Recommended Products for
Oral Mucositis
Mouthwashes
Magic Mouthwash
Magic Mouthwash is a catch-all name for different versions of Oral Mucositis mouthwashes. Other names for formulations with the same purpose include Duke’s Mouthwash and Mary’s Mouthwash. There is no consistent recipe for Magic Mouthwash, the formula depends on your physician or pharmacist who have their own recipes, but it typically contains three or more of the following ingredients: anesthetic, antacid, antihistamine, antibiotic, antifungal, corticosteroid, and other agents including alcohol.
Magic Mouthwash does not help heal Oral Mucositis, but it helps with pain and inflammation, in addition to helping keep the mouth clean.
Even though Magic Mouthwash is the most recommended option for Oral Mucositis, it’s important to note the college of nursing explicitly advises against it on their “Choosing Wisely” guidance. Additionally, recent studies have shown Magic Mouthwash is no more effective than salt and sodium bicarbonate rinses. View additional Magic Mouthwash study here.
Use: Use 2-4 times a day or every 3-6 hours, and hold liquid in the mouth for 1-2 minutes before spitting. Wait 30 mins before eating or drinking
Dose: Recommended amounts vary, but they can range from 0.3-1 oz per use
Cost: Magic Mouthwash is sometimes covered by insurance, but it can range from $34 - $84 for 8 oz which is a 2-4 day supply or up to $42/day
Dexamethasone
Dexamethasone rinses are usually alcohol-free steroid mouthwashes. This mouthwash helps manage mucosal inflammation and is usually prescribed for patients at risk of developing or already experiencing Oral Mucositis. It typically requires mixing and preparation.
Use: Swish the prepared mixtures for 30 seconds and then spit the solution. Wait 30 mins before eating or drinking
Dose: 0.25-5 ml per day, depending on physician directions. The total daily dose can be split into smaller doses taken 2-4 times per day
Cost: $69 per bottle or $5.75/day
Benzydamine Hydrochloride
Benzydamine is a locally acting nonsteroidal anti-inflammatory drug with local anaesthetic and analgesic properties for pain relief and anti-inflammatory treatment of inflammatory conditions of the mouth and throat.
Use: Rinse or gargle the mixture for at least 30 seconds, then spit. Use every 1.5-3 hours or as directed by a physician
Dose: 15 ml per use.
Cost: $80 per bottle or $40/day, but overall cost depends on brand, location, and insurance
Glutamine Products
Glutamine or L-Glutamine is an amino acid commonly found in protein-rich foods such as eggs and meats. This amino acid plays an essential role in the repair of damaged cells. Glutamine has been known to help with gut function, healing, muscle repair, and neuropathy. Glutamine also plays a major role in the maintenance of the intestinal mucosa; the layer that lines and protects your mouth and digestive tract.
Unlike standard mouthwashes, Glutamine products don’t contain analgesics for the pain, but they can help with healing, and can help reduce the severity and duration of Oral Mucositis. In most cases, mouthwashes and glutamine products can be used in conjunction as long as they are staggered throughout the day. Always check with your medical team.
Healios
Healios is a Glutamine-based nutritional supplement specially formulated by oncologist Dr. Peter Anderson, for patients with Oral Mucositis. The main challenge with Glutamine supplementation has been absorption. However, the ingredients found in the Healios’ formulation have been shown to boost uptake of Glutamine by the cells lining the mouth and throat at more than 100-fold compared to solutions with Glutamine alone. This product comes in three different flavors (orange, grape, and unflavored), as a light and refreshing swish-and-swallow solution, and promotes healthy mucosal lining in the mouth, throat, and esophagus.
Use: Mix 1 scoop of Healios with 25-100 ml of water, swish for 10 seconds, spit or swallow. Healios can also be mixed with other water-like solutions, such as apple juice.
Dose: 2 scoops per day
Price: $69 per container (a two week supply) or $4.90/day
Juven
Juven is a Glutamine-based powder made by Abbott. It’s meant to support nutrition and wound healing such as pressure and diabetic foot ulcers, surgical incisions, burns and acute or chronic wounds. Although, it’s not made specially for cancer patients with Oral Mucositis, some healthcare providers recommend it. Juven can be used orally, by gastrostomy, or by nasogastric feeding tube. This product comes in three flavors (orange, fruit punch, and unflavored) and it contains HMB, Arginine, Collagen, and vitamins C, E, and B12.
Use: Mix 1 pack of Juven with water, or soft foods
Dose: 2 packets per day
Price: $80 for 30 packets; $5.30/day
Glutasolve
Glutasolve is a Glutamine powder made by Nestle. It’s used for tube feeding, peripheral neuropathy, and it’s meant to be mixed with soft foods such as yogurt, apple sauce, or pudding. Like Juven, this options isn’t made specifically for cancer patients at risk for Oral Mucositis, but it has been recommended as an option to supplement the body with Glutamine. In addition to Glutamine, this product contains Maltodextrin which is a starch-like powder that improves flavor, thickness, and shelf life. This product is not for IV use.
Use: Mix 1 pack into 4 fl oz of water, or with soft foods such as yogurt, or apple sauce
Dose: 2-3 packs per day
Price: $135 for a pack of 56 or $4.90/day
Cryotherapy
Cryotherapy or the application of ice can be used to manage pain, reduce inflammation, and reduce the likelihood of developing Oral Mucositis. This approach is a preventative option for cancer patients undergoing chemotherapy, but not for patients going through radiation.
Ice chips
This option requires you to apply ice to the mouth during chemotherapy infusions. You can suck on ice chips, or you can try eating and drinking cold foods. This method works because the cold helps decrease blood flow to the mouth. Since blood flow is reduced, this means the chemotherapy agents that would usually reach your mouth and cause damage are also diminished.
The Chemo Mouthpiece
In addition to ice, cryotherapy devices such as the Chemo Mouthpiece exist. This device acts as a custom ice pack for the mouth that can uniformly cool the oral cavity. This device can be reused and it’s meant to comfortably fit inside the mouth.
Use: Insert or apply inside the mouth during chemotherapy.
Mucosal Protectants/Bioadhesives
Mucosal protectants or mucoadhesives are substances that act like a bandaid, coating and protecting the inside of the mouth. There are different types and most come in the form of mouthwashes. It’s important to note, that if you are using mucosal protectants in conjunction with others products, you’ll need to stagger their use. These mucoadhesives create a protective barrier that can prevent other products from acting as desired.
Prevention Oncology
Prevention Oncology mouthwash is alcohol-free and it contains hydrogen peroxide, sodium citrate, zinc, and glycerin. It provides temporary pain relief to irritated areas of the mouth, lips, and throat, and rehydrates and moisturizes the oral cavity to alleviate dry mouth symptoms. It also helps keep the mouth clean and it contains natural menthol and peppermint oil for freshness.
Use: Rinse 3 – 5 times a day
Dose: 10 ml or 1 cap (included in the packaging) per use
Cost: $14 per bottle or up to $2 per day
Gelclair
Gelclair is also an alcohol-free mucoadhesive that works to soothe the mouth by adhering to the mucosal surface and protecting it. This product comes in the form of portable gel packets that can be applied directly, or can be diluted with water to help with swishing.
Use: Mix 1 single-dose packet into a glass and mix with 15 ml of water. If needed, you can dilute the packet in up to 45 ml of water. Use immediately and rinse around the mouth for at least 1 minute. Garble and then spit. Wait 30-60 min before eating or drinking. Use 3 times a day
Dose: 1 single-dose packet per use
Cost: $60 for a pack of 12 or $15/day. Cost can be lower if purchased in bulk
Episil
Episil is a preservative-free, liquid spray that coats the mouth and creates a protective film. The product contains peppermint for freshness and relieves oral pain within 5 minutes and for up to 8 hours.
Use: Spray with 1-3 pumps of Episil to the affected area. Help distribute the liquid around the mouth by using your tongue. Use 2-3 times per day
Dose: 1-3 pumps per use
Cost: $155 per 10 ml container (~66 applications) or $22/day
Honey
Honey is sometimes recommended for Oral Mucositis. Honey contains several vitamins such as B complex, vitamin C, and minerals. New studies show that when applied topically, the coating properties of honey can help protect sores and prevent infections, while its moisturizing properties can help promote healing. These findings makes honey a practical addition to an Oral Mucositis treatment plan, but it shouldn’t be used alone.
Use: Coat the inside of the mouth and apply on mouth sores
Dose: Apply throughout the day as needed
Price: Prices vary by source
Lubricants
Lubricants are sometimes prescribed or recommended for patients with Oral Mucositis. Because chemotherapy and radiation treatments tend to cause dry mouth, the lack of moisture can irritate and worsen the lesions and sores that develop. These lubricant’s won’t mitigate pain or help the mouth sores heal, but they can offer some relief and comfort. Some popular options are Biotene and Caphosol.
Remember to always check with a medical professional to make sure the products you select match your health and treatment needs.