Medical Oncologist
Mouth care
A daily mouth care routine for chemotherapy
Rinse with salt and baking soda water several times a day. Brush gently twice with a soft brush. Sip water through the day. Look inside the mouth once daily with a torch. That is the whole routine and it takes under ten minutes. Nearly all of the benefit comes from doing it from the first day of each cycle rather than starting once the mouth is already sore.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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The short answer
What does the daily mouth care routine actually involve?
Rinse with salt and baking soda water several times a day. Brush gently twice a day with a soft brush. Sip water through the day. Look inside the mouth once a day with a torch. That is the whole routine, and it takes under ten minutes across the day.
The reason it deserves a page of its own is that almost all of the benefit comes from doing it consistently from the first day of each cycle, rather than starting when the mouth is already sore. Prevention is far more effective here than treatment.
Write it out and stick it up
This is a routine that fails because people forget, not because they disagree with it. Copy the steps below onto a sheet of paper and put it where the person actually is — by the washbasin, or beside the bed if they are not moving much. A caretaker should tick it off rather than remember.
If you are the attendant, take responsibility for the daily look inside. It is the step most often skipped and the one that catches problems early.The routine
What to do, through the day
Copy this out. Tick each one off rather than trusting memory during a difficult week.
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On waking
Rinse with salt and baking soda in cooled boiled water, swished gently and spat out. Then brush gently with a soft brush and a mild fluoride toothpaste. Apply lip balm.
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After breakfast
Rinse again. This is also the easiest moment for the daily look inside, in good light, with the tongue lifted and the cheeks pulled out.
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Mid-morning and through the day
Sip water steadily rather than drinking only at meals. Rinse again mid-morning. If the mouth is sore, rinse more often — up to every couple of hours while awake.
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Before and after lunch
Rinse before eating as well as after. A clean mouth hurts less and tastes more, and both make the meal go better.
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Evening
Rinse after the evening meal. Take dentures out and clean them. Check whether anything has changed since the morning look.
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Before bed
Brush gently again, then rinse. Leave dentures out overnight. Put water within reach of the bed, because the mouth dries most overnight.
Not sure whether this applies to you?
Ask an oncologistThe kit
What to keep in the house from the first cycle
- A soft or extra-soft toothbrush, replaced monthly and after any infection
- A mild fluoride toothpaste, without whitening agents or strong mint
- Salt and baking soda, and a clean glass kept only for rinsing
- A pan for boiling drinking water, and a covered jug to cool it in
- A torch for the daily look, so the back of the mouth is actually visible
- Lip balm, because cracked lips break down the same way the lining does
- A denture container, so they can be left out overnight
- A thermometer, and the helpline number written where the whole house can see it
- A sheet of paper for the daily ticks and anything noticed
!
Stop the routine and go in the same day
A fever · a mouth too sore to drink · white patches with pain and difficulty swallowing · bleeding from the gums that will not settle · facial swelling. Go to the nearest emergency department and say clearly that the person is on chemotherapy. Do not give paracetamol and wait to see how the night goes, and do not start a leftover antibiotic from home. No amount of rinsing addresses any of these.
The one recipe
Making the rinse, and the daily look
Boil about a glass of water and let it cool to room temperature. Add a small pinch of salt, roughly a quarter of a teaspoon, and the same of ordinary cooking soda. It should taste faintly salty rather than like sea water. Swish gently for about half a minute and spit it out. Make it fresh each day.
If the soda makes them gag
Leave it out and use plain mild salt water. A rinse that is actually used beats a better one that is refused. Cooling it slightly helps too.
The daily look, in a minute
Good light, a torch, and someone else doing the looking if possible. Lift the tongue and look underneath. Pull each cheek out and look at the inside. Look at the roof of the mouth and as far back as is comfortable. You are checking for ulcers, white patches, redness and bleeding.
What to write down
Anything new, and whether eating or drinking has been affected. One line is enough. It is what turns "the mouth has been a bit sore" into something an oncologist can act on at the next appointment.
Keep rinsing between cycles, not only on the bad days. That is where the prevention happens.Leave a number, we will call you
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Being straight with you
What this page cannot tell you
It cannot tell you whether your treatment needs anything more than this. Some schedules affect the mouth heavily and your team may want to add preventive measures, a prescribed rinse or pain relief. Ask what applies to you rather than assuming the basic routine is the whole answer.
It also cannot tell you what you are looking at during the daily check. Treatment ulcers, a fungal infection, a cold sore and a dental problem all look broadly similar to someone who is not used to seeing them, and they are treated completely differently. The check is for spotting change, not for diagnosis.
What to do next
Copy the routine onto paper and put it where the person is. Gather the kit today rather than when it is needed. Start the rinsing from day one of the next cycle even if the mouth is fine, and keep one line of notes per cycle to take to the appointment.
Questions we are asked
Common questions about the daily routine
How many times a day should the rinse be done?
Four to six times a day as a baseline — after meals, on waking and before bed. If the mouth is sore you can go more often, up to every couple of hours while awake. Frequency matters far more than strength; a mild rinse used often beats a strong one used twice.
Is there a printable version?
The most useful version is the one you write out yourself onto a sheet and stick by the washbasin, because it can carry your own notes and the helpline number. Ask the day-care nurse to check it over at your next visit and add anything specific to your treatment.
Should we start before the mouth is sore?
Yes, and this is the most important part. Mouth soreness usually appears several days after a cycle, so starting on day one means the mouth is already being cared for when the lining begins to thin. Waiting until it hurts means catching up rather than preventing.
Can the routine be done for someone who is bedbound?
Yes, with adjustments. Sit them as upright as is safe, use a very soft small brush with a little water, and work in short sessions. Soft swabs help where a brush will not reach. Ask the nursing team to demonstrate once in person — doing it safely is easier shown than described.
What if brushing causes bleeding?
Keep brushing, more gently, with a softer brush, and use plain water if toothpaste stings. Some bleeding is expected when platelets are low. Bleeding that does not stop after a few minutes, or that starts without brushing, should be reported the same day.
Do we need a special mouthwash as well?
Usually not. The salt and baking soda rinse is what most teams recommend, and anything containing alcohol should be avoided during treatment. If your team has prescribed a medicated rinse, use it as instructed alongside the routine rather than instead of it.
How long should we keep this up?
Right through treatment, including the good weeks between cycles, and for some weeks after the last cycle while the lining finishes repairing. Many people also find it worth keeping the habit of the daily look for a while afterwards.
Is any of this different for a child?
The principles hold but the practicalities differ, particularly around whether a child can reliably spit rather than swallow a rinse. Ask the paediatric team for their own instructions rather than adapting adult advice, and expect them to have a version suited to the age.
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Sources
- National Cancer Institute — Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ)
- Cancer Research UK — Mouth problems and cancer drugs
- Macmillan Cancer Support — Mouth care during cancer treatment
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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