Mucositis is a term that describes inflammation of the mucous membranes lining the mouth and throat. It is a common complication of chemotherapy drugs and radiation to the head and neck area. Although mucositis is commonly seen, effective treatment for mucositis has proven difficult.

If you are experiencing mucositis, the following treatments can be considered:

Gentle Mouth Care: Soft bristled toothbrushes, less aggressive brushing, gentle water pik teeth cleaning and soft foods help protect the mucosa.

Avoidance of citrus fruits, alcohol, tobacco: Certain foods that are high in acidity such as citrus fruits may aggravate mucositis.

Alcohol and tobacco products can similarly aggravate mucositis and should be avoided.

Mouth rinses: One of the mainstays of mucositis treatment has been mouth rinses. Mouth rinses are felt to have several benefits including lowering the bacteria count in the mouth, preventing additional infection, and improving healing. Try to use a mouth rinse 5 times a day. A commonly used recipe is: Add 1 tsp of table salt and 1 tsp of baking soda to 1 quart of water. This recipe is cheap and readily available to all.

Water soluble jellies: Over the counter water soluble lubricating agents such as artificial saliva, KY jelly, glycerin, etc can all be utilized for dry mouth and mucositis.

Medications that may help Mucositis:

Antifungal medications: Oral candidiasis, or thrush, is an oral infection where a fungus species (Candida) takes over the normal flora and causes redness and a whitish coating in the mouth. This can occur when patients are on antibiotics, steroids (dexamethasone, prednisone) or have received chemotherapy. Most patients with oral candidiasis respond promptly to treatment with Fluconazole (Diflucan) or a Nystatin solution which they swish and swallow. Because it is sometimes difficult to tell whether or not a patient has thrush, erring on the side of treating may help patients.

Magic Mouthwash: This is a mouthwash that contains viscous lidocaine, a numbing agent that can help pain associated with mucositis. It comes as a mixture of viscous lidocaine, mylanta, and benadryl. Patients can use 1 to 2 teaspoons every 2 hours as needed. Rinse for one minute and then either spit or swallow. It can be swallowed if the throat is sore as well as the mouth. Do not exceed the recommended dosing if swallowed. If symptoms involve only the mouth, spit it out. I typically dispense 240 cc.

Ice Cubes/Cryotherapy: Patients who are receiving chemotherapy can benefit from having ice chips in the mouth at least 20 minutes prior to, during chemotherapy, and for 1 to 2 hours afterward. The ice causes blood vessels to constrict and decreases the exposure of the oral mucosa to chemotherapy. This treatment is most efficacious for patients receiving a chemotherapy drug (especially 5fu) by a rapid intravenous infusion. If you are receiving 5-fu are receiving a slow infusion through a mechanical pump over days to weeks mucositis is less common and using ice is not practical.

Orabase: Colgate has a line of products for over the counter mouth care. These may be of benefit for patients with mucositis. Orabase has a topical numbing agent. A new product Orabase Soothe-n-seal may be of benefit. A link to their website is http://www.colgate.com/app/CP/US/EN/OC/Products/Other-Oral-Care.cvsp

Tetracaine spray: This is a numbing spray that helps with pain associated with mucositis. Patients can use 1 to 2 sprays every 2 hours as needed. It has the convenience of being in a spray bottle that can be easily transported. This medicine can be prescribed and filled at a pharmacy that also does compounding. This is dispensed as a 2% spray, 60 ml.

Antiviral herpes medications: A number of patients can have reactivation of herpes virus (fever blisters) during chemotherapy. These sores begin as blistering painful lesions on the lips and gums that several days later become reddened and crusty. If you have a history of fever blisters and any of your symptoms seem remotely similar, treatment with an oral anti herpes medicine, such as acyclovir, is a consideration. The sooner therapy starts the better.

Pain Medications: For patients with mucositis, pain medications such as Lortab (hydrocodone/tylenol) or Percocet (oxycodone/tylenol) may be required to help with pain. This medicines are administered 1 to 2 tablets every 4 to 6 hours as needed. Patients can also used non steroidal anti inflammatory medications such as tylenol, ibuprofen, alleve, etc. as directed to help with the inflammation associated with mucositis.

Biotene products: This company produces a variety of over the counter mouthwashes, moisturizers, sprays, and toothpastes for patients with mucositis and dry mouth. These are available over the counter at most drug stores. You can see their entire product line at www.biotene.com.

Gelclair: Gelclair is a presciption mouth gel that is designed and approved for the management and relief of pain caused by mouth sores. Gelclair works by forming a barrier that protects nerve endings that cause pain. Gelclair comes in packets. Pour the entire contents of a packet into a glass and add one tablespoon of water (15 cc). Stir and rinse for at least 1 minute to coat the entire mouth. Gargle and spit out. Wait at least one hour before eating and drinking. Patients typically use Gelclair three times a day. A link to their website is www.gelclair.com.

Caphosol: Caphosol is a prescription mouth rinse that helps moisten the mouth and improve symptoms of mucositis. Caphosol lubricates and cleans the mouth to help with pain, swallowing, and speaking. It is a supersaturated mix of calcium and phosphate. It comes in a package of 30 for a one week supply and 120 for a one month supply. Each dose contains a ampule of caphosol A and caphosol B. Mix the contents together immediately prior to use. Swish 1/2 of the solution in the mouth for 1 minute, then spit it out. Repeat with the remaining 1/2 of the solution and spit out. A link to their website is www.caphosol.com.

MuGard: Mugard is a mucoadhesive oral rinse produced by Access Pharmaceuticals designed to form a soothing protective hydrogel coating the mouth. 5 cc (1 teaspoon) of Mugard for one minute, and either swallow or spit. Repeat 4 to 6 times daily. Avoid eating or drinking for one hour after use. It is dispensed in 8 oz bottles. A link to their website is www.mugard.com.

Chlorhexidine Gluconate: This is an oral over the counter germicidal mouthwash that helps with mucositis by decreasing the bacterial count in the mouth. There are a variety of mouthwashes with chlorhexidine available. A commonly used one is called Periogard. Use as directed.

Amifostine (Ethyol): This is an intravenous medication that helps counter free radical damage caused by radiation and chemotherapy. It has come in and out of favor over the past several years. It is given just prior to a radiation treatment and may to lower the risk of dry mouth (xerostomia) and mucositis in patients with head and neck cancer. Conflicting efficacy data, logistical difficulties (radiation centers often are not set up to infuse medicines) and side effects of low blood pressure and nausea have limited its use. Subcutaneous administration lessens hypotension, but not nausea.

Kepivance (Palifermin): This is an intravenous growth factor medication that has helped decrease mucositis in patients with hematologic malignancies (leukemia, e.g.) undergoing stem cell bone marrow transplant. The safety and efficacy in patients with non hematologic malignancies (head and neck cancer, e.g.) has not been established and therefore insurance coverage is poor. Kepivance is given three before chemotherapy and three days after.