From the Guidelines
The management of oral mucositis secondary to chemotherapy should prioritize preventive measures such as oral care protocols and cryotherapy, alongside treatment approaches including pain management with topical anesthetics and systemic analgesics, as recommended by recent guidelines 1. The goal is to reduce morbidity, mortality, and improve quality of life for patients undergoing chemotherapy. Key preventive measures include:
- Oral care protocols, which the panel suggests should be used to prevent oral mucositis in all age groups and across all cancer treatment modalities (III) 1
- Cryotherapy, which the panel recommends for patients receiving bolus 5-fluorouracil chemotherapy (II) 1
- Low-level laser therapy, recommended for patients receiving HSCT conditioned with high-dose chemotherapy, with or without total body irradiation (II) 1 Treatment approaches for oral mucositis focus on pain management and include:
- Topical anesthetics such as 2% viscous lidocaine, benzocaine, or dyclonine hydrochloride rinses used every 2-3 hours
- Systemic analgesics including NSAIDs or opioids for more severe pain, with the panel recommending patient-controlled analgesia with morphine for patients undergoing HSCT (II) 1
- Anti-inflammatory agents like benzydamine hydrochloride mouthwash, which may reduce severity
- Coating agents, though sucralfate mouthwash is recommended against for prevention and treatment in several contexts 1 It's also crucial to address secondary infections with appropriate antifungals (nystatin suspension or fluconazole) or antivirals (acyclovir) based on clinical presentation, and to provide nutritional support focusing on soft, bland, non-acidic foods and ensuring adequate hydration. The use of palifermin (keratinocyte growth factor) at 60 μg/kg/day for three days before and after chemotherapy may be considered for high-risk patients, as recommended for those receiving high-dose chemotherapy and total body irradiation, followed by autologous stem cell transplantation, for a hematological malignancy (II) 1. Overall, a multifaceted approach to managing oral mucositis, guided by the most recent and highest quality evidence, is essential for optimizing patient outcomes.
From the Research
Management Options for Oral Mucositis
The management of oral mucositis secondary to chemotherapy involves various topical oral solutions and medications. Some of the commonly used options include:
- Magic mouthwash, which typically contains a combination of ingredients such as diphenhydramine, viscous lidocaine, magnesium hydroxide/aluminum hydroxide, nystatin, and corticosteroids 2
- Nystatin and lidocaine pastilles, which have been shown to be effective in treating oral mucositis due to their slow dissolution and extended residence time in the oral cavity 3
- Sucralfate, which has been reported to decrease the appearance and severity of mucositis when used as a cytoprotector 4
Other Medications
Other medications that have been studied for the management of oral mucositis include:
- Doxepin mouthwash, which has been shown to reduce oral mucositis-related pain in patients undergoing head and neck radiotherapy 5
- Diphenhydramine-lidocaine-antacid mouthwash, which has also been found to be effective in reducing oral mucositis pain 5
- Palifermin, cryotherapy, and low power laser irradiation, which have been reported to offer benefits in reducing the incidence and severity of oral mucositis 4
Comparison of Treatment Options
A randomized clinical trial compared the effectiveness of three mouthwashes (salt and soda, chlorhexidine, and "magic" mouthwash) in treating chemotherapy-induced mucositis, and found no significant differences in time for the cessation of signs and symptoms among the three groups 6. Another study found that doxepin mouthwash and diphenhydramine-lidocaine-antacid mouthwash were both effective in reducing oral mucositis pain, but the effect size was less than the minimal clinically important difference 5.