Oral mucositis

Last reviewed: 25 Aug 2022

Last updated: 12 Aug 2021

Oral mucositis is an acute inflammation of the oral mucosa following systemic cancer therapy and/or radiotherapy. Diagnosis is typically based on clinical history and physical examination.

Clinical presentation varies from erythema to patchy or confluent ulceration with a superficial pseudomembranous membrane or, rarely, overt necrosis.

If severe, may warrant an undesirable dose-reduction and/or a break in cancer therapy.

Lesions are often very painful. Treatment is symptomatic and includes oral hygiene and pain control.

Preventive treatments include palifermin (during hematopoietic stem cell transplantation), low-level laser therapy, and use of ice-chips during chemotherapy infusion therapy.

Definition

Oral mucositis secondary to cancer therapy is an acute inflammation of the oral mucosa in response to systemic oncology therapy and/or radiation to fields involving the oral cavity. The clinical presentation ranges from a general erythematous oral mucosa to erosive lesions and overt ulceration. Lesions are often very painful, may compromise nutrition and oral hygiene, and can increase the risk of local and systemic infection. Furthermore, severe oral mucositis may necessitate an undesirable dose-reduction and/or a break in cancer therapy. Therefore, mucositis is a highly significant complication of cancer therapy, with a potential impact on patient prognosis.[1]

History and exam

Key diagnostic factors

presence of risk factors
erythema or ulceration of oral mucosa
oral pain

More key diagnostic factors

Other diagnostic factors

dietary impairment
diarrhoea
fever

Other diagnostic factors

Risk factors

intensive chemotherapy regimens
radiotherapy to the oral cavity
chemoradiation
genetic polymorphisms in drug metabolic enzymes

More risk factors

Diagnostic investigations

1st investigations to order

clinical diagnosis

More 1st investigations to order

Investigations to consider

FBC and differential
blood cultures
superficial smear of lesion for microscopy
fungal culture
viral culture or polymerase chain reaction (PCR)

More investigations to consider

Treatment algorithm

INITIAL

undergoing haematopoietic stem cell transplant: preventive measures

receiving bolus fluorouracil: preventive measures

receiving radiotherapy to oral cavity: preventive measures

ACUTE

established oral mucositis

Contributors

Authors

Rajesh V. Lalla, DDS, PhD, DABOM

Associate Professor

Associate Dean for Research

Section of Oral Medicine

University of Connecticut School of Dental Medicine

Farmington

Disclosures

RVL serves as a consultant for Galera Therapeutics, Ingalfarma, Mundipharma and Sucampo Pharma, and has received research funding from Onxeo, Sucampo Pharma, Galera Therapeutics and Novartis.

Ourania Nicolatou-Galitis, DDS, MSc, DrDent

Professor

Hospital Dentistry

National & Kapodistrian University of Athens

Athens

Greece

Disclosures

ONG has received fees from Angelini pharma to author a review article on oral mucositis. ONG is an author of several references cited in this topic.

Nikolaos Tsoukalas, MD, MSc, PhD

Medical Oncologist

Associate Director

Department of Oncology

401 General Military Hospital

Athens

Greece

Disclosures

NT declares that he has no competing interests.

Acknowledgements

Professor Ourania Nicolatou-Galitis and Dr Nikolaos Tsoukalas would like to gratefully acknowledge Dr Eleni Arvanitou, who contributed to the updating of this topic, and Dr Rajesh V. Lalla, a previous contributor.

Disclosures

EA declares that she has no competing interests. RVL serves as a consultant for Galera Therapeutics, Ingalfarma, Mundipharma and Sucampo Pharma, and has received research funding from Onxeo, Sucampo Pharma, Galera Therapeutics, and Novartis.

Peer reviewers

Michael Brennan, DDS, MHS

Associate Chairman and Oral Medicine Residency Director

Department of Oral Medicine

Carolinas Medical Center

Charlotte

Disclosures

MB is an author of a reference cited in this topic. MB is part of the Mucositis Study Group of MASCC/ISOO, and participated in the review of mucositis.

Maria Michelagnoli, MB ChB, MD, FRCPCH

Consultant Pediatric and Adolescent Oncologist

University College London Hospitals

London

Disclosures

MM declares that she has no competing interests.

Differentials
- Oral candidiasis
- Herpes simplex virus infection
- Graft-versus-host disease
More Differentials
Guidelines
- Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation
- MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy
More Guidelines
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Oral mucositis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

undergoing haematopoietic stem cell transplant: preventive measures

receiving bolus fluorouracil: preventive measures

receiving radiotherapy to oral cavity: preventive measures

established oral mucositis

Contributors

Authors

Rajesh V. Lalla, DDS, PhD, DABOM

Disclosures

Ourania Nicolatou-Galitis, DDS, MSc, DrDent

Disclosures

Nikolaos Tsoukalas, MD, MSc, PhD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Michael Brennan, DDS, MHS

Disclosures

Maria Michelagnoli, MB ChB, MD, FRCPCH

Disclosures

Differentials

Guidelines

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