Caring of mouth sores (mucositis / stomatitis)

Author:  Maria Yiallouros, Editor:  Dr. med. habil. Gesche Tallen, Reviewer:  Prof. Dr. med. Dr. h.c. Günter Henze, English Translation:  Hannah McRae, Last modification: 2020/05/15

Some chemotherapy medicines and radiotherapy are not only damaging cancer, but also other, healthy cells that divide often and fast, such as the cells in the digestive tract (mouth, pharynx, esophagus, stomach, and intestines), thereby causing mouth sores. The inside of the mouth and other parts of the digestive tract can get red and have painful sores. The child may therefore have difficulty swallowing, dry mouth, and changes in taste for certain foods. Sometimes, there may also be some small, raised white plaques that can be indicative of a fungal infection.

If the stomach and intestines are affected, the patient may experience nausea, pain, vomiting and/or diarrhea. In a healthy organism, the multiple bacteria living in our mouth and intestines do not cause any harm but help us digest properly. In a child with a suppressed immune system plus broken mucus membranes as in a cancer child with mouth sores, these bacteria can enter the patient's blood stream, travel to other parts of the body and cause serious infections.

Good to know: If mouth sores are a problem and also to reduce the risk of infection, it is important to regularly and carefully rinse the mouth with a mouthwash recommended by the patient's health care provider. Avoid using toothbrushes with hard bristles and ingesting sharp or spicy, heavily seasoned or sour foods, fresh fruits and vegetables to prevent injury or pain.

Severe mouth sores are treated with pain medication as well as either antibiotics or antiviral drugs. If the patient has considerable difficulty swallowing, the food and fluid intake may be reduced. Therefore, it is sometimes necessary to bypass the gastrointestinal tract by applying parenteral nutrition (see nutritional supportive care).

If diarrhea occurs, it may be necessary, depending on the severity/fluid loss, restrict to certain foods with reduced fibercontent such as rice, noodles with broth, cream of wheat, or canned fruit, rather than cereal, grain breads and raw vegetables. Also, the patients should be encouraged to drink plenty of liquids. Sometimes, antibiotics are necessary for successful treatment of diarrhea as well as large volumes of liquids given intravenously to replace severe fluid loss.

Caring of mucositis and stomatitis in patients receiving radiotherapy is similar. However, the effects of radiation such as dry mouth, for example, are generally easier to manage, even if they last longer than those after chemotherapy.