Mouth and throat sores

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The mouth, throat, and intestines are lined with cells that divide rapidly and can be severely damaged by chemotherapy drugs. This is more common for children on very intensive protocols and for those having stem cell transplants. The sores are very painful and can prevent eating and drinking. Check your child's mouth periodically for sores, and if any are present ask advice from the oncologist. Some parent suggestions are:

• To prevent infection, the mouth needs to be kept as clean and free of bacteria as possible. After eating, have your child gently brush teeth, gums, and tongue with a soft, clean toothbrush.

• If your child is old enough, the doctor may recommend a rinse to decrease the amount of bacteria in your child's mouth. This may help prevent mouth sores.

When David was told to use Peridex, I asked the doctor if we could substitute 0.63 percent stannous fluoride rinse. He said yes. As a dentist, I knew Peridex kills bacteria and lasts up to eight hours, but it tastes terrible and stains teeth. Patients do not like using it. The 0.63 percent stannous fluoride has the same bacteria-killing properties and also lasts up to eight hours, but has a better taste and does not stain as badly. The fluoride also helps prevent cavities and makes the teeth less sensitive. It comes in a variety of flavors like mint, tropical, and cinnamon. It is a prescription drug that a lot of dentists dispense.

Mix 1/8 ounce of concentrate with warm water, making 1 ounce. A measuring cup comes with the bottle. I have David swish with half the mixture for one minute. (Time it, because it's longer than you think!) This can only be used by kids who are old enough not to accidentally swallow it. Six-year-old David has no problem taking this once a day before he goes to bed. If and when he starts developing mouth sores, he will take it morning and evening. It's important not to eat or drink for 30 minutes after rinsing. That is why David rinses before bedtime, after he has taken his meds and brushed his teeth.

• Keep a record of what your child eats and drinks. Your child may need prescription pain medication to allow him to swallow and take adequate fluids.

• Serve bland food, baby food, or meals put through the blender.

• Use a straw with drinks or blender-processed food.

Preston got bad mouth sores every time he was on high-dose methotrexate. He could not swallow, but we were supposed to be forcing fluids to flush the drugs out. The only thing that felt good on his throat was guava nectar. It was very expensive and hard to find, and he would drink several quarts a day. Unfortunately, my daughter and husband both developed a liking for it, too. At one point we cornered the market on guava nectar at three grocery stores in our neighborhood.

There are several prescription products available to treat mouth sores. One common product is called Magic Mouthwash, containing equal parts of Benadryl, Nystatin, Maalox, and viscous Xylocaine. Some formulations add dexamethasone. If your child has painful mouth sores, ask the oncologist for a prescription. Since large amounts of lidocaine can numb the back of the throat and cause difficulty swallowing, this medication should be used at a dose recommended by the oncologist.

Glutamine, a nutritional supplement available at most drug and health food stores, may be helpful in preventing or minimizing mouth sores in some children. If your child is receiving chemotherapy with a high probability of causing mouth sores, you may want to try glutamine as a prophylactic measure. The powder can be mixed in juice and should be started one or two days before your child receives a cycle of chemotherapy. Be sure to get your oncologists approval before starting this treatment.

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