Oral mucositis

Oral mucositis (OM) is an acute inflammation of the oral mucosa following systemic cancer therapy, particularly chemotherapy, 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.

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

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

Preventive measures in high-risk patients include palifermin, intraoral low-level laser therapy, and use of oral cryotherapy during chemotherapy infusion.

OM is an acute inflammation of the oral mucosa in response to systemic oncology therapy, particularly chemotherapy, and/or radiation therapy to fields involving the oral cavity.[1]Sroussi HY, Epstein JB, Bensadoun RJ, et al. Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med. 2017 Dec;6(12):2918-31. https://onlinelibrary.wiley.com/doi/10.1002/cam4.1221 http://www.ncbi.nlm.nih.gov/pubmed/29071801?tool=bestpractice.com

The clinical presentation ranges from a general erythematous oral mucosa to erosive lesions and, rarely, overt necrosis. Lesions are often very painful, may compromise nutrition and oral hygiene, and can increase the risk of local and systemic infection.[2]Lalla RV, Saunders DP, Peterson DE. Chemotherapy or radiation-induced oral mucositis. Dent Clin North Am. 2014 Apr;58(2):341-9. http://www.ncbi.nlm.nih.gov/pubmed/24655526?tool=bestpractice.com [3]Elting LS, Cooksley CD, Chambers MS, et al. Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies. Int J Radiat Oncol Biol Phys. 2007 Jul 15;68(4):1110-20. http://www.ncbi.nlm.nih.gov/pubmed/17398022?tool=bestpractice.com

Severe OM may necessitate an undesirable dose-reduction and/or a break in cancer therapy, thereby potentially impacting patient prognosis.[2]Lalla RV, Saunders DP, Peterson DE. Chemotherapy or radiation-induced oral mucositis. Dent Clin North Am. 2014 Apr;58(2):341-9. http://www.ncbi.nlm.nih.gov/pubmed/24655526?tool=bestpractice.com