Everything You Need To Know About Radiotherapy And Chemo Mouth Sores

Undergoing cancer treatment, whether radiation therapy to the mouth or neck or chemotherapy, can bring about various side effects, one of which is mouth sores. These painful occurrences, also known as mucositis, can make everyday activities such as eating and talking challenging. However, understanding what mouth sores are and how to manage them can help you stay more in control and alleviate discomfort during your cancer treatment journey.

Mouth Sores or Mucositis: Understanding the Basics

Mouth sores, or mucositis, refer to the inflammation and ulceration of the mucous membranes in the mouth. Appearing as small cuts, ulcers, or swelling, these sores can affect the mouth and throat, making daily activities painful and difficult. If not managed properly, severe mucositis can even necessitate a pause in cancer treatment.

What Causes Mouth Sores?

Several factors related to cancer treatment can lead to the development of mouth sores. Knowing the cancer treatment that will cause mouth sores will help your healthcare team manage it well.

Below are the leading causes of cancer-related mouth sores:

• Chemotherapy medicines
• Radiation therapy to the head and neck area
• Bone marrow transplant and stem cell transplant
• Bad mouth care
• Targeted therapy
• Immunotherapy

How Long Do Mouth Sores Last?

The duration of mouth sores can vary significantly depending on the type of treatment being received. After chemotherapy, mouth sores generally appear within a few days following treatment. These sores may persist for up to a few weeks before beginning to heal. The severity and longevity of the sores can be influenced by the specific drugs used in the chemotherapy regimen, the dosage, and the individual’s overall health.

In the case of radiation therapy, particularly when the treatment is concentrated on the head and neck areas, the healing process for mouth sores can take longer. It is not uncommon for these sores to take six to eight weeks to heal fully. This extended healing period is due to the cumulative nature of radiation, which can cause ongoing irritation and damage to the sensitive tissues in the mouth over the course of treatment.

Understanding the timeline for the development and healing of mouth sores is essential for both patients and caregivers. It helps in managing expectations, preparing for the challenges that may arise during treatment, and implementing appropriate care strategies to alleviate discomfort and promote healing. Regular communication with healthcare providers is crucial during this time to ensure that the symptoms are managed effectively and to prevent complications such as infections, which can arise due to the presence of open sores in the mouth.

How Can Cancer Treatment Affect Your Mouth?

The different cancer treatments, sometimes harm the normal cells in your mouth in the process of killing the cancer cells. Some of these treatments can disturb the activities of the good bacteria in your mouth and expose you to different infections, which can cause mucositis or sore mouth.

This can lead to issues with your teeth, gums and even the gland in your mouth that produces saliva. The effects of cancer treatment or drugs depend on the individual and the amount used.  

You can’t predict what will happen but can prepare for whatever develops. You may experience dry mouth, bleeding gum, tooth pain, or taste changes. 

What Do Chemo/Radiation Therapy Sores Look Like?

The sores can vary in appearance and severity but commonly present in the following ways:

1. Red, Inflamed Areas: The inside of the mouth may become red and inflamed, particularly in the areas that have been exposed to radiation. This inflammation can cause the mouth to feel sore and sensitive.
2. Ulcers: Open sores or ulcers may develop, similar to those caused by chemotherapy. These can appear on the tongue, the inside of the cheeks, the gums, or the lips. They often have a white or yellow center with a red border.
3. White or Yellowish Patches: Similar to chemotherapy-induced sores, you might see white or yellowish patches on the mucous membranes inside the mouth. These patches can be painful and may make it difficult to eat, drink, or speak.
4. Dry, Cracked Skin: The radiation can cause dryness in the mouth, leading to cracks and sores on the lips and in the mouth. This can make it painful to open the mouth or eat.
5. Bleeding Sores: In more severe cases, the sores may bleed, particularly if the skin or mucous membrane has cracked or peeled.

Additional Symptoms:

• Difficulty Swallowing: The inflammation and sores may make swallowing difficult or painful.
• Increased Risk of Infection: Like with chemotherapy, these open sores can become infected, which may require additional treatment.

What Can I Do To Prevent Mouth Sores?

Managing and preventing mouth sores during cancer treatment requires a proactive approach that begins before treatment and continues throughout the process.

Before Treatment: Dental Care

• Consult a Dentist: Visiting a dentist who specializes in caring for cancer patients is crucial. They can assess your oral health and address any issues before treatment begins.
• Complete Dental Work: Ensure all necessary dental work is completed well before starting cancer treatment to allow for healing.

During Treatment: Oral Care Routine

• Keep Your Mouth Clean: Brush gently using a soft toothbrush after meals and before bedtime.
• Monitor Your Mouth: Regularly check for any signs of sores and report them to your healthcare provider immediately.
• Hydrate Often: Keep your mouth moist by drinking water regularly and using ice chips.
• Use Mild Oral Care Products: Avoid mouthwashes containing alcohol. Opt for gentle, non-irritating products.

Develop the habit of regularly rinsing your mouth with this solution

This mixture includes: EITHER

• 1 teaspoon of baking soda
• 2 cups of water

OR

• 1 teaspoon of salt
• 1 teaspoon of baking soda
• 1 quart of water

Stir the solution very well, then gently swish it in your mouth before spitting it out.

How To Care For Your Mouth During Treatment

Do the following during treatments:

• Keep your mouth clean at all times: you can do this by gently and regularly brushing your teeth, gum, and tongue with a soft toothbrush after eating and before bed.
• Pay attention to your month: inform your doctor immediately if you notice an ulcer, pain or sensitivity to cold or hot things.
• Continue to use the above solution: use the salt and baking soda solution several times daily to keep your mouth moist. You may even ask your health care doctor to recommend a suitable mouthwash that is not alcohol based
• Eat right: eat foods like fresh fruit and veggies; they can help prevent and fight infections during treatment. To reduce painful mouth sores, take more warm water and food. Avoid extremely cold foods and acidic foods. Consider eating room-temperature foods instead of hot food that can hurt your tender mouth during chemo.
• Use ice chips or water: to reduce the pain from mouth sore due to chemo, always have ice chips or cold water in your mouth to stay hydrated
• Floss gently: when you floss daily, it helps to reduce bacteria buildup in your mouth, increasing your risk of infection.
• Avoid the use of dentures: if you wear dentures before treatment, reduce the number of times you wear them. Please don't wear it during meals and at night.
• Rinse your mouth a few times daily: do not use mouthwash containing alcohol. Mix a small salty solution into your mouth, or rinse with cold water.
• Protect your lips: consider using mild lip balm to keep your lips moist at all times.
• Keep your mouth moist: this you can achieve if you drink plenty of water daily. Get yourself a fancy and handy water bottle to remind you to drink. You can even suck and chew on sugar-free candies and gums.

Do Anti-Inflammatories Help With Chemo Mouth Sores?

According to the American Cancer Society, the anti-inflammatory medication Benzydamine can be used to treat mouth soreness in people who did radiotherapy to the mouth and throat . Morphine rinses may also be used to ease mouth sores. Dexamethasone is used in mouthwashes for cleansing and irritation.

Treatment Of Mouth Sores And Pain

Dental check-ups before and during treatment, especially before head and neck radiation or chemotherapy will help stop and relieve sores.

Dentists can guide you on a good dental health plan and treat dental problems and cavities before cancer treatment. This can go a long way in helping you deal with mouth sores during treatment. Below are other things that can help:

Low-level laser therapy

Researchers show low lasers (LLLTs) help treat sore throats resulting from stem cell transplantation.

Cryotherapy

When cryotherapy is used, the patient sucks on ice chips before, during, and after short infusions of certain chemotherapy treatments. Some studies have shown this to help prevent mouth sores by decreasing tissue blood flow and limiting high chemical exposure from treatment.

Medication

Some vitamins can help with rashes or mouth sores, but you should consult with a medical professional before consuming any. Treatment options available to relieve mouth sores include the:

• Painkillers, which may relieve discomfort and pain but do not help treat mouth ulcers.
• Steroids or non-steroidal anti-inflammatory drugs can help with both healing and discomfort.
• Palifermin helps oral tissue to grow fast, it has been used in some patients receiving radiation therapy to the head and neck, and in some receiving high-dose chemotherapy or stem cell transplants.

Final Thoughts

Don't suffer from chemo-sore mouth on your own, talk to your Doctor, nurse or health care team who can help you deal well with mouth sores. Follow the tips in this article.

You can also share with us your experiences and other tips that can help with cancer mouth sores

Oluwatoyin Joy Oke

Oluwatoyin Joy Oke finished her 4 years course/ program in 2018 as a public health practitioner in Osun State University, Nigeria. And has developed in skills involving prevention, treatment and care of diseases.

She works as a Linkage Coordinator connecting people from the community to treatment and care of Tuberculosis and HIV. She recently picked up another skill in writing which she so far enjoy.

She volunteers in creating awareness for people on topics relating to Cancer, mostly the ones common to women (Cervical and breast cancer), mental health, and HIV. In past years she has received certificates of appreciation from different organizations.

Her hobbies are cooking, watching movies, and writing. She places her worship of God as first in her life and giving of herself to her family and others is a priority.