Mucositis: Symptoms and Coping Methods

Mucositis is a common side effect of chemotherapy. According to Cancer Supportive Care Programs, this side effect occurs in approximately 20 to 40 percent of patients that are treated with chemotherapy. It also occurs in approximately 50 percent of cancer patients who undergo both chemotherapy and radiation. Mucositis is the result of the chemotherapy treatment causing a low white blood cell count in the immune system. If radiation is used in conjunction with chemotherapy, it causes the cells in the mucosal linings to die off leaving the linings exposed.

There are several consequences that may occur due to the development of mucositis. These include:

  • Hypovolemia or a decrease in blood volume
  • Electrolyte abnormalities
  • Malnutrition

These consequences have the potential to be fatal if the patient is not treated and depending on the severity of the condition.

Chemotherapy often causes nausea and vomiting. This complicates the situation because the mucous linings in the mouth are particularly sensitive and prone to infection and ulceration with mucositis. Vomiting can cause the lining of the mouth and the digestive tract to become irritated. Because cells are damaged in these mucous linings, they are unable to heal properly and vomiting can cause complications in the mucous lining of the mouth. Research also suggests that patients with head and neck cancer tend to be more prone to severe mucositis because the treatment is targeting these sensitive mucous linings and severe damage may be caused to those cells.

Another consequence of this condition is taste loss. The amount of taste that is lost increases in proportion to the strength and aggressiveness of the chemotherapy treatment that the patient is receiving. Because the mouth is already sore, eating is already difficult. It is even more difficult for those patients who are unable to taste their food. If a patient is unable to eat, they begin to lose weight, muscle mass and strength. They are also unable to have a strong immune system due to the lack of energy the body is receiving. Adequate nutrition during cancer treatment is very important and can be difficult without side effects such as mucositis because the chemotherapy treatment already has a side effect of appetite loss on its own. Mucositis only adds to the severity of this side effect.

Coping with Taste Loss and Taste Aversion

Taste loss and taste perception is common in those people who are receiving cancer treatments that target the head and neck area. This condition is temporary and occurs due to the effect that the treatment has on the taste buds of the tongue. Many patients complain that their food tastes too bitter, sweet or even metallic. This makes it hard for patients to eat. Time and healing often solves the problem, however patients must learn to cope with these side effects during their treatment. Doctors suggest that patients avoid eating their favorite foods the day that they receive chemotherapy so that they do not develop a taste aversion that may cause them not to be able to eat those foods again.

If foods taste too bitter, you may try adding sweet fruits to the meal, adding honey or a sweetener, eating meat cold or at room temperature or marinating foods to add to their flavor. Patients can also eat bland chicken or fish, mild cheeses, eggs or tofu instead of red meat. These foods often taste better when they are prepared in a casserole style and mixed with other flavors. At the same time, be sure to brush your teeth regularly and use a mouth rinse. Patients may also mix salt with water or use hydrogen peroxide to upset the bacteria living in the mouth that may be causing foods to taste bitter.

If foods taste too sweet, patients can use a product called Gymnema Sylvestra. This is an herbal tea that deadens the taste buds to sweets for about 20 minutes. This product should be held in the mouth for about 5 minutes prior to eating a meal. Adding items such as wine, beer, mayonnaise, and sour cream to soups or sauces also helps to disguise the taste of foods that may taste badly. Breads, potatoes, rice and plain pasta should also not have a sweet taste and be easy to eat. Do not add butter or fats to these starches as it will cause these foods to taste sweet. Eat bland foods, as they are likely to taste normal instead of sweet.

Other tips for coping with taste abnormalities include eating in a relaxed and pleasant area. This can help you relax and may reduce taste issues. Flavorings and seasonings may also help disguise odd tasting goods. Remember that citrus and acidic foods tend to stimulate taste buds and can help you to overcome these taste problems. However, the acid may irritate some patient’s mouths and you don’t want to aggravate this problem. If you are having problems eating properly, be sure that you are receiving adequate protein and take supplements if necessary to ensure you are receiving proper nutrition.

A sore mouth can often be healed quickly if the patient is able to eat properly and receive proper nutrition. When the body does not receive nutrients the body is unable to recover as quickly. This is also important because anorexia is also a common side effect of chemotherapy and nutrition is important in fending off this condition as well. Of course, mucositis makes it very difficult to eat and may contribute to weight loss. Treatment of ulceration of the mouth is largely supportive. It is important that you tell your doctor about the extent of your mucositis because you want to ensure that you receive the proper treatment for this condition. The severity of it may be mild to severe and if left untreated it may become very serious. It takes approximately 7 to 14 days for the cells of the ulcerated mouth to heal. Ulceration may occur anywhere from three to ten days after chemotherapy.

To deal with a sore, ulcerative mouth patients may use lozenges, anesthetic gels or Chloraseptic spray to numb the mouth and ease the pain. Frequent use of a gentle mouthwash, such as baking soda and water can also ease pain in the mouth. Oral pain relievers such as Advil and Tylenol are also helpful.

Importance of Dental Hygiene

While the mouth is ulcerated it is necessary to take extra care in oral hygiene. Patients need to keep their mouths free of infection. A good oral hygiene program should include dental cleaning, scaling, daily brushing, and careful flossing. Patients should brush three to four times per day with a soft toothbrush. They should take care not to cut the gums with floss. They should also rinse their mouth regularly with salt water or baking soda after chemotherapy. Before the dentist performs any work, patients will want to have their blood counts checked to be sure that the mouth could heal should it become infected.

If brushing is painful for the painful, patients may try softening their toothbrush by soaking it in warm water. Baking soda is also often easier to brush with, as it does not irritate the mouth as much as commercial toothpaste. Biotene toothpaste is also non-irritating can help to control bacteria through natural salivary enzymes. Patients should also avoid commercial mouthwashes. Alternatives to toothbrushes include cotton swabs or Q-tips. Toothetes are also helpful as they are sponge tips containing toothpaste.

Steer Clear of Infections

A patient’s main goal with mucositis is to stay clear of developing infections. The body already has a low white blood cell count due to the treatment they are receiving and healing takes considerably longer than it would in a healthy individual. Many patients often vomit and are nauseous during chemotherapy treatment, which makes it even more difficult for the patient to eat and provide the body with the energy that it needs. The combination of low nutrition and low white blood counts means that the body is hindered in its ability to heal itself. This means that it is imperative for the patient suffering mucositis to avoid any and all infectious contacts.

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