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Oral mucositis

Last reviewed: 28 Oct 2023
Last updated: 12 Aug 2021



History and exam

Key diagnostic factors

  • erythema or ulceration of oral mucosa
  • oral pain
More key diagnostic factors

Other diagnostic factors

  • dietary impairment
  • diarrhea
  • fever
Other diagnostic factors

Risk factors

  • intensive chemotherapy regimens
  • radiation therapy 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

  • CBC 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


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 Professor

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


Hospital Dentistry

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

Medical Oncologist

Associate Director

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.

Peer reviewers

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 mucositis images
  • 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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