Mouth Care for the Leukemia and Lymphoma Patient

Preventing and Coping with Oral Mucositis Mouth Sores

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Treatment for leukemia and lymphoma, such as chemotherapy and radiation therapy, can lead to very painful sores in your mouth or throat. This side effect is called oral mucositis, and while it may be difficult to treat once it occurs, there are steps you can take to help prevent it and decrease the likelihood of developing complications from it.

Chemotherapy and radiation can also decrease your saliva production, leaving your mouth dry and more susceptible to infection.

What Causes Oral Mucositis in Chemo and Radiation Treatment?

Unfortunately, chemotherapy and radiation therapy are unable to tell the difference between blood cancer cells and normal healthy cells.

  • Chemotherapy has a tendency to affect any rapidly dividing cell. Since chemotherapy travels through the body in your bloodstream, this may include the cells that line your mouth and throat, as well as leukemia or lymphoma cells.
  • On the other hand, radiation therapy has an effect on any cells that the energy has contact with. So if you are receiving radiation treatments to your head or neck, your mouth cells may be injured.

What Kind of Complications Can Mucositis Cause?

The most obvious complication is the pain associated with mucositis. It can range from a discomfort or redness in mouth, all the way to open ulcers on the tongue, lips and gums. The discomfort of mucositis can also make you not feel much like eating or drinking. It hurts! But it is important to keep your nutrition up while you are undergoing treatment.

Mouth pain may also make it hard for you to talk and laugh with loved ones. Patients sometimes complain that it makes them feel very lonely and sad when they have difficulty communicating.

Infection of the mouth sores is also a very common complication from mucositis. Our mouths are nice, warm, cozy environments for bacteria, fungi, and viruses. In addition, your disease or chemotherapy may have decreased your body’s ability to keep these bugs at bay. Mouth infections can be very difficult to treat and can lead to infection in the blood if they progress.

How Can I Prevent Mucositis?

A daily mouth care program can minimize the development of mucositis and can help to promote healing when you have it. You should begin a mouth care program before you develop mouth sores or discomfort.

For everyday mouth care during chemotherapy or radiation therapy, you should:

  • Brush your teeth and tongue with a very soft toothbrush four times a day for 2-3 minutes.
  • Use a mild toothpaste. If your toothpaste causes discomfort, stop using it.
  • Rinse your toothbrush under very hot water when you are done using it, and allow it to air dry between uses.
  • Rinse your mouth often throughout the day, and often while brushing. Use club soda, mild saline solution (1 teaspoon salt in 4 cups of water), or baking soda solution (1 teaspoon. baking soda in 1 cup of water). Take one tablespoon of the rinse, and swish it around in your mouth for at least 30 seconds before spitting it out.
  • Avoid harsh mouthwashes, or those that contain alcohol.
  • Floss gently once per day. If your platelets are less than 40,000 or if it causes you discomfort, take a break from flossing for a little while.
  • Use a lip balm several times throughout the day to prevent chapping and cracking.

I wear dentures. Are there any special things for me to do as far as mouth care?

No. Just be sure to remove your dentures for mouth care, and try to leave them out of your mouth overnight and several times throughout the day to give your gums a break and prevent irritation. Just as you would with your natural teeth, keep your dentures very clean to help prevent infection.

I don’t have any sores, but my mouth is so dry! What can I do?

The drying effects of chemotherapy and radiation on the mouth can also be uncomfortable! Try to:

  • Suck on ice or popsicles
  • Stimulate the saliva glands with sugar-free candy or gum
  • Keep your fluid intake and hydration up
  • Moisten dry foods with sauces or broth to make them easier to chew or swallow
  • Eat soft foods

I have open ulcers in my mouth. What do I do now?

Although it may be difficult, continue with as much of your mouth care program as you can. Avoid things that can make your mouth irritation worse. These may include:

  • Hot or spicy foods
  • Citrus fruits or acidic foods like tomatoes
  • Smoking or tobacco products
  • Alcoholic beverages
  • Sugary gum or candies

Speak to your healthcare provider about medications to help lessen the pain of mucositis.

It hurts! What can I eat?

  • Soft, cold foods. Pureed foods such as applesauce are worth a try
  • Low-acid fruits such as melon or bananas
  • Nutritional supplements or sports drinks
  • Sugar-free gum to promote saliva production
  • Plenty of water to stay well-hydrated

When should I contact my healthcare provider?

You should contact your nurse or doctor if you develop any of the following symptoms:

  • Dry mouth
  • Painful mouth
  • Mouth sores or ulcers
  • White patches in your mouth
  • Bleeding gums
  • Fevers

You should also have your dentist speak to your treatment provider, or ask if your cancer center has a dentist on staff that can help if you have any dental work that needs to be done.

While it may be nearly impossible to completely eliminate the risk of developing mouth sores while undergoing treatment for leukemia or lymphoma, there are steps you can take to help minimize the extent of damage and promote healing. Ask your physician or healthcare provider if they have any further recommendations for your particular situation.