If you are not sure if a product contains alcohol, check with your pharmacist.

For People Who Wear Dentures or Removable Appliances

  • Make sure you clean them properly every day.
  • Do not wear your dentures while you sleep at night.
  • Weight gain or loss can cause dentures to lose their “fit”. Should this happen to you, have your dentist adjust your dentures to avoid injuring the tissues in your mouth.

What You Can Do

  • Brush your teeth even if your mouth is sore. If a toothbrush causes too much discomfort, you can use an oral swab, which is similar to a Q-tip®, but has a sponge on the end instead of cotton.
  • Eat soft foods. Avoid hard, crunchy and chewy foods.
  • Soften foods in a blender with some form of liquid such as gravy, juices, milk or water, and drink them from a cup or through a straw.
  • Ice chips may help with mouth pain and/or swelling.
  • To lessen mouth pain, gargle with a 1/8 teaspoon of salt and 1⁄4 teaspoon of baking soda mixed with 8 ounces of warm water. Swish it around in your mouth for a few minutes and then spit it out.
  • To prevent aggravating any existing mouth problems, avoid all tobacco products (smoked or chewed), lemon and glycerin swabs, all products containing alcohol, citrus fruits, condiments or foods with vinegar, and spicy, hot or acidic foods and drinks. Cola, teas, and coffee are all acidic.
  • Take over-the-counter medications for mouth discomfort. You may take one or two 500mg acetaminophen tablets every 6 hours as needed OR you may take one or two 200mg
    ibuprofen tablets every 8 hours, as needed. Always check with your doctor before you take either of these medications because they can mask a fever, which is a sign of infection, or
    affect your liver or kidney function.

Prescription Medications

Pain Relievers
Your health care provider will discuss the options that are available for you if prescription medication is necessary.

Mouth Rinses

  • Nystatin as an anti-fungal rinse, or clotrimazole, a lozenge, may be prescribed to reduce your risk of getting an infection from mouth sores. In more severe cases, you may be prescribed an antibiotic that you can take by mouth.
  • BMX suspension is a specially-made compound in the pharmacy that combines Benadryl®, lidocaine, and Maalox® and can be used to reduce pain and irritation.
  • Gelclair® is a prescription mouth gel that is designed and approved for the management and relief of pain caused by mouth sores. It works by forming a barrier that protects the nerve endings that cause pain. You can eat, drink, and take medications while using Gelclair®. Avoid drinking or eating anything within one hour of Gelclair® treatment.

Important Points to Remember

  • Mouth sores are a common problem when you are receiving cancer treatments.
  • There are treatments available to reduce your risk of having problems, and to reduce pain and discomfort if you do get sores.
  • If your mouth problems are severe, you may have to delay or discontinue your treatment.

When to Call Your Doctor

  • If your pain is moderate to severe, if you cannot eat or drink, or if your quality of life is significantly affected.
  • If you develop open mouth sores. Do NOT ignore the early signs such as pain, redness, tenderness in and around the mouth. Open sores increase your risk of getting an infection.
  • If you get a temperature of 100.5°F or higher.