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It can be very difficult to deal with painful mouth ulcers after undergoing cancer treatment. We outline the methods and medications that have been proven to be most effective in helping manage the condition.

Mouth ulcers, also called mouth sores, can be a mild or severe side effect that people undergoing cancer treatment have to face. These mouth sores can appear with either chemotherapy, radiotherapy or a combination of the two [1]. 

Unfortunately, there is no sure-fire way of preventing these ulcers from occurring in the first place, although diligent oral care during cancer treatment is probably the best bet. 

The management of mouth ulcers caused by cancer treatment aims at minimizing the discomfort faced by patients and providing symptomatic relief for pain, burning sensation, difficulty in talking, eating and swallowing [2]. 

Here are some of the most common approaches that are utilized.

Cold Therapy

The use of ice chips or cold water in the mouth during the use of certain chemotherapy drugs has been found to be very effective in reducing the incidence of oral mucositis and mouth ulcers.

The cold temperature causes the blood vessels inside the mouth to constrict and thus minimize the severity of chemotherapy drugs that find their way into that region.

It is a simple and inexpensive way that most doctors recommend following [3]. 

Palifermin

The breakdown of mucosal cells in response to cumulative doses of radiation causes mouth sores. Palifermin is an FDA-approved drug that helps in promoting the repair of ulcerated areas [4].

Topical Gels and Ointments

Many agents are available over the counter or through a prescription, and they claim to provide relief to patients by coating mouth ulcers and preventing them from coming in contact with any external influences. 

Sucralfate is one agent that has been found to be quite useful when dealing with mouth ulcers and your doctor may choose to prescribe it [5]. 

Your dentist might also advise you to use other ointments that contain agents that provide a soothing effect or pain relief. 

Removal of Irritants and Prosthetic Devices

Your doctor might suggest you remove any prosthetic device which causes minor trauma or irritation to the mouth. You should not use removable dentures until the mucosa has healed after the completion of radiation treatment [6].

Your dentist might even suggest you remove or at the very least round off malaligned teeth that were asymptomatic before cancer treatment begins, so that they do not cause traumatic ulcers or worsen them [7].

Things That Patients Can Do

It is possible for the patient to follow some instructions and decrease the severity, likelihood, and duration of which mouth ulcers occur during cancer treatment.

You should avoid tobacco and alcohol under all circumstances. Non-spicy, soft food should be eaten primarily until the mouth ulcers have healed [8].

Patients should follow a strict oral hygiene regimen which involves brushing 2 to 3 times a day with a soft nylon brush. The bristles can be further softened before use by rinsing the toothbrush with hot water. 

The toothpaste that you use must also be non-abrasive and mild on the tissues. If you are unsure as to which toothpaste you should use during cancer treatment then ask your doctor to prescribe you a suitable one [9]. 

Patients are also required to rinse their mouth out 3-4 times a day with either a commercially available mouthwash or one that can be easily made at home by mixing baking powered and water in the correct proportions. 

Using a straw to drink any liquids and maybe even for the intake of blended food is something that will allow you to get the essential nutrition without having to deal with pain and other discomforts. In some cases, the esophageal tract also gets ulcerated, and this can require hospitalization and the use of a feeding tube.

Newer Approaches

Some new approaches are currently being tested to see if the less non-healing ulcers/ slowly healing ulcers can be treated more efficiently. 

Low energy lasers, growth factors which have been proven to increase the likelihood of cell growth and repair as well as naturally occurring agents of the inflammatory response which can help further the process of healing have been tried out [10]. 

Your doctor may choose to use one of these recent advances in severe cases of mouth sores after cancer treatment.

Conclusion 

Mouth ulcers are an unfortunate side effect of radiation aimed at the head and neck region and can occur even though a patient is maintaining good oral care during cancer treatment and his or her dentist takes every single precaution.

It is evident though that certain common sense steps, like proper shielding during radiation, using as targeted a field as possible, good oral care provided before the cancer treatment began, and other palliative measures will decrease the likelihood of mouth sores. The steps that we mentioned above will make patients more comfortable.

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