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Oral Mucositis
Author Bios
Introduction
Etiology of Oral Mucositis
Prevalence
Diagnosis
Currently selected section: Treatment
Biological Mechanisms of Mucositis
Assessment Scale
Clinical Trial Design
Population Selection and Randomization
Data Collection and Assessment Measures
Quality Control Techniques
Anaysis and Presentation
Conclusion


Chapter 17: Oral Mucositis: Treatment of Oral Mucositis
        

Currently, mucositis is treated by palliation and, to some extent, by prevention. Palliative methods include using topical rinses, behavioral modifications, and analgesics. The World Health Organization Pain Ladder is the most commonly used assessment in deciding whether or not to prescribe adjuvant, non-opioid and/or opioid analgesics.

Figure 5.1: World Health Organization Pain Ladder
Pain Ladder, where increasing pain goes from level one to level three. Level 1, non-opioid plus or minus adjuvant therapy. Level 2, Opioid for mild to moderate pain plus or minus non-opioid, plus or minus adjuvant therapy. Level 3 Opioid for moderate to severe pain plus or minus non-opioid, plus or minus adjuvant therapy.

Many topical rinses are available. Some are simple solutions, such as viscous 2% lidocaine rinses, or baking soda and saline solutions, while others are more of a cocktail solution, for instance BAX (lidocaine, diphenhyramine, sorbitol and Mylanta). Other investigative or mucoprotective adjuvant therapies include but are not limited to, beta carotene, tocopherol, laser irradiation, prophylactic brushing the oral mucosa with silver-nitrate, misoprostol, leucovorin, systemic TGF and KGF, pentoxifylline, allopurinol mouthwash, systemic sucralfate, chlorhexidine gluconate, and cryotherapy.

Behavioral modifications that can help reduce the incidence and severity of mucositis include:

  • Avoiding hard, spicy or hot foods that can trigger pain;
  • Frequent rinsing with saline or water with baking soda; and
  • Sucking on ice chips or popsicles.

Analgesic medications are almost always administered. Patients often decline the use of opioid medications because of side effects such as drowsiness, constipation, and decreased mental acuity.

Preventive measures taken to reduce the severity of mucositis include performing a full dental evaluation and addressing potential sites of oral infections such as grossly decayed teeth and periodontal disease. Insuring that patients have good oral health prior to treatment primarily helps to decrease the chance of systemic infections. Maintaining good oral hygiene during treatment through antibacterial mouth rinses, brushing/swab, and oral antifungal medications will decrease the bacterial load in the mouth which can reduce the chance that ulcerative mucositis will become secondarily infected and/or cause systemic infections during chemotherapy or radiation treatment.

 

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