ASK DIS: Oral Mucositis : Treatment

Mucositis occurs when cancer treatments break down the rapidly divided epithelial cells lining the gastro-intestinal tract (which goes from the mouth to the anus), leaving the mucosal tissue open to ulceration and infection
most common, debilitating complication of cancer treatments, particularly chemotherapy and radiation.
can lead to several problems, including pain, nutritional problems as a result of inability to eat, and increased risk of infection due to open sores in the mucosa.
It has a significant effect on the patient’s quality of life and can be dose-limiting

Oral debridement

Because patients with oral mucositis lesions are frequently neutropenic and thrombocytopenic, perform oral debridement with caution because toothbrushing can cause gingival bleeding and, more importantly, result in transient bacteremia.
Mucolytic agents, such as Alkalol, help to soften and dislodge them.

Oral decontamination (mouth care)

This regimen consists of antifungal and antibacterial rinses.
Antibacterial rinses with chlorhexidine are effective in reducing the overall bacterial load in the oral cavity.
Mucositis Study Group of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology advocate not using chlorhexidine in patients with solid tumors of the head and neck who are undergoing radiotherapy
It is important to not use any medicine containing alcohol because it will burn the mouth
Candidal prophylaxis usually includes nystatin rinses or clotrimazole troches. None of these treatments has been shown to specifically reduce the risk of developing oral mucositis.

Topical and systemic pain management

Pain in patients with oral mucositis may be severe and not just limited to the oral mucosa. Local rinses (eg, 2% viscous lidocaine, magic mouthwash preparations, and topical morphine solution (0.2%)) and systemic analgesics are used together to control pain.
"miracle mouthwash" consists of a mixture of equal parts of viscous lidocaine, diphenhydramine, and magnesium aluminum hydroxide (Maalox).
Topical solutions should be kept in the mouth from 2-5 minutes, as tolerated.
Orabase B (OTC) is an adhesive paste with a topical anesthetic (benzocaine) that may be helpful.
Frequent rinsing with sodium chloride solution helps to keep the mucosa moist, reduces caking of secretions, and soothes inflamed/ulcerated mucosa.
Pain may be severe enough to require systemic oral or parenteral opiates. Morphine is recommended as the opioid of first choice for patient-controlled analgesia
The oral route is preferred if the patient can swallow. Another option that is suitable for patients who cannot swallow is transdermal fentanyl

Prophylaxis/prevention

Patients should suck on ice chips for 30 minutes prior to and during the chemotherapy infusion.
Palifermin (keratinocyte growth factor) is FDA approved for the prevention of oral mucositis in patients undergoing hematopoietic cell transplantation (HCT) with myeloablative conditioning (see below).
Neither antiviral nor antifungal prophylaxis prevents mucositis.

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