What is Oral Mucositis (Mouth Sores)?
Most people receiving radiation or chemotherapy for head and neck cancer develop mouth and throat sores, called oral mucositis. It’s one of the most common — and most difficult — side effects of treatment.
Mucositis happens because treatments target fast-growing cancer cells but also damage the fast-growing cells that line your mouth and throat. Sores can range from mild discomfort to severe pain that makes it hard to eat, drink, or talk.
What to Know BEFORE Cancer Treatment Begins
Managing Mucositis During and After Treatment
Risk Factors
Half of all patients receiving chemotherapy, as well as most patients getting radiation, will develop mucositis.
Other risk factors include:
Poor oral hygiene & dental health
Smoking or using tobacco products, including chewing tobacco
Using alcohol
Not drinking enough fluids
Immunosuppression or a weakened immune system due to the cancer or therapy
Dry mouth
Malnutrition
Sex — Women are more likely to develop mucositis than men
Age — Younger patients are more likely to develop mucositis than older patients due to higher cell turnover rate. However, this also means they may heal faster.
Having another disease, such as diabetes, HIV/AIDS, kidney disease, etc.
Genetic risk: Some people may have genes that make them more likely to get mucositis. In the future, doctors might use genetic testing to personalize prevention, but this is not standard practice yet.
Symptoms & Timing
Oral mucositis usually begins with discomfort or pain in your mouth. The painful areas will then turn red, and eventually, open sores will develop.
Symptoms that you may experience include:
- Pain or soreness your mouth or throat
- Red, swollen areas
- Open sores (sometimes covered with white or yellow buildup)
- White patches
- Trouble eating, drinking, swallowing or talking
- Increased mucus or thick saliva
Timing
- Chemotherapy: mucositis usually starts 5–10 days after treatment and lasts about 1–2 weeks, improving as white blood cell counts recover.
- Radiation: Mucositis begins 1–3 weeks after treatment starts, continues through therapy, and usually improves 4–6 weeks after the last session.
what can help?
- See a dentist/oral medicine specialist familiar with cancer care. Ideally, fix dental problems 4-6 weeks before starting radiation or chemotherapy.
- If you wear dentures or another oral prosthetic, make sure they fit properly.
- Stop smoking and/or using tobacco products
- Avoid alcohol
- Stay hydrated and nourished: Eat soft, moist foods and drink plenty of fluids. Focus on protein, which helps your body rebuild and repair itself.
- Try honey: Some studies show that medical-grade honey and propolis may help reduce the severity and pain of mouth sores. Further clinical trials are needed.
- Talk to your doctor: about natural plant compounds that may help protect your cells, like chamomile, yarrow, or curcumin (sometimes found in gel or mouthwash forms). Further clinical trials are needed.
- Try cryotherapy (ice chips): Sucking on ice chips or popsicles, and sip cool drinks often during certain chemo treatments may help lower your risk of sores.
- Control pain: Use pain medicine, numbing rinses, or gels as prescribed. Topical pain relievers, including corticosteroids (anti-inflammatory drugs), lidocaine, benzocaine, or dyclonine hydrochloride may provide temporary relief. Hyaluronic acid has also shown some promise in reducing pain.
- Ask your medical team about medications or treatments that may reduce the risk of developing oral mucositis. These may include:
- Photobiomodulation therapy: (like MurevaOM) A type of light therapy that may prevent or reduce oral mucositis.
- Amifostine (Ethyol®): A drug that protects the salivary glands and oral mucosa against damage caused by radiation.
- Oral glutamine: This supplement may help protect the mouth and ease pain from mucositis.
- Benzydamine: A medication that may prevent mucositis in patients receiving moderate-dose radiation.*Note- this is not FDA approved for commercial use in the US, although has orphan drug designation and may be available with a prescription from a compound pharmacy. It is widely available over the counter or by prescription in other countries under the brand name Tantum or Difflam.
- Many resources suggest using “magic mouthwash” – a mixture of lidocaine (a pain reliever), diphenhydramine (an antihistamine and anti-inflammatory), and Maalox. “Magic mouthwash” should be used with caution because Maalox can cause drying of the lining of the mouth, which can make mucositis worse.
- Be open to a feeding tube: You can still eat and drink if you’re able, and the tube can be removed once your risk of mouth sores has passed.
- Tell your care team right away: If sores are very painful, prevent you from eating or drinking, or show signs of infection.
- Choose soothing foods: Cold (popsicles, frozen fruit, ice cream), soft (yogurt, smoothies, cottage cheese), and well-cooked meals (mashed potatoes, pasta, stews).
- Make food easier to eat: Add sauces, gravies, or dressings; drink through a straw.
- Avoid irritants: Acidic, spicy, crunchy, hot, alcoholic, carbonated, or sugary foods/drinks.
Search our recipe database for meal ideas!
It is important to take good daily care of your mouth, especially during treatment and if mucositis develops.
- Brush gently: Use a soft toothbrush (manual or electric) and with a mild, fluoride toothpaste (like Prevident) or plain baking soda. Avoid whitening pastes and harsh swabs. Brush at least twice daily, aiming for every 4 hours and before bedtime.
- Floss once daily: Be gentle.
- Rinse often: Use salt/baking soda rinse or prescription rinses; avoid alcohol-based mouthwashes.
- Recipe: 10 g/ (2 teaspoons) of baking soda dissolved in 1 L (4 1/ cups) of sterile water or saline and used at 15 mL (1 tablespoon) /2 min/4 times/day, starting from the day before RT and continuing for two weeks after treatment is completed.
- Make it fresh daily: Mix the solution each day and store it at room temperature in a covered container.
- Rinse and spit: Take a sip of the rinse, swish it around in the mouth and gargle for 2 minutes, then spit it out. Do not swallow it.
- Use frequently: For proactive and palliative care, rinsing is recommended multiple times per day (at least 4), including after meals and before bed.
- Start the day before radiation, continuing to rinse daily until two weeks after radiation is complete.
- Keep lips moist: Use balm (not Vaseline).
- Dentures: Remove when possible. Don’t wear them if they’re loose or painful. Clean daily.
Complications
Mouth sores can lead to:
- Nutrition problems: Pain makes it hard to eat or drink, causing weight loss or dehydration and slow healing. Sometimes a feeding tube is needed.
- Infection risk: Open sores give bacteria, viruses, and fungi an easy way in, which can cause infections in the mouth or body.
- Sepsis Risk: With very low white blood cells, infections can become life-threatening.
- Treatment delays: Severe mucositis may force your doctor to pause or reduce your cancer treatment.
- Quality of life: Many patients say mucositis is the hardest part of treatment — but it is temporary and there are things that can be done to help. Always tell your care team if you’re struggling physically or emotionally.
Talk to Your Doctor
Contact your care team right away if you:
- Have a fever over 100.4°F
- Notice worsening sores, white patches, or pus in your mouth
- Can’t eat or drink enough to stay hydrated
- Feel emotionally overwhelmed
Bottom line
Mouth sores are common in head and neck cancer treatment. They can be painful and disruptive, but there are many ways to reduce pain, protect your health, and get through treatment safely. Always involve your care team early.
