# Oral care and oral mucositis prevention during cancer treatment

Source: https://onco.cc/protocols/oral-mucositis-prevention-and-oral-care/  
OnCo record `oral-mucositis-prevention-and-oral-care` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some cancer treatments cause painful mouth sores. See a dentist first if you can, check your mouth daily, keep brushing gently with a soft brush even when counts are low, rinse with salt and baking soda rather than an alcohol mouthwash, and tell your team early about pain or sores. Depending on treatment, the team may add ice chips during the drip, a benzydamine mouthwash or a low-level laser.

## Summary

MASCC/ISOO (2020) build prevention on basic oral care: a multiagent combination oral care protocol (brushing, flossing, bland rinses, moisturising) is suggested during chemotherapy, head and neck radiotherapy and haematopoietic stem cell transplant (level III), with dental evaluation and treatment before cancer therapy as expert opinion. Their 2024 practice statement says toothbrushing with a soft or very soft brush twice daily should continue through neutropenia and thrombocytopenia, and that brushes are preferred over foam swabs. Chlorhexidine is not to be used to prevent mucositis during head and neck radiotherapy.

Targeted measures depend on the treatment. Oral cryotherapy (ice chips) is recommended for 30 minutes during bolus 5-fluorouracil and during high-dose melphalan conditioning before autologous transplant (level II). Benzydamine mouthwash is recommended for head and neck radiotherapy at moderate dose, below 50 Gy (level I), and suggested with chemoradiotherapy (level II). Intraoral photobiomodulation with low-level laser is recommended for adults having high-dose conditioning for transplant (level I), head and neck radiotherapy alone (level II) and head and neck chemoradiotherapy (level I), using one of the protocols the guideline specifies. For children, the 2021 paediatric guideline uses cryotherapy only for older cooperative children on short melphalan or 5-fluorouracil infusions and photobiomodulation across transplant and head and neck radiotherapy. Topical 0.2% morphine mouthwash is suggested for mucositis pain in head and neck chemoradiotherapy (level III), and honey for head and neck radiotherapy or chemoradiotherapy (level II).

The NCI patient guide (2024) gives the home routine: dentist at least two weeks before, check the mouth daily, extra-soft brush after meals and at bedtime, fluoride toothpaste, no alcohol mouthwash, a baking soda and salt rinse three to four times a day, gentle flossing (ask if platelets are low), keep the mouth moist, soft cool foods, and call if it hurts a lot.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: mouth care during chemotherapy; oral care during chemotherapy; mouth care at home during cancer treatment; mouth sores from chemo; oral mucositis prevention; mouthwash during chemotherapy; salt and baking soda mouth rinse; ice chips during chemotherapy; oral cryotherapy; benzydamine mouthwash; photobiomodulation for mucositis; low-level laser for mouth sores; basic oral care
- Tags: protocol; mucositis; oral-care; supportive-care

## Connected records

- drugs: [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [Melphalan (including hepatic delivery system)](https://onco.cc/drugs/melphalan/), [Palifermin](https://onco.cc/drugs/palifermin/)
- protocols: [Bleeding precautions at home when platelets are low](https://onco.cc/protocols/bleeding-precautions-when-platelets-are-low/), [Dental assessment before head and neck radiotherapy and osteoradionecrosis prevention](https://onco.cc/protocols/head-and-neck-radiotherapy-dental-assessment-osteoradionecrosis/), [Enhanced recovery after major head and neck cancer surgery with free flap reconstruction](https://onco.cc/protocols/enhanced-recovery-after-head-and-neck-free-flap-surgery/), [Mouth care and oral mucositis prevention during head and neck radiotherapy](https://onco.cc/protocols/head-and-neck-radiotherapy-oral-mucositis/), [Preventing mouth sores (oral mucositis) in children having cancer treatment or a stem cell transplant](https://onco.cc/protocols/paediatric-oral-mucositis-prevention/)
- cancers: [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Oral cryotherapy (ice chips) to prevent mucositis](https://onco.cc/technologies/oral-cryotherapy-mucositis/), [Photobiomodulation (low-level laser) for oral mucositis](https://onco.cc/technologies/photobiomodulation-mucositis/)
- institutions: [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/)
- terms: [Mucositis and stomatitis](https://onco.cc/terms/mucositis/)
- ideas: [Ice chips in the chair for every bolus fluorouracil and high-dose melphalan infusion](https://onco.cc/ideas/idea-upgrade-oral-cryotherapy-with-bolus-chemotherapy/)

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