Managing Mouth Sores (Oral Mucositis) During Chemo: 15 Practical Tips for Prevention and Relief

Oral mucositis—painful ulceration of the mouth and throat—affects ~40% of chemotherapy patients and up to 80% with head/neck radiation. Proactive care reduces severity and complications.

Prevention & Daily Care

1. Baseline Dental Exam: Treat cavities, gum disease, ill-fitting dentures before treatment starts.
2. Meticulous Oral Hygiene: Soft toothbrush, fluoride toothpaste, gentle flossing 2×/day; alcohol-free mouthwash (saline/baking soda rinses q4–6h).
3. Cryotherapy: Suck ice chips 30 min before, during, and after 5-FU, melphalan, or high-dose chemo infusions—vasoconstriction reduces mucosal exposure.
4. Hydration: 2–3 L/day water; avoid alcohol, caffeine, acidic/sugary drinks.
5. Diet Modification: Soft, bland, lukewarm/cool foods (yogurt, smoothies, mashed potatoes, soups). Avoid spicy, acidic, rough, hot, or carbonated.

Symptom Relief

6. Topical Anesthetics: Viscous lidocaine 2% swish/spit or gel before meals.
7. Coating Agents: Sucralfate slurry, GelClair®, MuGard® form protective film.
8. "Magic Mouthwash": Compounded: typically lidocaine + diphenhydramine + antacid (Maalox) ± nystatin ± corticosteroid. Rx only.
9. Systemic Analgesics: Acetaminophen → NSAIDs (if platelets OK) → opioids for severe pain.
10. Antifungals: Nystatin swish/swallow or fluconazole if candidiasis suspected.
11. Palifermin (Kepivance): IV keratinocyte growth factor for high-dose melphalan transplant—reduces severe mucositis.

Lifestyle & Environment

12. Humidifier: Bedroom moisture prevents overnight drying.
13. Tobacco/Alcohol Cessation: Both delay healing.
14. Stress Management: Cortisol impairs mucosal repair.
15. Nutritional Support: Oral supplements, feeding tube if intake inadequate >5–7 days.

When to Call Your Team

Inability to swallow liquids, uncontrolled pain, fever >100.4°F, white plaques (thrush), bleeding. Early intervention prevents hospitalization.