The treatment for many kinds of cancer requires chemotherapy and radiation therapy. One of the most unfortunate side effects of chemotherapy is mucositis.
It is an inflammation of mucosal tissue (which goes from the mouth to anus) and affects almost 40% of patients undergoing chemotherapy.
The oral cavity is the most common location for mucositis, and oral mucositis is probably the most common, debilitating complication of cancer treatment, particularly chemotherapy and radiation therapy.
It has a significant effect on the patient’s quality of life and may require a reduction in subsequent chemotherapy doses.
This article will attempt to understand mucositis in detail and how to deal with its severe complications.
What is mucositis?
Mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer.
Oral mucositis refers to the particular inflammation and ulceration that occurs in the mouth. It is a common and often debilitating complication of cancer treatment.
What causes mucositis?
High dose chemotherapy and localized high dose radiation therapy to the head and neck region are the leading causes of oral mucositis.
These treatments target the rapidly dividing cancer cells but inadvertently affect the normal healthy cells such as the oral mucosa lining of the inside of the mouth. (1)
Minor trauma to the mouth from speaking, chewing and swallowing is sufficient to breakdown the mucosa, resulting in painful ulcerations.
Signs and symptoms of mucositis
Sign and symptoms of mucositis include –
- Red, shiny or swollen mouth and gums
- Blood in the mouth
- Sores in the mouth or on the gums or the tongue
- Soreness or pain in the mouth or throat
- Difficulty in swallowing or talking
- Feeling of dryness, mild burning or pain when eating food
- Soft, whitish patches or pus in the mouth or on the tongue
- Increased mucus or thicker saliva in the mouth
- In extreme cases, a condition called confluent mucositis is seen in which the mucous membrane of the patient’s entire mouth and tongue can be coated by a white mucus coating that is up to a millimeter thick. It makes it difficult or even impossible to eat.
Risk factors for mucositis
The majority of oral cancer patients receiving chemotherapy with radiation will experience at least some degree of mucositis. It can be due to low white blood cell count or the necrotic and inflammatory effect of radiation energy on the oral mucosa.
Factors that can increase the likelihood of developing mucositis or that can make it worse if it does occur, include –
- Poor oral hygiene
- Smoking or chewing tobacco
- Alcohol drinking
- Females are more likely than men to develop mucositis
- Low body mass index
- Kidney disease, diabetes or HIV/AIDS
- Previous cancer treatments
- Chronic irritation from ill-fitting prostheses or faulty restorations
- Hyposalivation before and during treatment
- Younger patients tend to develop oral mucositis more often than older patients.
Impact of mucositis
The consequences of mucositis can be mild, requiring little intervention but they can also be severe, resulting in a fatality. Oral mucositis can –
- Cause pain
- Restrict oral intake
- Act as a portal of entry for organisms (2)
- Contribute to interruption of therapy
- Increase the use of antibiotics and narcotics
- Increase the length of hospitalization
- Increase the overall cost of treatment
Patient with oral mucositis and low white blood count have a relative risk of septicemia. Mucositis is further complicated by nausea and vomiting that often occurs with chemotherapy.
Patient with damaged oral mucosa and reduced immunity are also prone to mouth infections.
Taste loss tends to increase in proportion to the aggressiveness of the treatment. Nausea, pain, vomiting, diarrhea, a sore or dry mouth may make eating difficult.
Reduction of calorific intake can lead to weight loss, loss in muscle mass strength and other complications, including a decrease in immunity and longer healing time from treatments.
Treatment for mucositis
The treatment for mucositis is supportive mainly, and oral hygiene is the mainstay of the treatment.
- Patients are encouraged to clean their mouth after every four hours and at bedtime.
- Water-soluble jellies can be used to lubricate the mouth, and salt mouthwashes can soothe the pain and keep food particles clear to avoid infection.
- Your dentist may prescribe you mouthwashes with chlorhexidine gluconate and viscous lidocaine, which can numb the oral tissues and relieve the pain and discomfort.
- Barrier protection agents such as concentrated oral gel products may provide symptomatic relief of the pain of oral mucositis.
It is difficult to stop mucositis from occurring after chemotherapy, but you can take some steps before the beginning of your cancer treatment to help alleviate its side effect and symptoms.
The following preventive measures can help you manage mucositis –
- Visit a dentist before starting your cancer treatment. If you wear dentures, you will need to make sure they fit correctly. If any dental work needs to be done, it should be completed at least one month before starting therapy. This makes sure that your mouth has completely healed and can prevent damage to your existing teeth, gums, and jaws.
- A good oral care routine can help prevent or decrease the severity of mucositis and also prevent the development of infection through open mouth sores.
- Avoid alcohol and spicy, hot, acidic or coarse foods.
- Use a soft-bristled toothbrush and mild tasting toothpaste with fluoride. You can also add an anti-bacterial rinse to your routine.
- Rinse your mouth before and after meals and at bedtime with either normal saline or salt and soda. (3)
- Avoid toothpaste with whitening agents.
- Avoid mouthwashes with alcohol.
- Keep your lips moist with moisturizers.
- Limit the use of dental floss to prevent injury to your gums.
- Increase your fluid intake and try to include foods high in protein in your diet.
- Always suck on ice chips during chemotherapy administration. Oral cryotherapy will cool the oral tissues and cause vasoconstriction, which will restrict the amount of chemotherapy drugs delivered to the oral tissues. (4)
Mucositis is a pervasive and debilitating side effect of chemotherapy and radiation therapy. It has a significant impact on the quality of life of the cancer patient.
It leads to several problems including pain, inability to eat and increased risk of infections.
A good oral hygiene routine can help in preventing or decreasing the severity of mucositis. Numerous studies have determined that just plain old salt water is the best and most cost-effective mouth rinse available for mucositis.
Your dentist and oncologist can work together to help relieve your symptoms for mucositis and ease some of your discomforts.