Oral Mucositis (Stomatitis)
TOPIC SEARCH: Radiotherapy and: PubMed
Cancer Treatment and Mucositis: PubMed
Oral mucositis is an inflammation of the mucous membranes in the mouth. It can range from redness to severe ulceration. This is a side effect associated with many standard cancer treatments, particularly chemotherapy. The consequences can range from mild to severe.
Mucositis "occurs when cancer treatments break down the continually dividing epithelial cells lining the GI tract, particularly in the oral cavity, leaving the mucosal tissue open to ulceration and infection. It can occur anywhere along the digestive tract from the mouth to the anus."
Stomatitis (mouth and oropharynx), oesophagitis (oesophagus), gastritis (stomach), enteritis (small intestine), colitis (colon), proctitis (anus) and vaginitis (vagina) are all examples of mucositis.
Source: GONG Cancer Guidelines
Patients have reported that oral mucositis is a distressing side effect of standard-dose chemotherapy, occurring in approximately one third of patients. Source: professional.cancerconsultants.com
Mucositis is painful and can affect nutrition, increase your risk of infection, and can delay or limit treatment. It can lead to major complications after or during cancer treatment.
Good oral hygiene practices are thought to reduce pain, bleeding, infection, and dental complications (Rubenstein et al 2004).
Potential complications include:
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Infection, such as herpes simplex virus, candida albicans and other opportunistic agents
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Bleeding from non-intact mucous membranes
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Pain, secondary to lesions
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Decreased dietary intake leading to dehydration and poor nutritional status
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Diarrhea or constipation
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The inability to talk comfortably may lead some patients
with severe oral mucositis to suffer from depression
Adapted from GONG Cancer Guidelines
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Treatment for mucositis should be guided by your doctor.
In general, hydration should be maintained with oral fluid intake and regular care of mucous membranes, such as regular mouth care with a soft brush is recommended to reduce incidence of complications.
In the News
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Clinical Oncology: Management of Oral Mucositis in Cancer Patients
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Education on Preventive and Management Practices, and Related Services:
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Related Services:
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Dietician for dietary education
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Medical Provider education on assessment, management and prevention of mucositis
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Dentist for treatment of dental disease before commencement of treatment for cancer
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Education on Preventive and Management Practices
Ask your health care provider:
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How to assess and report changes in oral mucous membranes at home
including changes to vaginal and rectal mucous membranes
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Mouth care regime:
Regular cleaning of teeth and gums with a soft toothbrush or swab as tolerated
Cleaning dentures daily and leaving out when at rest and whenever a mouthwash is used;
Gums and areas under a denture should be brushed on a regular basis
Your doctor might recommend rinsing mouth after all meals with
a warm salt water or sodium bicarbonate mouth rinse.
(Avoid mouthwashes containing irritants, such as alcohol, phenol or chlorhexidine).
Sucking on ice cubes may ease discomfort (check that water source is pure)
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Avoid hot food and drinks, spicy food, alcohol and smoking
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Lubricate lip and mouth as necessary
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Discuss use of topical anesthetics and analgesics if necessary.
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Discuss strategies to prevent risks associated with sexual activities
Avoid trauma to the genital areas such as the use of tampons,
suppositories, chemical irritants from deodorants, and
vaginal or anal intercourse until areas have recovered.
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Discuss need to maintain good hygiene, including encouragement of bathing and cleaning
after each urination and bowel movements.
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Discuss need to report bleeding from non-intact mucous membranes
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Adapted from GONG Cancer Guidelines
Resources on Mucositis
Oral Mucositis WebMagic Patient Tips:
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It is called magic mouthwash but to tell you the truth, I used frozen things like popsicles. I was advised to even start with ice chips during my treatment and continue with very cold things.
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This is the recipe for "Magic Mouthwash" that the onc nurse gave me....
Equal parts of hydrogen peroxide and water, mixed together.
Swish around in mouth, DO NOT GARGLE OR SWALLOW.
ALWAYS ASK YOUR ONCOLOGIST BEFORE TRYING THIS OR ANYTHING NEW.
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I used CAPHOSOL®. It tasted almost like a salt water rinse. I found it worked longer than the magic mouthwash and didn't have any aftertastes which I was sensitive to at the time.
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Much sympathy to your friend. I got nailed with sores pretty hard after the first round of chemo and the doctor gave me a life-time supply of CAPHOSOL®. It did help, and it had some cool geek cred because its two liquid components come in separate plastic ampules which have to be mixed.
It did not, however, represent a dramatic improvement over the saline/baking soda solution. I found that being really diligent about rinsing regularly, regardless of whether I felt any sores oncoming or not, was the best routine for me.
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Oral Mucositis Research News and Resources
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Chlorhexidine prophylaxis for chemotherapy- and radiotherapy-induced stomatitis:
a randomized double-blind trial. Oral Surg Oral Med Oral Pathol. 1990 Mar;69(3):331-8.
PMID: 2179802 PubMed
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A controlled evaluation of chamomile for preventing stomatitis in patients receiving 5-fluorouracil based chemotherapy asco.org
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Mayo Clinic on chemo mouth sores: what causes, which days are worst, how to help prevent, how to cope. http://bit.ly/78jiYn
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Preventing / managing oral mucositis (resources) - common and serious side effect related to high dose therapy and stem cell transplantation Abstract
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A prospective, randomized study of cryotherapy ...
[ice chips and ice-cold water shortly before, during, and for additional 90 min after completion of treatment] ... during administration of high-dose melphalan to decrease the severity and duration of oral mucositis in patients with multiple myeloma undergoing autologous peripheral blood stem cell transplantation. Bone Marrow Transplant. 2006 Jun;37(11):1031-5. PMID: 16633359
Compared to the normal saline group, patients using cryotherapy experienced less grade 3-4 mucositis, 14 vs 74%, P=0.0005. Patients receiving cryotherapy also had statistically
lower uses of narcotics and TPN, although there were no differences in length of
hospitalization or weight loss. Patient-reported pain was significantly lower and
activities were significantly better in the cryotherapy group.
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Oral thrush
Oral thrush presents as distinctive lesions of the mouth, tongue, or cheeks -- caused by infection of the mouth with the fungus (yeast) Candida albicans.. Lesions are easily brushed away revealing a reddened, tender area that may bleed slightly." MedlinePlus
Loss of taste sensation is called Ageusia.
Anosmia is the technical name for loss of smell.
These are expected side effect of localized radiation treatment, which can improve with time. These effects can have " devastating physical and psychological consequences for the patient. Oral complications include xerostomia, dental decay, mucositis, taste loss, osteoradionecrosis, infection, and trismus. In many instances, these problems can be eradicated or controlled with appropriate treatment."
"As the effects of the treatment fade away things return to normal, but it may take up to a year for your sense of taste to return." source cancerbacup.org.uk
Consulting a nutritionally oriented health professional is advised to determine nutritional deficiencies that may contribute to the problem, as well as nutrients that might help to rebuild the cells damaged by treatment, such as Zinc, and vitamin B-12, glutamine.
About oral thrush CDC
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Information from Merck Manual
"Depending on the cause of the taste disorder, a doctor may recommend changing or stopping a suspected drug, keeping the mouth wet by sucking on candy, or just waiting several weeks to see if the problem disappears. Zinc supplements, which can be purchased without a prescription, are claimed to speed recovery, especially from taste disorders that follow a bout of the flu. The effect, however, has not been scientifically confirmed."
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Taste and smell impairment CancerSupportiveCare
"The cells comprising taste buds usually will regenerate within four months after treatment. However, the degree of long-term impairment of taste is quite variable from patient to patient."
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Impaired taste info MedlinePlus
"Vitamin (Vitamin B-12) or mineral (Zinc in diet) deficiency"
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Disorders of taste and smell eMedicine.com
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