Mouth Care and Oral Mucositis

These instructions are for Children's Hospital of Philadelphia (CHOP) patients who have received chemotherapy or radiation to the head and neck that can cause mouth sores.

Important information:

• Mouth sores or ulcers may appear when your child's white blood cell (WBC) count starts to drop after receiving cancer treatment. This is called mucositis. Once your child's WBC count begins to rise, the mucosa will start to heal.

• Before mouth sores appear, your child's mouth may feel more sensitive, like it does after a food burn.

• Mucositis can cause pain in the mouth and throat. It may hurt when your child swallows.

• Sores or ulcers in the mouth and GI tract are a risk for infection.

• Some children will need to be admitted for pain medicines and intravenous (IV) fluids if they are unable to eat or drink or if there are signs of infection.

Instructions for good mouth care during treatment:

• Clean teeth and gums regularly, especially after meals and before bed.

• Brush teeth two times a day with a soft-bristled toothbrush and fluoride toothpaste. Consider replacing the toothbrush after illness.

• Rinse mouth three times a day with an oral rinse or sterile water. Do not eat or drink for 30 minutes after rinsing.

• Make mouth care a regular activity for your child. Talk to your healthcare team for tips about how to do this successfully.

• Always check with the oncology healthcare team before scheduling an appointment with a dentist:

  • The healthcare team may want to check your child's blood counts.

  • If your child wears braces, talk to the healthcare team about a plan.

Instructions for managing oral mucositis:

• If brushing with a toothbrush is painful, you may use sponge swabs. Use 4 swabs (one for each cheek, one for the teeth, and one for the tongue).

• Your child should only use dental floss if they know how to use it safely.

  • If they can floss, do it gently once a day.

  • If flossing causes pain or a lot of bleeding, skip the problem area but keep flossing the other teeth.

• Saltwater rinses may help; mix ½ teaspoon of salt in 1 cup of warm water.

• Apply Vaseline® or Chap Stick® to prevent dry, cracked lips.

• Encourage liquids even when your child refuses to eat foods.

  • Try high calorie drinks such as Carnation Instant Breakfast®, Boost®, or Ensure®.

  • Cool drinks such as smoothies and milkshakes may relieve pain.

  • Drinking with a straw may be more comfortable.

• Offer these foods that may be easier to eat:

  • Soft foods: eggs, custard, pudding, Jell-O, or blended foods (like baby food).

  • Room temperature foods or cold foods which may be soothing: popsicles and ice cream.

  • Bland or mild foods

• Avoid dry or hard foods (like potato chips) and seasoned or spicy foods because they may irritate the mucosa.

• Avoid citrus juices and tomatoes.

• If your child's mouth is dry, chewing sugarless gum or sucking tart candy can be helpful.

Call your CHOP oncology team with any questions or concerns, or if your child has:

• Pain when swallowing

• A decrease in urination, less than 5 to 6 times daily

• Dark urine

• Dry skin, lips or mouth

• Crying with no tears

Oncology Contact Information

Reviewed November 2024, by Kimberly DiGerolamo, DNP, RN, PCNS-BC, CPHON, CPN, EBP-C, FCNS