Have a mouthful of trouble? Mucositis may be the name of your pain. Mucositis refers to the swelling and ulceration in the lining of your mouth and gastrointestinal tract resulting from cancer treatment. This dreaded complication affects almost all patients undergoing high dose chemotherapy and nearly 80% of those receiving radiation to the head and neck. Mucositis causes altered taste perception, significant pain, and difficulty swallowing; and severe mucositis can result in weight loss, infection, and dehydration. If you're suffering symptoms of oral mucositis (also called stomatitis) it's important to maintain oral intake and practice good oral hygiene to avoid potentially life-threatening complications.

RECOGNIZE MUCOSITIS:

Patients on high dose chemotherapy often experience symptoms four to five days after beginning treatment, with symptoms being most severe around day 10. Patients receiving head and neck radiation begin having symptoms near the end of the second treatment week; the pain and inflammation may last up to eight weeks. At the onset, your mouth's lining becomes thin and red and then begins to slough, leaving an inflamed ulcerated surface exposed and prone to infection and bleeding. At this time you may experience intense burning pain and difficulty speaking, eating, or even opening your mouth. Over time the ulcers develop a yellowish-white clot known as the "pseudomembrane" and they typically resolve over a period of a few weeks. During this time, you must take good care of your mouth and choose foods that are easier to tolerate to help you feel better and heal faster.

MEASURES TO LESSEN THE PAIN

Soft or liquid foods will be easier to tolerate.

• Smoothies or milkshakes

• Soft fruits, including bananas, applesauce, and watermelon.
• Canned fruits
• Peach, pear, and apricot nectars.
• Cottage cheese
• Mashed potatoes
• Macaroni and cheese
• Custards, puddings, or yogurt
• Scrambled eggs
• Oatmeal or other cooked cereals
• Warm soup
• Casseroles

Some things go down easier than others

• Take small bites of food and chew it completely.
• Cook your food until soft and tender.
• Cut your food into small pieces.
• Process hard vegetables or meats with a blender until smooth.
• Eat foods cold or at room temperature when possible
• Add gravy, broth, or sauces to make foods easier to swallow.
• Use ice chips or flavored popsicles to numb your mouth
• Use straws to bypass mouth sores when drinking

Reduce your risk of cavities and other mouth infections:

• Schedule a dental visit before, during, and after your treatment for cancer
• Rinse your mouth after every meal and snack
• Brush your teeth three times daily

Avoid food and drink that could be irritating:

• Avoid rough, coarse, or dry foods, including raw vegetables, granola, toast, and crackers.
• Avoid foods that are spicy or salty and avoid foods that are acidic, such as vinegar, pickles, and olives.
• Avoid citrus fruits and juices, including orange, grapefruit, and tangerine.
• No smoking or alcohol!

OTHER OPTIONS:

Your doctor may recommend various mouthwashes that contain numbing agents to ease your pain, including "magic mouthwash" which is a mixture of Lidocaine, Benadryl, and Maalox. Your care team may also prescribe oral suspensions of glutamine, an amino acid involved in cellular repair, which is proven to decrease the severity and duration of mucositis.