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Palliative cancer care - oral problems - Management
How should I treat someone with mucositis?

  • Self care of the mouth before, during, and after treatment with chemotherapy or radiotherapy reduces the severity of mucositis and helps prevent secondary infection.
  • Seek urgent specialist advice if mucositis is severe.
  • Seek urgent specialist advice if spontaneous gingival bleeding occurs.
  • Prevention of secondary infection, oral hygiene, and supportive therapy are very important.
  • Use ice chips to soothe the affected area.
  • Treat any infection (such as candida infection).
  • Avoid spicy and acidic foods (including pineapple chunks and fruit-flavoured ice cubes), sweets, alcohol, tobacco, and hot or fizzy drinks. Advise consumption of soft foods with a low salt content.
  • Ensure frequent oral care and use of sterile saline mouth rinsing.
  • Avoid acidic mouthwashes.
  • Morphine may be required for pain.
Clarification / Additional information
  • Many non-prescription oral preparations are acidic (e.g. Listerine®, hydrogen peroxide, Plax®, glycerine and lemon swabs, lemon/raspberry mousselage, Glandosane® aerosol spray) and should not be used, as they are likely to increase oral discomfort.
  • Seek specialist advice if mucositis is severe, as it may limit the person's ability to tolerate chemotherapy or radiotherapy.
  • With severe mucositis, hourly sterile saline mouth rinsing may be needed [Kinley, Personal Communication, 2007].
Basis for recommendation
  • The basis for this recommendation is expert opinion [Doyle et al, 2004] and national guidance [Royal College of Surgeons of England, 2004].
  • Some weak evidence from a Cochrane review indicates that allopurinol mouthwash, immunoglobulin, and placental extract may be beneficial in improving or curing mucositis. The current evidence does not justify the use of any of these measures.
  • There is no specific treatment for oral mucositis, although many strategies have been tried [Kostler et al, 2001].
  • Mucositis occurs about 5 to 7 days after chemotherapy, often a few days before the person's haematological lowest point is reached. The mucosal disruption therefore provides a portal of entry for micro-organisms at the time of maximal myelosuppression [Doyle et al, 2004].
  • Spontaneous gingival bleeding is likely to occur when the platelet count falls below 10 x 109 cells/L (10,000 cells/mm3) [Doyle et al, 2004].
  • Mucositis due to radiotherapy is self-limited and heals within 2 to 3 weeks of the end of radiation treatment [Doyle et al, 2004].

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