Brushing up on Mouth Care in Cancer Patients With Mucositis
Brushing up on Mouth Care in Cancer Patients With Mucositis
The first step in mouth care for oral mucositis is prevention. Preferably, before cancer treatment starts, patients should undergo a baseline dental evaluation with X-rays and have cavities filled. Once treatment begins, instruct patients to brush the teeth with a soft toothbrush for 90 seconds at least twice daily and to floss at least once daily (unless the patient is thrombocytopenic). As appropriate, advise them to rinse the mouth at least four times daily with saline solution, sodium bicarbonate, or a mixture. Stress the importance of getting adequate hydration and using a water-based moisturizer to protect the lips. (See Oncology Nursing Society recommendations.)
Despite preventive measures, most patients develop NCI CTC grade 2 or 3 (moderate to severe) toxicity, depending on the extent of chemotherapy and radiation. To relieve pain from mucositis, guidelines recommend use of a patient-controlled analgesia pump with morphine, especially in stem-cell transplant patients. In other patients receiving conventional or high-dose chemotherapy, a transdermal fentanyl patch is preferred. Specifically in head and neck cancer patients who undergo radiation, 2% morphine mouth rinse is suggested, as well as 0.5% doxepin rinse.
Intervention
The first step in mouth care for oral mucositis is prevention. Preferably, before cancer treatment starts, patients should undergo a baseline dental evaluation with X-rays and have cavities filled. Once treatment begins, instruct patients to brush the teeth with a soft toothbrush for 90 seconds at least twice daily and to floss at least once daily (unless the patient is thrombocytopenic). As appropriate, advise them to rinse the mouth at least four times daily with saline solution, sodium bicarbonate, or a mixture. Stress the importance of getting adequate hydration and using a water-based moisturizer to protect the lips. (See Oncology Nursing Society recommendations.)
Despite preventive measures, most patients develop NCI CTC grade 2 or 3 (moderate to severe) toxicity, depending on the extent of chemotherapy and radiation. To relieve pain from mucositis, guidelines recommend use of a patient-controlled analgesia pump with morphine, especially in stem-cell transplant patients. In other patients receiving conventional or high-dose chemotherapy, a transdermal fentanyl patch is preferred. Specifically in head and neck cancer patients who undergo radiation, 2% morphine mouth rinse is suggested, as well as 0.5% doxepin rinse.
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