Mucositis

Also called Oral mucositis, Mouth sores from treatment

The lining of the mouth and gut breaking down during cancer treatment. Painful enough to stop people eating, and largely preventable with mouth care.

What it is

Inflammation and ulceration of the lining of the mouth and digestive tract, caused by chemotherapy and radiotherapy damaging rapidly dividing cells.

It is common, affecting a large proportion of people having chemotherapy and almost everybody having radiotherapy to the head and neck.

It matters more than a sore mouth sounds. Severe mucositis stops people eating and drinking, causes weight loss and dehydration, provides an entry point for serious infection at exactly the time white cells are low, and is a leading reason cancer treatment is delayed or reduced. That last point makes it a treatment outcome issue and not just a comfort one.

It typically starts around five to ten days after chemotherapy and heals as the blood counts recover.

**Basic oral care is the single most effective prevention**: a soft brush used gently after every meal, regular bland mouth rinses, keeping the mouth moist, and a dental check before treatment starts. It is simple, it is evidence-based, and in busy wards and at home it is routinely not done properly.

Pain relief needs to be adequate, including strong analgesia where required. Nobody should be unable to eat because of untreated mouth pain.

Sucking ice chips during certain chemotherapy infusions reduces it significantly and is under-used.

Signs you might notice

A sore, red mouth, becoming increasingly painful.

Ulcers on the tongue, gums, cheeks and lips.

Pain on eating, drinking, swallowing or talking.

Thick saliva, or a dry mouth. See xerostomia.

Bleeding gums.

White patches, which may be oral thrush developing on top.

Further down the gut: diarrhoea, abdominal pain and bleeding.

Urgent, the same day: fever, which in someone on chemotherapy is a medical emergency; inability to drink; signs of dehydration; or bleeding that will not stop. See neutropenia.

Also: white patches or a sudden worsening, which may be a treatable infection.

How it can affect day-to-day life

Eating becomes the central daily struggle: soft, cool, bland food, plenty of fluid, and small frequent amounts. Salty, spicy, acidic, rough and very hot foods all hurt.

Alcohol-containing mouthwashes sting and dry the mouth further, and should be avoided; a simple salt and bicarbonate rinse is better and costs nothing.

Dentures often cannot be worn during a bad episode, which affects eating and appearance.

A dental assessment before cancer treatment prevents a great deal of later trouble and is easy to skip in the rush to start.

For anyone dependent on others for personal care, mouth care needs to be a named task with a frequency, not an assumption. It is one of the most commonly omitted parts of fundamental care.

Pain relief is frequently inadequate. Ask for it to be escalated rather than enduring it.

Supporting someone well

Get a dental check before cancer treatment starts.

Brush gently with a soft or baby toothbrush after every meal and at bedtime, using fluoride toothpaste.

Rinse regularly with a bland mouthwash: a teaspoon of salt or bicarbonate in a glass of warm water. Avoid alcohol-based mouthwashes.

Keep the mouth moist with sips, ice chips and saliva substitutes.

Ask about sucking ice chips during the chemotherapy infusion, where it is appropriate.

Eat soft, cool, bland food, and avoid acidic, spicy, salty and rough textures.

Ask for adequate pain relief, including strong analgesia if needed.

Report fever immediately; it is an emergency during chemotherapy.

Make mouth care a named daily task for anybody who cannot do it themselves.

Where to get help

The chemotherapy helpline or oncology team, urgently for fever or inability to drink.

A dentist before treatment starts, and for advice during it.

A GP or the oncology team for pain relief and for suspected thrush.

Macmillan Cancer Support on 0808 808 00 00.