Oral problems are commonplace when being treated with chemotherapy and the drugs used predominantly for ovarian cancer - Carboplatin, Cisplatin, Paclitaxel and Bevacizumab - are known for causing oral mucositis, the inflammation of the mouth lining, responsible for most difficulties. Mary Tanay, oncology nurse tutor at London’s King’s College explains what to do.

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What oral problems are typical after chemotherapy?

“Most oral problems caused by chemotherapy happen as a result of oral mucositis (OM), with older women and people with poor oral hygiene at higher risk.

Difficulties include pain, mouth ulcers, gum swelling and bleeding, dryness of the mouth and lips. If not managed properly, these may cause further problems. Pain may lead to difficulty in chewing and swallowing, as well as problems with communication and sleeping.

Dryness of the mouth may cause further breaks in the mouth lining. Breaks in the mouth lining (ulcers) are potential entry points for bacteria. Remember that chemotherapy also decreases the body’s ability to fight infection therefore be vigilant for signs of infection.”

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How can problems be avoided?

“Good and strict oral hygiene is of prime importance. Use high-fluoride toothpaste and a soft-bristled toothbrush for brushing at least two times a day; and floss daily (but avoid flossing if your platelet count is low). Your doctor or nurse will recommend alcohol free mouthwashes or salt-solutions - use these regularly as directed. If applicable, remove and clean dentures frequently; and make sure they fit well.

It is also important to keep the mouth lining moisturised and healthy. Apply water-based moisturisers. Unless you are on fluid restriction, drink adequate amounts of fluid to prevent dehydration; and eat a well-balanced, high-protein diet. Some medications also cause dryness of the mouth. Ask your doctor to review your medications to see if it is appropriate to replace or stop.

Minimise consumption of alcohol and avoid tobacco especially during treatment, as they make OM symptoms worse. Avoid hot, acidic, coarse or spicy food because this can irritate.”

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What should women watch out for?

“Use a torch to view your mouth while standing in front of the mirror. Report changes such as redness or extreme dryness, soreness or pain, cracks, ulcers, blisters or white patches, bleeding from your mouth or difficulty swallowing."

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How can problems be treated?

1. Pain

“Use analgesic mouthwashes and gels directly applied on the area, oral medications, or mucosal protectants, to relieve OM pain. If your mouth is constantly painful, take your painkillers regularly, round the clock. Speak to your doctor if pain relief is ineffective so something stronger can be prescribed.”

2. Mouth infection

“It may be necessary to add antibacterial mouthwashes or gel to your oral care regime. It is important to report any signs of infection to ensure you receive antibiotic/antiviral/ anti-fungal treatments.”

3. Dryness of the mouth

“Drink plenty of fluids frequently. There are many products that can help relieve dryness such as moisturisers, sugar-free gum or artificial saliva.”

4. Bleeding

“Apply pressure to the site of bleeding using a piece of clean gauze dipped in ice water. If tolerated, rinsing with ice water may also help.”

5. Nutritional problems

“Poorly managed nutritional problems and dehydration may lead to more serious problems. Take painkillers one to two hours before meals. If your mouth is sore, eat frequently and in small amounts. Speak to your dietitian."

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Article reviewed by Dr Tracie Miles, lead gynaecology oncology nurse specialist at Royal United Hospital, Bath.

First published in the Ovacome Autumn Newsletter 2015.