Mouth Soreness and Ulceration
Certain chemotherapy drugs cause either generalised rawness of the mucosal lining of the mouth and throat, or patches of ulceration. Others may cause lip ulceration. The lowered immunity associated with chemotherapy may cause outbreaks of oral herpes simplex eruptions (“cold sores”). Here are some tips for good mouth care during chemotherapy to minimize these problems:
- Suck ice during the infusion of Adriamycin or Epirubicin. This protects the oral mucosal lining from the acute effects of the chemotherapy drug. (It only works for Adriamycin, and not for methotrexate or fluorouracil, two of the other breast cancer chemotherapy drugs that commonly cause mouth problems.)
- Use a sodium bicarbonate mouth-wash regularly. Make this yourself by mixing a teaspoon of sodium bicarbonate in a 250ml of water. Gargle with it at least four times daily.
- Use alkaline toothpaste, like Colgate Bicarbonate and Peroxide, and brush your teeth regularly and carefully.
- Floss your teeth regularly.
- If painful ulcers occur, use Bonjela to sooth the discomfort. Other helpful products include Difflam-C mouthwash (green bottle) or Kenalog in Orabase solution.
- Avoid alcohol-containing mouthwashes and preparations, like Listerine. Biotene mouthwash is good.
- If the symptoms are sufficiently severe to prevent eating or swallowing immediately seek medical advice.
- Outbreaks of cold-sores should be treated promptly with topical Zovirax.
- Have a dental check before you start chemotherapy. Minor work can be done safely during chemotherapy, preferably choosing days when the blood count is likely to be least affected (usually just before, or just after the days on which your chemotherapy is given). Major work, such as extractions or root canal therapy, should be reserved until after you have recovered from your final chemotherapy if possible. Otherwise, ask your dentist to call your oncologist to arrange a suitable schedule. At Westmead Hospital there is a special consultative service in Oral Medicine to which you can be referred for special problems.