What is it?
Mucositis is inflammation of the mucosa which is lines the gastrointestinal tract. Characterized by mouth sores, intraoral mucosal redness, tissue sloughing, and a burning sensation, mucositis is an acute side effect associated with radiation treatment, chemotherapy, and stem cell transplants. It may affect any tissues in the oral cavity but is more commonly seen on movable mucosa such as the buccal mucosa (cheeks), lips, tongue and soft palate. Not just limited to the oral cavity, mucositis may affect the GI tract including the pharynx and esophagus. Mucositis differs from stomatitis (stoma is the Greek word for mouth) which encompasses inflammation of the oral cavity including non-mucosal tissue.
Often painful, mucositis may preclude patients from oral intake of food and fluids resulting in malnutrition and weight loss. Unfortunately, mucositis sometimes may be complicated by secondary infections as the ulcerations may serve as an entry point for pathogens to the systemic circulation.
Who does mucositis affect?
Not all patients experience mucositis, and the severity of mucositis is highly variable. Among other risk factors, poor oral hygiene is associated with mucositis along with tobacco and alcohol usage. Mucositis is an acute condition meaning that it will resolve after completing treatment.
When does mucositis occur?
In patients undergoing head and neck radiation therapy, mucositis is most commonly seen in the second week of radiation therapy.
In patients undergoing dose chemotherapy, it is also normally seen two weeks after administering high dose chemotherapy at which point the neutrophil counts have dropped. There seems to be an increased risk of developing mucositis after the first administration of chemotherapy.
When does mucositis resolve?
Mucositis resolution is directly related to an increase in neutrophils. Commonly, mucositis resolves in patients undergoing chemotherapy within two weeks after cessation of chemotherapy.
Patients undergoing head and neck radiation treatment often notice a resolution six to eight weeks after completing radiation treatment.
Which chemotherapies and anti-cancer treatments are often associated with mouth sores?
There are several treatments associated with mouth sores. The following medications may present with mouth sores (please note that this list is not a complete list of medications associated with oral ulcers):
bleomycin
fluorouracil
mTOR inhibitors
platininum complexes containing cisplatin and carboplatin
busulfan
doxorubicin
cyclosporine
methotrexate
melphalan
Can mucositis be prevented?
We cannot predict whether or not a patient will develop mucositis. Nonetheless, the literature suggests that the duration and severity of mucositis may be exacerbated by poor oral health and poor oral hygiene. In other words, maintaining excellent oral hygiene is recommended.
How do we treat mucositis?
As mentioned above maintaining excellent oral hygiene is recommended, and visiting a dentist prior to undergoing high dose chemotherapy or head and neck radiation therapy is recommended to eliminate any sources of infection. Depending on the severity and other symptoms associated with mucositis, there are several treatments that may help with treating the pain as well as the infections that may complicate mucositis.
Further reading
Little, James W. Dental Management of the Medically Compromised Patient. St. Louis: Mosby, 2002. Print.
Oral Complications of Cancer Treatment: What the Dental Team Can Do. NIH, n.d. Web. 4 Dec. 2014.
"Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®." National Cancer Institute. N.p., n.d. Web. 19 Nov. 2014.
Neville, Brad W. Oral and Maxillofacial Pathology. St. Louis, MO: Saunders/Elsevier, 2009. Print.