Good mouth care helps to keep the mouth clean, moist and comfortable. It is especially important to take good care of your mouth while you are receiving treatment:

Chemotherapy affects rapidly dividing normal cells such as those that make up the lining of the mouth and gut. This may result in inflammation and ulceration of the mouth lining causing pain and discomfort; Radiotherapy in or around the area of your mouth can make it dry and sore. Inflammation of the mouth is called mucositis. In these cases or if your white cell count is low after treatment, you will be susceptible to oral infections such as thrush (candida) or cold sores (herpes simplex). Careful attention to mouth care will help reduce the risks of infection and the following instructions are designed to help you keep your mouth clean and comfortable. Oral mucositis  often can be painful, and this in turn can make it difficult to eat and drink.  

Treating and preventing a painful mouth 
Tell your medical team if you develop a sore mouth, particularly if you have any of the following symptoms as these are more often associated with infection:

• red areas
• blisters
• white spots
• coated tongue
• bleeding

Your medical team will often prescribe an anti-fungal lozenge or tablet. If severe they may also reduce your chemotherapy dose at the next cycle. Otherwise the following tips may help:-

• Clean teeth thoroughly but gently after each meal and before going to bed. If the gums are delicate it is better to use a soft toothbrush (baby/infant). 
• Brand name antibacterial mouthwashes such as Corsodyl may be used but are quite strong and may damage the fragile lining of your mouth whilst on treatment. Check with nursing staff for further advice. 
• Saline mouthwashes (5 mls salt: 500 mls tepid water; 1 tsp. salt: one pint tepid water), swill around the mouth for two to three minutes but do not swallow. Useful before meals but it is best not to eat or drink anything for 10 minutes after using the mouthwash, to gain maximum effect from it. May be used frequently during the day, provided they are not swallowed. 
• Soluble Paracetamol mouthwash/gargle.
• Lip salve is also useful to prevent dryness and cracking. 
• An oral gel gelclair is available which forms a protective barrier over the inside of the mouth. 
• Painkilling brand name mouthwashes, e.g. Difflam may be useful but please check with nursing staff before using as some consultants prefer not to prescribe them. 
• In some cases you will be advised to suck ice/ice-lollies immediately prior to and during chemotherapy. This is to reduce damage from certain drugs.  

• Clean teeth thoroughly but gently after each meal and before going to bed. If the gums are delicate it is better to use a soft toothbrush (baby/infant).

• Brand name antibacterial mouthwashes such as Corsodyl may be used but are quite strong and may damage the fragile lining of your mouth whilst on treatment. Check with nursing staff for further advice.

• Suck sugar free sweets (be careful too many cause diarrhoea). Be careful with boiled sweets in case they cut your mouth.
• Spicy, acidic or salty foods can be uncomfortable. 
• A yougurt with a meal is useful lubrication.
• Use plenty of fluids, e.g. gravy, sauces, melted butter or margarine to keep foods moist.
  Aim for small and frequent meals, i.e. take something nourishing every two hours if you cannot manage large meals.
• Have soft foods or cold foods.
• Supplement your diet with Complan or Build Up.
• Use a straw for drinking.
• Avoid tobacco and alcohol.
• Avoid wearing dentures. 

• Mouth breathing e.g. a blocked nose
• Painkillers - opiates, codeine
• Antisickness - hyoscine
• Antidepressants or amtitrypiline
• Problems with the salivary glands - Particularly after radiotherapy to the head and neck area
• After prolonged chemotherapy regimens the production of saliva can temporarily reduce.
• Dehydration from any cause
• High calcium in blood stream (hypercalcaemia)

Tips for a dry mouth

Good mouth care when you have a dry mouth can help to keep the mouth clean, moist and comfortable. It is especially important to take good care of your mouth while you are receiving treatment: Careful attention to mouth care will help reduce the risks of infection and the following instructions are designed to help you keep your mouth clean and comfortable. If a dry mouth becomes inflamed this is called oral mucositis often can be painful, and this in turn can make it difficult to eat and drink.  

• Saline mouthwashes are recommended if tolerable; 5 mls salt: 500 mls tepid water; (1 tsp. salt: one pint tepid water). If you are suffering from a mark dry mouth, this supervising doctor needs to be told, otherwise, the following suggestions may help:

• Have frequent drinks, even just a few sips at a time to keep your mouth moist.  Fizzy drinks may be most refreshing

• Avoid alcohol or smoking
• Try sucking ice cubes/ice lollies (these can be flavoured with cordials, fruit juice or juice based supplements
• Try making home-made lollies or in the freezer using fruit juice and/or supplements
• Moisten food with lots of  gravy or sauces, butter, custard, cream
• Some people report that chocolate and pastry stick to the roof of the mouth-avoid them if they do
• Try sucking sugar free boiled sweets, fruit drops/pastilles, chewing gum or try eating pineapple chunks or grapefruit segments to increase saliva flow
• Artificial saliva preparations are available and can be prescribed by your doctor if   felt appropriate
• Use a mouthwash and brush your teeth regularly
• Keep lips moist with lip balm
• Avoid wearing denture

It may be necessary to change the diet to foods which are soft and moist. Also if there are signs of secondary infection further treatment may be needed.

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.