Managing Mouth Ulcers after Chemotherapy and Tips:

Managing mouth Ulcers after Chemotherapy is very important. Chemotherapy drugs damage the oral mucosa, which results in oral ulcers or mouth sores. Ulcers are very painful and affect the patient’s oral intake.

Sometimes so severe that even the patient becomes unable to take a sip of water. Ulcers begin 5-7 days after starting chemotherapy and last for 12-15 days. Also, it gets worse when the patient goes into the neutropenic phase.

Care of a Patient with Mouth Ulcers:

The following are some tips for managing mouth Ulcers after Chemotherapy.

• Avoid spicy and very hot food.
• Use mouthwash regularly, and prefer any mouthwash containing antifungal in it.
• Avoid drinking milk, which can coat the ulcer and delay healing. Avoid cold drinks containing more acids.
• Try to take a liquid diet and juices to maintain good nutrition.
• Can take prescribed painkillers for pain relief if needed.
• Use plum (phat kadi in Hindi) water to rinse your mouth twice or thrice daily. Make 0.5 litres of plum water by putting at least 1/3 teaspoon of plum in ordinary drinking water.
• Avoid mouthwash containing alcohol.
• Try to eat food that is easy to swallow, such as blended food, ice cream, etc.
• Use lip moisturizers to protect lips from cracking due to dryness.
• Applying honey to the mouth 3-4 times a day. Do not use honey with warm water, as it can cause diarrhea.

Prevention of Mucositis :

Some tips and practices are effective in preventing mucositis.

Mucositis is prevented with a therapy called cryotherapy or cold therapy, in which patients’ oral mucosa is kept cold during chemotherapy treatment.

It can be done by offering ice chips or ice cream to the patient. This causes blood vessels in the mouth to be narrowed, causing decreased blood flow to the oral mucosa, resulting in decreased formation of oral sores.

This therapy is not necessary with all chemotherapeutic drugs; it can be done during the infusion of chemotherapeutic drugs, which are highly potent in damaging the oral mucosa. Such drugs are inj mehphalan or chemotherapeutic drug methotrexate.

How do mouth sores affect patient health?

Mouth ulcers have a greater impact on patients’ intake. Patients become unable to eat properly due to ulcers. It directly affects patients’ weight loss.

Secondly, there is a greater risk of dehydration. So, it is recommended that total parental nutrition should be started if the patient is having level 3 and 4 grade mucositis.

Secondly, the pain associated with oral ulcer distrubs pateints comfort level, which further causes alteration in the blood pressure and other vital signs of the patient. Therefore, it is necessary to manage patients’ pain associated with oral ulcers.

What kind of pain killer used for grade 3 and grade IV oral ulcers?

in the form of injections:

Patients with grades three and four need high-potency pain killers, such as opioids. Such medications should be given in a controlled environment with close monitoring for the following complications:

difficulty in breathing:

The main side effect of opioids is respiratory distress, which means that these drugs suppress the breathing centre in the brain, resulting in difficulty breathing and altered oxygen saturation. So, to prevent this complication, it is recommended to start supplemental oxygen at low levels.

Drop in blood pressure:

Another main side effect of opioids in sudden fall in blood pressure. To prevent this complication, healthcare providers should continuously monitor patients’ blood pressure and start intravenous fluids in advance.

urinary retention:

Another main side effect of opiod specially with injected morphine, is urinary retention, due to the side effects such as brain suppression and flaccid urinary bladder muscles resulting in urinary retention. However, this side effect is managed by placing indewling urinary catheter.

What to do to reverse the above side effects induced by opioids?

If a patient on opiod exibit above mentioned symptom, its antidote is administered. And the antidot of opiods is naloxone.

What are the stages or grades of ulcers/mucositis?

Mucositis is graded on the basis of the severity of the oral mucosa involved, and the signs and symptoms patients exhibit, such as being unable to drink liquids or drooling of saliva. The following are the grades of mouth ulcers. They are from grades 1,2,3, and 4.

Grade # 1:

In this stage, the oral mucosa is intact but becomes dry and mildly red. The patient will feel little dryness and a change in taste. However, patients need care in this stage, and the patient needs to keep the oral mucosa neat and clean by rinsing and brushing their teeth. secondly antifungal mouthwash should be used.

Moreover, the patient should clean the oral mucosa after each meal. After having breakfast, lunch, and dinner, one must clean the mouth to rinse the food particles to avoid infections due to food particles remaining in the oral mucosa for a long time.

Grade II:

In this grade, the oral mucosa become more redish and is damaged by forming an ulcer .patinet become more uncomfortable and cannot eat food or fluid in this stage. However, need for mild relief of pain in this stage with a low patent pain killer.

Grade III:

The oral mucosa in this stage is more affected by more ulcers and is more painful. In this grade, the patient is only able to take fluids. Pain management at this stage is necessary.

Grade IV:

This grade is the last grade, which involves the oral mucosa and the esophagus as well. The patient in this case could not swallow the liquids, and his saliva as well.

However, Mucositis is a common complication of chemotherapy. By applying the above-mentioned tips and guidelines, patients’ oral mucosa can be protected, alleviate patient suffering, and keep patients comfortable.

The above tips can be more effective and beneficial if done at the initial time of developing ulcers or before developing ulcers by practicing tips like cryotherapy(chewing ice cubes or ice cream).

Moreover, personal oral hygiene also plays an important role in preventing oral ulcers, so patients should be taught properly regarding the side effects of chemotherapeutic drugs at the time of start of drugs, and also at the time of admission for chemothery cycle.