From the Guidelines
The management of oral mucositis involves a multifaceted approach focusing on prevention, pain control, and maintaining oral hygiene, with the most recent guidelines suggesting oral care protocols, cryotherapy, and low-level laser therapy as effective preventive measures 1.
Key Components of Management
- Prevention: Regular oral care with soft toothbrushes and alcohol-free mouthwashes, as well as oral care protocols, can help prevent oral mucositis 1.
- Pain Management: Topical anesthetics like 2% viscous lidocaine or Magic Mouthwash, and systemic pain control with opioids for severe cases, are essential for managing pain due to oral mucositis 1.
- Cryotherapy: Ice chips held in the mouth for 30 minutes during chemotherapy administration can reduce mucositis severity for certain chemotherapeutic agents like 5-fluorouracil 1.
- Low-Level Laser Therapy: This may be beneficial in specialized centers for preventing oral mucositis in patients receiving high-dose chemotherapy, with or without total body irradiation 1.
- Nutritional Support: Soft, bland foods and adequate hydration are recommended, with patients advised to avoid spicy, acidic, rough-textured foods, alcohol, and tobacco 1.
Specific Recommendations
- Oral care protocols should be used to prevent oral mucositis in all age groups and across all cancer treatment modalities 1.
- Cryotherapy is recommended to prevent oral mucositis in patients receiving bolus 5-fluorouracil chemotherapy 1.
- Low-level laser therapy is recommended to prevent oral mucositis in patients receiving HSCT conditioned with high-dose chemotherapy, with or without total body irradiation 1.
- Patient-controlled analgesia with morphine is recommended to treat pain due to oral mucositis in patients undergoing HSCT 1.
From the Research
Management Approach for Oral Mucositis
The management of oral mucositis involves a variety of approaches, including preventative measures and treatment options. Some of the key strategies include:
- Preventative measures such as anti-inflammatory medications, growth factors and cytokines, cryotherapy, laser-and-light therapy, herbal medicines and supplements, and mucoprotective agents 2
- Treatment options such as antimicrobial mouthwash, erythropoietin mouthwash, and allopurinol 2, 3
- Oral hygiene and self-care, including atraumatic oral care and differentiation of patients with good previous oral care from those with a high risk of hemorrhage and infection 4
- Protection of proliferating cells through vasoconstriction, cytoprotection, or epithelial cell-inhibiting factors 4
- Increasing cell proliferation to accelerate epithelial restoration using sucralfate and growth factors 4
- Attenuating sepsis with antiseptics, amphotericin B, and antiviral agents or antibiotic lozenges 4
- Application of low-energy helium-neon laser to reduce the severity and duration of oral mucositis 4
- Frequent oral rinsing with a bland mouthwash, such as saline or a sodium bicarbonate rinse, to reduce oral microbial flora 5
- Dental care, consistent oral assessments, and initiation of a standardized oral hygiene protocol before cancer treatment 5
Current Research and Limitations
Despite the various management approaches, there is currently no single intervention that is completely successful at preventing or treating oral mucositis 3. Many studies have evaluated the effectiveness of different agents and methods, but the results are often inconsistent and limited by small sample sizes and inconsistent measures 5. Further research is needed to develop more effective treatments and preventative measures for oral mucositis 6.
Treatment Options by Phase
The treatment of oral mucositis can be tailored to the specific phase of the condition, including:
- Vascular phase: protection of proliferating cells through vasoconstriction, cytoprotection, or epithelial cell-inhibiting factors 4
- Epithelial phase: increasing cell proliferation to accelerate epithelial restoration using sucralfate and growth factors 4
- Ulcerative and bacteriological phase: attenuating sepsis with antiseptics, amphotericin B, and antiviral agents or antibiotic lozenges 4
- Healing phase: application of low-energy helium-neon laser to reduce the severity and duration of oral mucositis 4