Mucositis / Stomatitis

Oral mucositis as a result of chemo- or radiotherapy

Oral mucositis (ICD10-Code: K12.3) is an inflammation of the lining of the mouth and of the throat. Cancer patients are particularly often affected, since the mucosa are sensitive to chemo- and radiotherapy. The first symptoms can occur after just a few days of treatment.

 

What causes oral mucositis?

Cancer therapy aims to either destroy, or restrict the growth of, malignant tumour cells by preventing cell division. However, the process can also affect the cell division of healthy cells. Since mucosal cells grow quickly and are replaced continuously, patients soon see – and feel – the negative effects, particularly in their oral mucosa. Since radio- or chemotherapy also destroys regeneration of the mucosa, damaged cells are no longer replaced. This leads to damage, particularly in the mouth.

Since the damaged mucosa no longer act as a natural barrier, microorganisms can enter tissue and proliferate more easily too. This can cause very painful inflammation.

 

Frequency

Oral mucositis is one of the most common side effects of cancer therapy, particularly when the head and neck are irradiated, but also during high-dose therapy or bone marrow transplants.

85-100% Head/neck irradiation
70-80% Bone marrow transplants
75% High-dose chemotherapy
40% Standard chemotherapy

Symptoms

Symptoms of oral mucositis include painful alterations in the mucosa such as redness, swelling and soreness. During therapy, serious inflammation and infections in the mouth and throat can make it difficult to eat, swallow and speak; this significantly affects quality of life.

Symptoms of oral mucositis vary according to its severity. The WHO lists different grades ranging from normal, intact oral mucosa to the most serious stage, with agonizing pain.

Extent Symptoms
Grade I Redness, soreness, burning sensation, occasional mild pain;
difficulties with solid food
Grade II Redness, small inflammations; sporadic, tolerable pain;
difficulties with soft food
Grade III Larger inflammations; strong, permanent pain;
even drinking and speaking are increasingly difficult
Grade IV Most serious form with deep ulcers; agonizing pain
….. parenteral nutrition necessary

Bacterial infections or fungal infections such as candida albicans are also possible. Depending on its severity, oral mucositis can cause therapy to be interrupted or discontinued, and can therefore impede the desired therapy outcome.

Preventing mucositis

Before cancer therapy begins, existing dental and gum problems should be treated by your dentist. Other preventive measures include:

  • Intensive daily oral hygiene with regular medicinal mouthwashes
    (6 x daily, before and after meals; at least every 4 hours)
  • Brush teeth 3x daily with a soft toothbrush and a mild toothpaste
  • Avoid mouthwashes that contain alcohol or menthol (these dry out the mucosa)
  • Avoid dental floss, waterpicks and interdental brushes
  • Oil pull therapy before breakfast for deep cleansing and care
  • Remove dentures whenever possible
  • Apply a fat-based lip care cream
  • Drink enough so the oral mucosa stay moist
  • Avoid very acidic or spicy food
  • Cool drinks or ice cubes to relieve pain
  • Limit alcohol and cigarettes as much as possible

Conclusion

Oral mucositis can severely impair patients’ quality of life – particularly when eating, drinking and speaking are always painful, or are no longer possible at all. This promotes the development of malnutrition, and hence prevents the effective therapy on which life depends.

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