Recognizing oral mucositis
Chemotherapy and radiation to the head and neck injure the rapidly dividing cells of the oral lining. The result is oral mucositis (stomatitis): red, painful mucosa with ulcers, the most common acute oral complication of head and neck radiation. Frequent bland rinses with saline or sodium bicarbonate solution keep the mouth clean and soothe the mucosa with less pain. These rinses remove debris and bacteria without drying or burning the tissue.
Principles of mouth care in mucositis
Mouth care aims to keep the mucosa clean, moist, and intact while avoiding further injury. Key measures include: rinsing often, for example after meals and at bedtime, with a salt or baking soda solution; brushing gently with a soft toothbrush or foam swab; removing and cleaning the denture, and leaving it out when the mouth is very sore; using topical anesthetics before meals if prescribed; choosing soft, bland, moist foods; and avoiding alcohol, tobacco, and spicy or acidic foods. The nurse also inspects the mouth daily for infection such as candidiasis.
| Option | Effect on inflamed mucosa | Verdict |
|---|
| Firm toothbrush | Traumatizes ulcers and causes bleeding | Avoid; use a soft brush |
| Alcohol-based mouthwash | Dries and burns the mucosa | Avoid |
| Salt or baking soda rinses | Clean and soothe without irritation | Correct |
| Lemon-glycerin swabs | Acidic and drying; irritate ulcers | Avoid |
Why the distractors cause harm
A firm toothbrush injures inflamed tissue and can open new ulcers. Alcohol in commercial mouthwashes dehydrates the mucosa and causes stinging pain. Lemon-glycerin swabs seem moistening, but lemon is acidic and glycerin draws water from tissue, so they dry and irritate the mouth. Each of these increases pain and the risk of infection.
Watch out! Products marketed for freshness or moisture are not always safe in mucositis. Check whether they contain alcohol, acid, or drying agents.
Exam takeaway
Key point! For oral mucositis, teach frequent bland saline or sodium bicarbonate rinses and a soft toothbrush; avoid alcohol mouthwash, firm brushing, and lemon-glycerin swabs.