A Guide to the management of: Sore Mouth or Throat (Mucositis)

Oxford Centre for Head and Neck Oncology
A Guide to the management of:
Sore Mouth or Throat (Mucositis)
Dry Mouth (Xerostomia)
Oral Thrush (Candida)
Information for patients
This leaflet gives you some suggested remedies to help with your
sore, dry mouth caused by radiotherapy which previous patients
have found helpful. Other products may be available from your
chemist.
Some medications work well for one person and not for
another. It is often a case of trial and error. However, to know
if something works or not, you need to use it as instructed for at
least 3 days. Many of these things can be used together to get
maximum benefit. For example, taking a painkiller and using a
product inside your mouth may help.
Always start with good oral hygiene:
•Brush your teeth at least twice a day with a fluoride toothpaste
and a soft toothbrush
•Use a mild salt-water mouthwash (½ teaspoon of salt in a mug
of water) after meals or supplement drinks.
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Help for a sore or ulcerated mouth
Aspirin gargle / mouthwash
300mg aspirin dissolved in ½ glass of water. Rinse around the
mouth and spit out. Use up to 8 times in 24 hours, half an
hour before meals. Check with your doctor or nurse if you can
swallow it. Aspirin is available on prescription or can be bought
over the counter at a chemist.
Painkillers
A combination of drugs can help. These will normally be
prescribed by your doctor and may include paracetamol,
co-codamol and Voltarol (diclofenac). If you have been
prescribed paracetamol or co-codamol, DO NOT take any other
preparations containing paracetamol. Always take medication
regularly and before eating, drinking or exercises advised by the
Speech and Language Therapist. Check with your healthcare
professional before taking anything other than your prescription.
Painkillers are available on prescription; some can be bought over
the counter at a chemist.
Mucosal protectors
This is a group of medications designed to protect the inside of
your mouth and tongue. You will experience changes in the
lining of your mouth during your treatment. Pain can occur
when nerve endings are exposed, and this is what happens with
inflammation or ulceration. The aim of this group of medications
is to coat the inflamed / ulcerated areas in your mouth. This
stops the nerve endings which cause pain from being exposed,
reducing pain and making the inside of your mouth and tongue
feel more comfortable. All these products are available on
prescription.
•Orabase
This is a paste that is applied to the ulcerated area and
provides a protective coating. Works best on small areas and
can be used as needed.
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•Gelclair
This is an oral rinse, which coats the surface of your mouth
forming a protective layer. It comes in individual 15ml sachets.
Rinse around the mouth for 1 minute. However, you must
not eat or drink for 1 hour after using it to allow it time to
work. Gelclair can reduce pain and make your mouth more
comfortable enabling you to eat and drink and providing relief
for up to 7 hours.
• Caphosol
This is an oral rinse that lubricates and protects the inside
of your mouth during radiotherapy treatment. Rinse 30mls
around the mouth at least 4 times a day.
Help for a dry mouth (xerostomia)
Sip water regularly and carry a small bottle everywhere you go.
Artificial saliva
This is a saliva replacement you can spray into your mouth or
suck as a lozenge, e.g. Glandosane, A.S. Saliva Orthana or
Xerotin. It may have some benefit, but is short acting. Available
on prescription or over the counter at a chemist.
Salivary stimulants
These products are designed to stimulate the production of your
own saliva. For example:
•Sugar-free chewing gum
Chewing gum stimulates the production of your own saliva,
and keeps your mouth feeling clean. Brands that contain
Xylitol help protect your teeth from dental decay.
•Sugar-free sweets
These are OK, but if eaten in large quantities can have a
laxative effect.
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•Saline (salt water) mouthwashes
Saline solution stimulates your own salivary glands to produce
more saliva, as well as also promoting helpful bacteria to help
keep the mouth clean and debris free.
•Biotene / Oralbalance
These products contain a triple enzyme system that helps to
protect the mouth against bacteria whilst also stimulating
the production of saliva. This comes in a set of 3 products,
including a mouthwash, toothpaste and gel. They can be
used together or each one on their own. The gel is particularly
useful when used before bed, as it helps to alleviate dryness
over night.
All 3 products are available on prescription as a “system”
or the gel on its own (toothpaste on its own not available
on prescription). Can also be bought over the counter at a
chemist or ordered from the manufacturer direct, Tel: 01438
743070. There is also a web site, www.biotene.co.uk.
•BioXtra
This is another set of products including a mouthwash,
toothpaste, gel and gum. Use in the same way as Biotene.
Gel is available on prescription; other products over the
counter at a chemist. Or mail order from Toothbrush Direct
Tel: 01273 476471. If any problems contact BioXtra via
e-mail: info@molar.ltd.uk.
• Saliva Stimulating Tablets (SST)
These are tablets that dissolve slowly in the mouth. Probably
more useful after radiotherapy when tissues have healed.
Available on prescription or over the counter at a chemist.
Many patients who have undergone radiotherapy have told
us they found it helpful to combine painkillers with a mucosal
protector and a salivary stimulant during their treatment. If you
are unsure, then please discuss this with your doctor or nurse.
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Other ideas
Sometimes other medication may help – discuss this with your
doctor.
Patients have sometimes commented that acupuncture has
helped a dry mouth.
Avoid alcohol, tobacco, spicy / dry foods, very hot or cold food
and drinks, and salty or acidic foods, such as vinegar, citrus fruits,
citrus drinks or curries.
Thrush (candida)
It is common to get a white coating on the inside of your mouth.
This is caused by a fungal infection known as thrush (candida).
The medical team responsible for your care will be able to
diagnose thrush and prescribe treatment medication. The
medication may be liquid, lozenges or tablets which you must
take as prescribed. There are side-effects to these medications
that can include diarrhoea and sickness. If you experience these
side-effects then please contact your medical team. Thrush can
be painful and may affect your ability to eat and drink.
Prescriptions
From April 2009 anyone with a cancer diagnosis is entitled to
free prescriptions. If you have not yet applied for an exemption
card, please see your GP or see specialist nurse.
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How to contact us / further information
If you have any questions or concerns, or need any further
information, please contact your GP, or telephone:
Head and Neck Cancer Specialist Nurses
Tel: 01865 234346
(Monday-Friday 08.00-16.00)
Radiotherapy Specialist Nurses
Tel: 01865 235473
(Monday-Friday 08.30-16.30)
Oncology Ward
Tel: 01865 235012
(24 hours/day)
You will also be given the specialist nurses leaflet which contains
information on websites etc. that you may find helpful.
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If you need an interpreter or need a document in another
language, large print, Braille or audio version, please call
01865 221473 or email PALSJR@orh.nhs.uk
Compiled by Head & Neck Oncology Team
Version 7, October 2010
Review, October 2013
Oxford Radcliffe Hospitals NHS Trust
Oxford OX3 9DU
www.oxfordradcliffe.nhs.uk/patientinformation
OMI 2364