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Mouth Sores From Chemo Pictures

What Do Mouth Sores Look Like

Chemotherapy: How do I prevent mouth sores? | Norton Cancer Institute

Different conditions can cause mouth sores, according to the Merck Manual.

They may look different depending on the cause. Mouth sores can appear a different color than the surrounding tissue, including white, yellow, red, or purple.

The following images show different types of mouth sores. These images are not intended to provide a diagnosis. If you have unexplained mouth sores or mouth sores that come back or last for a long time, it is best to visit a doctor for a diagnosis and treatment.

How Can I Reduce My Risk Of Developing Mouth Sores

Here are some ways you can try to prevent mouth sores:

  • Visit a dentist before you get treatment to make sure your teeth and gums are healthy.
  • Practice good oral hygiene.
  • Use a soft toothbrush to brush your teeth several times a day. Rinse your toothbrush in hot water and store it in a cool place.
  • Floss every day. Avoid mouthwash that contains alcohol, as it can be drying. There are other mouthwash options that can reduce the risk of developing mouth sores or pain from mouth sores:
  • Ask your care team about whether prescriptionsteroid mouthwash might be helpful for you. A 2017 study in women diagnosed with hormone receptor-positive breast cancer taking exemestane and everolimus showed that when they used a prescription mouthwash containing the steroid dexamethasone, they had fewer and less serious mouth sores. Participants used the mouthwash for 2 minutes, four times a day.
  • Make a homemade mouthwash using either a half teaspoon of table salt or baking soda mixed in 8 ounces of water. Swish and spit before and after meals and before bed.
  • Eat healthy, nutritious food including plenty of fruits and vegetables.
  • Drink plenty of fluids. Try to drink 8-10 glasses of non-alcoholic, non-caffeinated beverages daily.
  • Keep lips moisturized.
  • Talk to your doctor if you have a history of mouth sores. Your doctor may be able to prescribe a medicine to prevent them during treatment.
  • If you smoke, it’s important to try to stop. Talk with your care team about getting help for quitting smoking.
  • What Are The Signs And Symptoms Of Mucositis

    The signs and symptoms of mucositis can vary but can include:

    • Red, shiny, or swollen mouth and gums.
    • Blood in the mouth.
    • Sores in the mouth, including on the gums or tongue.
    • Soreness or pain in the mouth or throat.
    • Trouble swallowing or talking.
    • Feeling of dryness, mild burning, or pain when eating food.
    • Soft, whitish patches or pus in the mouth or on the tongue.
    • Increased mucus or thicker saliva in the mouth.

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    Talking With Your Health Care Team About Mouth And Throat Problems

    Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

    • When might these problems start to occur? How long might they last?
    • What steps can I take to feel better?
    • What medicines can help?
    • What symptoms or problems should I call the doctor about?
    • What pain medicine and/or mouthwashes could help me?
    • Would you recommend a registered dietitian who I could see to learn about good food choices?
    • For people receiving radiation therapy to the head and neck: Should I take supplements such as zinc, to help my sense of taste come back after treatment?

    View Transcript

    What Are Mouth Sores

    Distinguishing oral mucosal injury of mammalian target of rapamycin ...

    Mouth sores are common ailments that affect many people at some point in their lives.

    These sores can appear on any of the soft tissues of your mouth, including the lips, inside of your cheeks, gums, tongue, and floor and roof of your mouth.

    Mouth sores, which include canker sores, are usually a minor irritation and last only 1 or 2 weeks. In some cases, they can indicate an infection from a virus, such as herpes simplex, or more severe causes, such as mouth cancer.

    Sores in your mouth caused by a common or short-lasting condition such as:

    • pemphigus vulgaris

    Keep reading to learn about the causes and symptoms of mouth sores and how to recognize and get rid of them.

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    Measurement Of Oral Mucositis

    A wide variety of scales have been used to record the extent and severity of oral mucositis in clinical practice and research. The World Health Organization scale is a simple, easy to use scale that is suitable for daily use in clinical practice. This scale combines both subjective and objective measures of oral mucositis . The National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 includes separate subjective and objective scales for mucositis 28 . The Oral Mucositis Assessment Scale is an objective scale, suitable for research purposes, that measures erythema and ulceration at nine different sites in the oral cavity. This scale has been validated in a multi-center trial with high inter-observer reproducibility and strong correlation of objective mucositis scores with patient symptoms 29. The Eastern Cooperative Oncology Group common toxicity criteria are also used in oncology trials to document severity of oral mucositis 30.

    When Are Oral Problems Serious

    Mouth problems are more serious if they interfere with eating and drinking because they can lead to dehydration and/or malnutrition. Its important to call your doctor or nurse if you have pain in your mouth, lips, or throat that makes it difficult to eat, drink, or sleep or if you have a fever of 100.5 °F or higher.

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    Treat Infections Your Healthcare Team Will Prescribe Medicines To Treat Infectionsin Your Mouth And Throat It’s Important To Treat These Infections Before Theyenter The Blood And Become Serious

    Fungal infections

    Thrush is a common fungal infection inthe mouth. It often causes white patches or a white coating in the mouth and onthe tongue. Topical antifungal medicines are usually used to treat a mild caseof thrush. These medicines can be given as:

    If you wear dentures, you may be told to soak them overnightin the mouth rinse or to use an antifungal cream on them.

    Treatment for moderate to severe fungal infections may alsoinclude oral antifungal medicines.

    Bacterial infections

    Many different types of bacteria can cause mouth infections.Treatment for bacterial infections may include oral antibiotics.

    Viral infections

    Viruses that can cause mouth infections include herpes simplexvirus, varicella-zoster virus and cytomegalovirus. The herpes virus can causecold sores. A cream containing antiviral medicine may be used to treat thesesores. Treatment for viral infections may also include oral or IV medicines.

    Professional Mouth Sore Treatments

    Let’s Talk Chemo: Coping with side effects- mouth sores

    When you see your doctor for mouth sores, they may prescribe a pain reliever, anti-inflammatory medicine, or steroid gel.

    If your mouth sores are caused by a viral, bacterial, or fungal infection, your doctor may prescribe antivirals, antibiotics, or antifungals respectively to treat the disease.

    Some mouth sores may be treated with a low-powered laser, which provides instant pain relief and often prevents sores from recurring.

    Chemically burning the sore with a tiny stick coated in silver nitrate may alleviate pain in a similar way, although it is not as effective as a laser.

    If mouth cancer is suspected, your doctor will order a biopsy for further examination. If oral cancer is detected, he or she will prepare a treatment plan for you which may include surgery or chemotherapy.

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    Palliation Of Dry Mouth

    Patients undergoing cancer therapy often develop transient or permanent xerostomia and hyposalivation . Hyposalivation can further aggravate inflamed tissues, increase risk for local infection and make mastication difficult. Many patients also complain of a thickening of salivary secretions due a decrease in the serous component of saliva. The following measures can be taken for palliation of a dry mouth:

    • Sip water as needed to alleviate mouth dryness. Several supportive products including artificial saliva are available.
    • Rinse with a solution of 1/2 tsp baking soda in 1 cup warm water several times a day to clean and lubricate the oral tissues and to buffer the oral environment
    • Chew sugarless gum to stimulate salivary flow.
    • Use cholinergic agents as necessary

    Please also see the article by Fischer and Epstein, Management of Patients Who Have Undergone Head and Neck Cancer Therapy, for more details.

    How To Manage Chemo Mouth Sores

    Chemotherapy is a group of powerful medicines that can help slow or stop some cancers. But chemo can affect healthy cells in your body, too, like those that line the inside of your mouth and the kind that make saliva. The result may be dryness, tenderness, and sores inside your mouth that make it hard to eat or even talk.

    Theyâre usually at their worst about 7 days into your treatment and typically go away around 10 to 14 days after your treatment ends. But there are some things you can do to help prevent the sores and manage them when you get them:

    Use a soft-bristle toothbrush: Itâs important to be gentle with the delicate tissue of your gums. You can make the bristles even softer by running them under hot water. Or you can go a step further and clean your teeth with simple cotton swabs or sponges made specially for your mouth.

    Brush often, but lightly: Brush or clean your teeth after each meal and at bedtime. Whether you use a soft toothbrush or something else, take care to do it gently so you donât damage the delicate tissue inside.

    Floss every day: It helps keep your mouth clean and prevents the buildup of bacteria that can lead to infection. As with brushing your teeth, do it gently so you donât damage your gums or cause bleeding. It’s best to avoid areas that bleed or hurt, but itâs still important to floss the other areas.

    Eat the right foods:

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    Foods To Eat And Avoid

    Taking some time to think about what you can and cannot eat will pay off in big dividends. It’s much easier to limit problem foods before they cause problems than to cope with a sore mouth as a reminder.

    • Eat a good diet with a variety of foods. Some vitamin deficiencies can make symptoms worse, and a good diet may help your body fight off infections.
    • Avoid foods that are spicy, salty, or foods with citrus acid and tomato juice. Pineapple and strawberries are often tolerated better than other fruits, and grape or apple juice may cause less discomfort than citrus and tomato juices.
    • Limit your intake of alcohol
    • Avoid foods with extreme temperatures
    • Drink plenty of water
    • Avoid foods that are sharp, such as crackers, toast, and dry cereal
    • Try adding moist foods over dry foods, such as using gravy and sauces
    • Good food choices can include mashed potatoes, cooked cereals, applesauce, cottage cheese, pudding, yogurt, smoothies , soups, Jello, baby food, or food pureed in the blender
    • Drinking liquids through a straw is sometimes very helpful in keeping the fluids away from tender mouth sores

    How Are Mouth Sores Treated


    The best way to manage mouth sores is to prevent them or treat them early. If you are receiving chemotherapy, sucking on ice chips right before and during treatment may prevent mouth sores. Visit a dentist that specializes in cancer care before starting radiation therapy to the head or neck area.

    Your doctor may also recommend pain relief strategies, like a mouthwash solution called magic mouthwash, magic mud, or triple mix. Ingredients in this mouthwash may vary, but it typically includes an antihistamine, anesthetic, an antacid, antibiotics, and/or an antifungal. You may be prescribed prescription pain medicine or they may suggest over-the-counter acetaminophen. Avoid taking aspirin during cancer treatment unless your doctor tells you otherwise. Your health care team may use a prescription liquid medication called palifermin . This medicine is given by vein . It can be used before and after certain treatments to reduce the risk of mucositis.Its important to continue to eat and drink regularly during cancer treatment, but mouth sores may make it uncomfortable. To help, take your pain medicine 30 minutes before you eat or drink. Talking with a registered dietitian can be very helpful to get other strategies to help with mouth sores. For instance, they can help figure out whether you need to take food supplements, such as protein shakes, to get the nutrition you need.

    It is a good idea to take special care of your mouth during cancer treatment. The following tips may help:

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    Clinical Management Of Oral Mucositis

    Management of oral mucositis has been largely palliative to date, although targeted therapeutic interventions are now being developed 31. Based on a comprehensive systematic review of the literature, the Mucositis Study Group of the Multinational Association for Supportive Care in Cancer and the International Society of Oral Oncology has developed clinical practice guidelines for the management of mucositis 32. These guidelines are referenced below as applicable. Management of oral mucositis is divided into the following sections: nutritional support, pain control, oral decontamination, palliation of dry mouth, management of oral bleeding and therapeutic interventions for oral mucositis.

    What Is Cancer Of The Palate

    The palate is commonly called the roof of the mouth. It is divided into two parts: the bony hard palate in the front, and the fleshy soft palate in the back of the mouth. The hard palate is part of the oral cavity and the soft palate is part of the oropharynx.

    The hard palate creates a barrier between the mouth and the nasal cavity. A natural opening in the palate for nerves and blood vessels can create a passageway for a tumor to spread into the nasal cavity.

    The soft palate closes the nasal passage during swallowing so food does not enter the nose. It also helps create speech sounds. If the palate does not function correctly during speech, air escapes through the nose, and the speech has a nasal sound. During a sneeze, the soft palate closes the nasal passage to protect it. Substances in the sneeze are thrown out into mouth.

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    Dont Let Your Mouth Become Too Dry


    Use care when ingesting caffeine, salt, acidic foods and liquids. While a nice cup of tea or your favorite cola drink may sound refreshing, the high acidity and caffeine can actually leave you more dehydrated than when you started. Salt, while it has many re-hydrating properties, can actually dry out your mouth if it is taken in excessive quantities.

    Make certain to drink lots of fluids during cancer treatment. Dont make it difficult for your mouth to get hydration. The most logical way to stay hydrated is, of course, by ingestion. If possible, frequently sip water and rinse it around your mouth before swallowing.

    During my mothers cancer treatments, I would physically hold a cup of water with a straw for her to sip every hour to ensure she stayed properly hydrated.

    Mouth Rinses

    You can also try an over the counter dry mouth rinse. Many oncologists will recommend a dry mouth rise for those with chronic dry mouth. These can help, but are not an end-all-beat-all solution to ending dry mouth. Many oncologists and cancer fighters report success with dry mouth rinses.

    Other cancer fighters have reported success with a salt water rinse. Simply add a tablespoon of salt to 8 ounces of water and stir well. Rinse in your mouth like a mouth wash. Spit out the mixture when done. Do not swallow the salt water. It will make you nauseous.

    Why Does Cancer Treatment Cause Mouth Sores

    Smart Tips – How To Soothe Mouth Sores Caused By Chemotherapy by Dr. Nalini Chilkov

    Cancer cells can grow very quickly. The aim of cancer treatment is to stop or slow down that growth. The cells in the mucous membranes lining your mouth are also fast-growing cells, so cancer treatments affect them, too.

    Cancer treatments also keep the cells in your mouth from being able to repair themselves efficiently when theyre damaged.

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    Future Directions In Mucositis Research

    As evident from the above discussion, this is an exciting period in mucositis research. One drug has received FDA approval for reducing the severity and duration of oral mucositis in patients with hematologic malignancies receiving myelotoxic therapies requiring hematopoietic cell support. Several other promising agents are in clinical development that eventually may be approved for the management of this debilitating condition. Future studies should evaluate if agents that work by different mechanisms can be used in combination for greater clinical effectiveness. Another approach that warrants further investigation is the use of novel drug delivery technologies that increase uptake of the active agent to the oral epithelial cells. In addition, developing improved algorithms to predict the risk for the development of clinically significant mucositis would also be valuable so that patients at increased risk can be targeted for therapy in a more cost-effective manner. Reducing the morbidity of mucositis will help to avoid unwanted dose reductions or unscheduled breaks in cancer therapy and thus improve outcomes of cancer therapy.

    Clinical Course Of Oral Mucositis

    Oral mucositis initially presents as erythema of the oral mucosa which then often progresses to erosion and ulceration. The ulcerations are typically covered by a white fibrinous pseudomembrane .3). The lesions typically heal within approximately 24 weeks after the last dose of stomatotoxic chemotherapy or radiation therapy. In immunosuppressed patients , resolution of oral mucositis usually coincides with granulocyte recovery however, this temporal relationship may or may not be causal.

    Mucositis ulcer involving the lateral tongue in the same patient as Figure 2.

    Several factors affect the clinical course of mucositis. In chemotherapy-induced oral mucositis, lesions are usually limited to non-keratinized surfaces 1. Ulcers typically arise within two weeks after initiation of chemotherapy. Selected agents such as antimetabolites and alkylating agents cause a higher incidence and severity of oral mucositis 25. In radiation-induced oral mucositis, lesions are limited to the tissues in the field of radiation, with non-keratinized tissues affected more often. The clinical severity is directly proportional to the dose of radiation administered. Most patients who have received more than 5000 cGy to the oral mucosa will develop severe ulcerative oral mucositis 26.

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