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Mouth Care

Introduction
What is good mouth care?
What should I eat and drink?
How do I care for my mouth?
Thick Mucous and Saliva
Sore Mouth and Swallowing Problems
Dry Mouth
Taste Changes
Dry Lips and Cold Sores

Introduction
The mouth is a very sensitive part of the body. It contains millions of nerve endings and specialized cells that can easily become hurt by radiation, chemotherapy and some types of medicine. The symptoms you may get include:

• Dry mouth and lips;
• Sores in your mouth;
• Cold sores;
• Thick mucous.

Although these problems are not pleasant, they are common and can be treated. Please tell a member of your healthcare team about any mouth problems, even if you feel better at your next visit.

It is important to know that taking good care of your mouth during your cancer treatment can make these symptoms less severe. It is a good idea to see your dentist before starting treatment. Eating well and drinking plenty of fluids can also help you maintain good mouth care and help you heal faster.

What is good mouth care?
Caring for your mouth means keeping your teeth, gums and mouth clean. This is done by brushing your teeth, flossing and frequent rinsing. People who have dentures should also take special care when they are having cancer treatment. The sooner you are able to start good mouth care, the better.

Overall, alcoholic drinks and tobacco should be avoided. These can worsen symptoms.

Brushing teeth

• Brush your teeth and gums after each meal and before bed. Floss after cleaning teeth.
• Brush your tongue.
• If your toothpaste bothers you, use toothpaste for sensitive teeth like Biotène® or Sensodyne®.
• Use a soft toothbrush or a foam toothette to prevent sore gums and bleeding.
• Use warm water to soften the toothbrush bristles.

Flossing
Continue to floss, but do it with care to avoid hurting your gums.

Rinsing

Rinsing helps your mouth make saliva. Saliva protects your gums and removes food from between your teeth, which can cause an infection if there is damage in your mouth

.

• Use the guidelines below when rinsing your mouth.
  Rinse your mouth out often or every 1 to 2 hours, if possible. If you cannot rinse this often, rinse your mouth right after you eat or at least 4 times a day. Use salt water, baking soda and water, or club soda to rinse your mouth. Many patients find that club soda tastes the best.
• Avoid store bought mouth washes. Most contain alcohol which can dry out your mouth and cause pain. Follow the chart below to make your own mouth rinse.

Caring for dentures

• Brush and rinse your dentures after eating.
• Have loose dentures adjusted.
• Remove your dentures if you develop mouth sores.
• Remove your dentures at night when sleeping.

What should I eat and drink?
These guidelines are for mild to moderate symptoms.

How do I care for my mouth when symptoms start?
Listed in this section are some common symptoms that may happen during your cancer treatment. Most symptoms start about 5 to 7 days after you begin your treatment. They may also go on for a few weeks after your treatment ends. It is best to start good mouth care before symptoms begin.

If the symptom you have is not listed or you need more information, talk to a member of your health care team at your next visit. You may also talk to a Dietitian by calling Supportive Care, London Regional Cancer Program (LRCP) at 519-685-8622. You do not need a referral.

Thick Mucous and Saliva
Thick mucous and sticky saliva may be caused by radiation therapy to the head and neck area. If the mucous builds up, it can even make you feel sick.

Rinsing your mouth out many times (every 1 to 2 hours) with salt water, baking soda and water, or club soda is the best way to treat this symptom. Many people find that chewing gum is also helpful to reduce thick mucous and saliva. Make sure you are drinking enough fluids. Most adults need 8 to 10 cups a day (1 cup = 8 ounces or 250 mL).

Sore Mouth and Swallowing Problems
The lining in your mouth is very sensitive to cancer treatments. Healing the lining in your mouth will be faster if you eat well, drink plenty of fluids and rinse your mouth out often. It is okay to sometimes use over-the-counter pain medicine (e.g., Ibuprofen, Acetaminophen). If you need stronger or ongoing pain medicine, please contact a member of your health care team.

Besides choosing foods listed above, the hints below may help you deal with a sore mouth and swallowing problems. Follow the guide to good mouth care and rinse your mouth out every 1 to 2 hours, if possible.

• Cook foods until they are soft and tender.
• Use extra margarine, sauces or broth on your food to add moisture and extra calories.
• Blend your foods. Ask the LRCP Dietitian for recipes.
• Mix canned, flaked meat or fish with mayonnaise, cream soups, or sauces.
• Add commercial infant foods to soups and casseroles.
• Use an artificial saliva (e.g., Moi-Stir®) that is available at most pharmacies. Salagen® is a medicine that may be helpful but you will need a prescription from your doctor.

Dry Mouth
The mouth becomes dry when it cannot make enough saliva. This can be caused by surgery, radiation therapy, chemotherapy and certain drugs. The symptoms of dry mouth include dry cracking lips and dry tongue.

Dry mouth makes chewing food and swallowing more difficult. At times it is painful and can increase the risk of infection and cavities. Good mouth care is important.

Besides choosing foods listed above, the hints below may help you manage dry mouth.

• Follow the guide to good mouth care and rinse your mouth out every 1 to 2 hours, if possible.
• Take small bites and chew your food well to increase the amount of saliva.
• Take a small sip of liquid, like a soup or water, to help swallow dry foods.
• Dunk or soak dry foods in liquids, like gravy or soup.
• Suck on hard candies, mints or chew gum to help make saliva. Try using sugarless products to help prevent cavities.
• Suck on ice chips or popsicles to help wet your mouth.
• Use an artificial saliva (e.g., Moi-Stir®) that is available at most pharmacies. Salagen® is a medicine that may also be helpful but you will need a prescription from your doctor.
• Use a room vaporizer, especially at night, to help relieve a dry mouth.

Taste Changes
Taste changes may happen with chemotherapy or radiation therapy. They can also happen because of the cancer itself. Some people’s sense of taste will dull, while others will find flavours much stronger. You may even develop a dislike for some foods. It is important to try foods more than once. Sometimes, what tasted bad the week before, may taste good today. For most people, changes in taste do not last a long time.

Besides choosing foods listed above, the hints below may help you manage taste changes.

• Follow the guide to good mouth care and rinse your mouth out every 1 to 2 hours, if possible.
• Use plastic forks, knives and spoons if foods taste like metal.
• Test foods at different temperatures. If something does not taste or smell good when it is hot, it may have a different flavour when it is cold or at room temperature.
• Try different cooking methods, such as barbecuing instead of deep frying.
• Try different forms of foods, like fresh, frozen or canned.
• Flavour meats by cooking them with fruit juices, soya sauce, barbecue sauce, sweet and sour sauce, wine, or salad dressings.
• Use spices, herbs, ketchup, gravy, sauces, mayonnaise to improve flavours or to cover a bad taste.
• Add sugar to foods that taste too sour.
• Add a little salt to flavours that taste too sweet.
• Suck on sugar-free candies to cover a bad taste in your mouth.

Dry lips and Cold Sores
Besides choosing foods listed above, the hints below may help you manage dry lips and cold sores.

• Follow the guide to good mouth care and rinse your mouth out every 1 to 2 hours, if possible.
• Wash your hands often and keep them away from your mouth.
• Drink plenty of fluids.
• Limit stress and sunlight if you have cold sores.
• Use a store bought lip balm or water-based lubricant. Avoid products with menthol or petroleum jelly (e.g., Vasoline®).