Mouth ulcers are a possible side effect from chemotherapy. I’ve come up with some strategies for avoiding them as much as possible, and for treating them quickly when they happen. It’s important because pain in your mouth goes straight to your mood. Mouth pain affects our ability to eat and to communicate, and struggling to do either has serious implications for how well we feel.
Eating well is one of the few things we can control during chemotherapy, and has the potential to help us feel positive about the extent to which we’re supporting our amazing bodies in the fight against cancer. Mouth ulcers undermine that.
With some good habits and a bit of vigilance it’s possible to get through chemotherapy without suffering from weeks of mouth ulcers. This routine will also help you to avoid oral thrush:
- Drink water. Yes, you will need to roll your stand to the loo a couple of times but the water will help to reduce the impact of the chemicals on your mouth.
- Suck the ice. For some types of chemotherapy (e.g.: FEC) they’ll offer you ice to suck during treatment. Keeping your mouth cool reduces the blood circulation and therefore the impact of the chemicals on your mouth lining. Keep putting a little ice in your mouth throughout treatment and you’ll reduce the risk of ulcers.
- Take some ice with you when you leave and keep putting it in your mouth for about half an hour after treatment.
- Drink water. Water is your body’s natural lubricant and much better for you than any other kind of drink. In particular, avoid sweet drinks like soda and fruit juice, or if you do drink them, have water afterwards. While it is possible to have too much of anything you can safely drink around two litres of water every day. This will also help to minimise the impact of your drugs on your liver. Make a point of drinking water as soon as possible after you’ve eaten anything, particularly anything sweet.
- Switch toothpaste. Strong, minty toothpaste usually contains something to make your mouth slightly numb. This increases the risk of you scratching your gums and providing a starting point for mouth ulcers. I really like the Grants brand:
It’s aluminium and fluoride free and contains aloe vera, so it’s very soothing on your mouth. I’ve also found that switching to this brand solved my problems with reflux and heartburn. It turns out that the strong peppermint in a lot of commercial toothpastes is an irritant.
- Get a new toothbrush: Only use a soft toothbrush. I’ve seen children’s brushes recommended but they’re so small you’ll spend half the day cleaning your teeth. I find that a good, soft, adult brush is just as good. There’s an OralB brush that has rubber bristles on the outside of the nylon bristles and I find this protects my gums from being scratched. I’ve recently found some bamboo toothbrushes and I’m switching to those because I like to avoid plastic as much as possible. They’re really soft, do a much better job of cleaning my teeth and last for around three months. I bought them here:
- Change your brushing technique. We all know that if we want to clean something we can use more effort for less time, or less effort if we take our time. The main aim during chemotherapy is to avoid scratching or cutting the gums, so going gently and cleaning for longer makes sense.
- Brush your tongue and the roof of your mouth. Just like your teeth, these parts of your mouth will accumulate plaque and bacteria. Brush them gently and if your toothbrush comes with a tongue cleaner (usually a bumpy bit on the back of the head) then get into the habit of using it.
- Floss gently, but only if you already floss. If you’re a regular flosser your gums will be used to it, but go carefully. If you’re not in the habit of flossing now is not the time to start. It’s likely you’ll make your gums bleed.
- Rinse thoroughly. When you’re done brushing, rinse your mouth a couple of times with water and spit the water out. This is particularly important if you decide to stick with one of those popular, minty toothpastes. Check the label. You really shouldn’t be swallowing this stuff.
- Choose your mouthwash carefully and use it after every meal. Alcohol based mouthwashes like Listerine can actually cause mouth ulcers. Try a good sized pinch of bicarb or salt in water but be careful not to overdo it. Too much bicarb can promote thrush. I’ve seen a lot of places recommending a whole teaspoon of bicarb. I think that’s too much. As an alternative you could try Biotene mouthwash. It’s designed for people that suffer with a dry mouth and my oncologist recommended it. It doesn’t contain alcohol and leaves your mouth feeling fresh without the explosive hit of an alcohol based mouth wash. They also make a spray that you can carry with you for times when you’re eating out and won’t be able to get to some bicarb.
My own routine is to use a pinch of bicarb in water after meals and then the Biotene at night before I go to bed.
- Pull coconut oil. Buy some organic coconut oil (also sold as coconut butter) and put about a tablespoon full in your mouth. Don’t worry if it’s solid because it will melt. Pull the oil back and forth between your teeth and swish it around your mouth for around five minutes. Spit out the oil. Coconut oil is naturally anti-fungal and this routine will help you to avoid thrush as well as conditioning your gums. Some people do this every day and if you’re particularly prone to ulcers or have active ulcers then daily is a good idea. If you’re just doing it for prevention then once or twice a week is fine. As a general guide, if your gums feel a bit raw or ‘furry’ when you run your tongue over them, then pulling coconut oil is a good idea. Pulling oil will also help to keep your teeth white and will provide a gently flossing action between your teeth. Brilliant! In Indian Ayurvedic medicine, they believe that pulling oil removes toxins from your body. I can’t find any proof of this but given all of the other benefits I’d highly recommend you try it. I believe that pulling oil and switching toothpaste are the main reasons I’ve had so few mouth problems.
- Avoid sugar, chocolate, artificial sweeteners, alcohol and very sweet food. Too much sugar will promote mouth ulcers and thrush. If you’re going to have something sweet then follow it with a long, slow glass of water. If you have active mouth ulcers then skipping the sweet stuff for a few days will help them to heal.
- Avoid food that’s likely to scratch your gums. I need to be really careful with some cracker biscuits and potato chips. You can still eat crispy food but please be careful.
- Eat well. Avoid highly processed foods and eat plenty of fresh fruit and vegetables. Your mouth, like the rest of your body, needs good food to be healthy.
- Avoid anything too hot. It’s easy to burn your mouth at the moment so you might need to let everything cool down a little. I haven’t had a problem with spicy food but I ate a lot of it before I became sick. Pay attention to what irritates your mouth and avoid it.
AT THE FIRST SIGN OF AN ULCER
- Kenalog Kenalog Kenalog! Kenalog in orabase is THE treatment cream for mouth ulcers. You need to ask the chemist for it. You don’t rub it in. If you can imagine covering the ulcer with a sticky blob of plastic then you’ve got the right idea. It’s best applied at the first sign of an ulcer, no matter what time of day it is, and then reapplied at night after you’ve cleaned your teeth.
- Diflam Diflam Diflam! Diflam make a range of sugar free lozenges that are anti-inflammatory and antibacterial. Look for a packet that says ‘plus anaesthetic’ because these will numb any pain from mouth ulcers. Carry some with you and pop one in your mouth if you get that tell-tale twinge.
- More Diflam. Diflam also make a mouth gel that’s handy to carry with you. It’s much easier to apply than Kenalog and is a good stop-gap until you get home and hit the hard stuff. If you’re happy to carry the Kenalog and use that then you won’t need this. Just a note here that I haven’t used the Diflam mouth wash but I notice they also recommend it for mouth ulcers. If anyone has tried it I’d like to know what you thought of it. I’ve spoken to some women that don’t like the taste or the feel of Kenalog and so they put up with ulcers. This cream won’t work as well or as quickly as Kenalog but it’s better than using nothing.
- Coconut oil. Any day that you have active mouth ulcers, or the twinge that tells you they’re on the way, I would strongly recommend pulling coconut oil. My own experience was that just doing this stopped a lot of ulcers in their tracks. Scroll up for all the details on pulling oil.
- Check your mouth care routine. Ulcers might be a sign that you’ve gotten a bit slack. You should be rinsing your mouth after every meal using either Biotene or water with salt or carb soda. If you’re eating out then at least have a drink of water after you’ve finished eating. You can also use Biotene mouth spray. Check that your toothbrush is in good condition and replace it if it’s not. Pull some coconut oil at least once a week.
- Avoid cleaning your teeth straight after eating. Seems odd, I know, but depending on what you’ve eaten the acid in the food will have left your teeth and gums more susceptible to damage. Drink water or use your mouthwash, but wait at least half an hour before you brush.
- Watch your snacking. It could be that your routine is great with regard to rinsing after meals, but if you’re having a lot of between-meal snacks you’ll be altering your mouth acid. Drink water after a snack, or have water instead of a snack. If you’ve had something very sweet then use mouthwash.
So that’s my ultimate guide to mouth care and avoiding the pain of mouth ulcers. So far I’ve only ever had to put up with an emerging ulcer for around twelve hours before this routine has restored things to normal.
I think what’s really important is to not just accept ulcers as part of your treatment. They will seriously effect your mood, your immune system and your enjoyment of food. If they’re serious they can effect your ability to talk and provide an entry point for serious infection which can lead to neutropenia and an unwelcome stint in hospital on intravenous antibiotics.
At chemotherapy yesterday I met a woman that told me she’s been suffering terribly with mouth ulcers. When I mentioned Kenalog she replied, “Oh, yes, I have some of that but I just haven’t been using it. I suppose we put up with a lot of things that we don’t need to put up with, don’t we?” I don’t understand this. Why would anyone put up with that pain when with a good routine and a bit of vigilance you can live without it? I want my body to be fighting cancer, not mouth ulcers.
The feedback I’ve had from other cancer patients is that my routine has helped them either avoid mouth ulcers, or treat them and prevent their return. The comment I hear most often is that, not unlike a toothache, mouth ulcers are the kind of pain that you put up with and then realise what a huge impact it was having on your life once it’s gone.
I hope you have as much success with it. Please let me know.