One of the most common complications occurring as a result of the two types of oncologic treatment, chemotherapy and radiation, is that of oral mucositis.
In medical terms, it is the acute inflammation and ulceration of the oral mucosa whose integrity is compromised by the damage of rapidly divided epithelial cells that line the gastrointestinal tract, incidental to chemotherapy and/or radiation therapy involving head and neck area.
Oral Mucositis is a debilitating condition that causes severe clinical and psychological effects. The severity and burden of its symptoms consist the borderline that differentiates simple mouth ulcers in healthy individuals from oral mucositis. In matter of fact, the impacts of this condition on patient’s life is so dramatic that may compromise ongoing life-saving cancer treatment and impede the proper application of therapeutic protocols.
In conclusion, the successful relief of other two cancer treatment induced complications, nausea and neutropenia, makes oral mucositis the most severe and dose-limiting side effect of chemotherapy and radiotherapy.
-Erythema (redness) in well defined areas in the oral cavity.
-Swollen mouth or gums.
-Sense of burning
-Presence of blood in the mouth
-Discomfort and pain that sometimes precede discernible lesions of tissues in mouth and throat.
-In the course of this condition, painful ulcerations are emerging on the insides of lips and cheeks and both sides and underside of tongue.
|Grade||Pain||Erythema||Ulcerations||Swallow Liquids||Swallow Solid Foods|
1.Who develops mucositis?
70%-100% of patients receiving chemotherapy and/or head-neck radiotherapy is expected to develop oral mucositis.
Oral mucositis is also associated with preparation for hematopoietic stem cell transplantation (HSCT).
Factors that may affect prevalence and severity of this pathogenic entity are:
Α. Therapy-related factors, such as:
-Type of chemotherapeutic agents used to date.
-Duration of cancer treatment.
Perceptibly, mucosa toxic agents are Actinomycin D, Cisplatin, Docetaxel, Methotrexate, 5-Fluorouracil, Doxorubicin, Picamycin, Pembrolizumab, mTOR inhibitors (Everolimus) and many more.
Β. Patient-related factors, such as:
-Poor dental health.
-Hyposalivation- reduction of saliva’s buffering capacity and of oral IgA leads to the development of infectious oral flora.
-Vitamin D and B12 deficiencies.
-Gender – women more often develop mucositis than men.
-Low body mass index ( BMI ).
2.When does oral mucositis occur?
It usually occurs 5-10 days after the initial administration of chemotherapy while for radiotherapy it takes 2-3 weeks to develop after the beginning of treatment.
A sense of burning, soreness and erythema may precede extended lesions.
3.How long does oral mucositis last?
Resolution of oral mucositis clinical signs is expected from one week to six or more after the administration of last chemotherapeutic dose and always depending on chemotherapeutic regimen, dose intensity, duration of treatment, the course of hepatopoietic recovery and the concomitance of other patient related factors.
Concerning radiotherapy related mucositis, the course of the disease is more chronic and healing is expected 2-5 weeks after the cessation of radiotherapy treatment, depending on radiation source, cumulative dose and patient’s immunocompetence.
4.What is the impact of Oral Mucositis?
Oral mucositis is the most serious complication of both cancer treatments, chemotherapy and radiotherapy involving head and neck.
Patients suffering from Oral Mucositis are having to face with a cluster of symptoms where prevails severe pain that causes difficulties in chewing and swallowing.
As a consequence to that, patients are becoming eventually unable to eat, drink or even speak.
The subsequent restriction on food intake can lead in Η στthe use of feeding tubes trying to compensate for life-threatening weight loss, muscle mass reduction and electrolyte disorders.
Pain dramatically affects patients’ quality of life while it can also lead to depression.
-Cancer treatment interruption
Oral mucositis is a dose-limiting side effect that endangers anticancer treatment continuity, imposes modification or even more cessation of therapy while compromises treatment’s efficacy and patient’s life itself.
Oral mucositis compromises the integrity of oral mucosa so that ulcerations serve as an entry to pathogenic micro-organisms.
Very often oral mucositis and neutropenia which dilutes patient’s immunological response are concomitants.
That involves the risk of systemic infection as bacteria from a localized infection invade systemic bloodstream.
In many cases, neutropenic patients with oral mucositis develop oral infections with multi-drug resistant bacteria, something that complicates treatment.
One serious impact of oral mucositis is the necessity of hospital admission for parenteral nutrition and intravenous administration of strong analgesics and antibiotic treatment.
Measurements that can be beneficial aiming prevention and management of OM are:
Patients that are about to undergo any anticancer treatment are highly recommended to have an accurate oral assessment by a specialist prior to treatment. That includes dentures for ill-fitting dentures should be removed.
Meanwhile, patients must be encouraged to regularly examine their oral cavity and report any kind of symptom -pain, bleeding, swelling- to their attending doctor.
Oral Hygiene Maintenance
-Gentle teeth, gums and tongue brush, two (2) to four (4) times daily.
-The use of a soft toothbrush is highly recommended in order to prevent injury or further irritation of the afflicted area.
-Toothbrushes must regularly be replaced at least once a month.
-Brush teeth after meals and before bedtime.
-Avoid intake of hard, sharp, spicy, salty and acidic foods for they can cause additional damage or worsens existing lesions.
-Make sure that dentures fit well. After meal, remove, clean with soap and rinse thoroughly with water.
-Drink water for adequate hydration.
-Mild mouth rinses and gargles using water or physiological saline solutions four (4) times a day.
-Keep lips moistened by using lubricants or lip balms.
-Regularly examine your oral cavity and immediately refer to your attending doctor or dentist if any symptom occurs.
-Immediate smoking cessation
-Alcoholic beverages avoidance