Oral mucositis is an acute inflammation of the oral mucosa following systemic cancer therapy and/or radiation therapy. Diagnosis is typically based on clinical history and physical exam.
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.
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.
History and exam
Key diagnostic factors
- erythema or ulceration of oral mucosa
- oral pain
Other diagnostic factors
- dietary impairment
- intensive chemotherapy regimens
- radiation therapy to the oral cavity
- genetic polymorphisms in drug metabolic enzymes
1st investigations to order
- clinical diagnosis
Investigations to consider
- CBC and differential
- blood cultures
- superficial smear of lesion for microscopy
- fungal culture
- viral culture or polymerase chain reaction (PCR)
undergoing hematopoietic stem cell transplant: preventive measures
receiving bolus fluorouracil: preventive measures
receiving radiation therapy to oral cavity: preventive measures
established oral mucositis
Rajesh V. Lalla, DDS, PhD, DABOM
Associate Dean for Research
Section of Oral Medicine
University of Connecticut School of Dental Medicine
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
National & Kapodistrian University of Athens
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
Department of Oncology
401 General Military Hospital
NT declares that he has no competing interests.
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.
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.
Michael Brennan, DDS, MHS
Associate Chairman and Oral Medicine Residency Director
Department of Oral Medicine
Carolinas Medical Center
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
MM declares that she has no competing interests.
- Oral candidiasis
- Herpes simplex virus infection
- Graft-versus-host disease
- 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
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