Oral mucositis is a widespread and a possible serious consequence of high-dose chemotherapy and radiotherapy treatments, often becoming evident as erythematic and aching ulcerative abrasions of the mouth and even the throat. The extent of the cut on the mouth or the mucosal tissue is directly proportional to the measure, category, and dose intensity of the chemotherapy and radiotherapy procedures used. But on a positive note, there are therapies available to cure even the worst degree of mucosal toxicity.
The therapy includes myelotoxic conditioning course necessary before hematopoietic stem cell transplantation (HSCT). Roughly around 70-80% of the patients having hematological malignancies and undertaking HSCT, suffer from this condition.
Causes
Chemotherapy and radiotherapy are the procedures followed, for the treatment of cancer. These therapies prevent and kill the growth of new cancer cells which are formed, when the existing cancer cells start spreading by dividing themselves. Now, the problem occurs when this treatment also kills the healthy cells, which keep rapidly dividing themselves, thereby replacing the surface cells of the mouth with new ones.
During radiotherapy for neck and head cancer or while undergoing HSCT, which is sometimes known as bone marrow transplant (BMT), the beam of radiation is passed through the mouth. This results in the killing of healthy cells along with the cancer ones, thus causing ulcers to form in the mouth. Below is the list of some of the therapies, known to cause oral mucositis.
- Melphalan
- Methotrexate
- 5-fluorouracil
- Etoposide
- Cyclophosphamide
- Doxorubicin
- Cytosine arabinoside
Oral mucositis has been recognized as an extremely devastating consequence of anticancer treatment by victims who went through it, while undertaking myelotoxic therapy for HSCT. Victims having an acute form of the condition will find it extremely tough to perform simple everyday mouth-related actions like chewing, biting, talking, swallowing, drinking, sipping, etc. Some of the commonly witnessed symptoms of oral mucositis are listed below.
- Formation of inflamed ulcers that are covered with yellowish white clot
- Painful burning sensation along with redness
- Difficulty in speaking, eating and other mouth-related activities
- Temporary loss of taste, which is called "taste blindness"
There are several ways to help alleviate the pain, that is prevalent in this condition. They are:
- Painkillers: Analgesics, having doses of sedatives in them, will help reduce the pain.
- Ice Pieces: Sucking ice pieces will also aid in relieving the pain.
- Mouth Rinses: There are a number of mouth rinses provided by practitioners that include antihistamines, antibiotics, anti-inflammatory and antifungal medications, and anesthetics.
- Good Oral Care: Regular checkups of mouth for swelling, pain, ulcers or sores, redness, brushing one's teeth gently twice or thrice a day, cleaning out floss between the teeth and using alcohol-free wash for mouth is necessary.
- Good Nutrition: Food taken should be soft, non-spicy, pureed or in a liquid form only. Hard foods must be cooked until it is soft. Foods that burn or irritate the oral area must be kept away. Food products such as cooked cereal, apple sauce, mashed potatoes, filtered soups, gelatin, custard, eggs and puddings can be taken without any trouble to eat. Even frozen foods such as milkshakes, ice creams and popsicles can also be consumed. Beverages can be chilled or at room temperature, but cannot be hot. Smoking, alcohol, citrus fruits, other acidic foods, coarse foods, tomatoes, etc., must be shunned.
- Other Remedies: They include: cryotherapy, chlorhexidine gluconate, pentoxifylline, misoprostol*, tocopherol, sucralfate, brushing the oral mucosa with silver nitrate prophylactically.
Now the "World Health Organization Pain Ladder" is a very frequently employed judgment process in choosing whether or not to prescribe either opioid or non-opioid sedatives. Also, simple vicious solutions viz-a-viz. baking soda and salt water, can be used for gargling, to assuage the burning sensation.
On the other hand, the use of opioid medicines may have other debilitating effects such as sleepiness, decreased mental acuity and constipation. Patients need to take a full dental examination and dressing up possible spots of oral infections like deeply decayed teeth and periodontal disease. These are the causes, symptoms and cures for oral mucositis, which have been elucidated and can be used as a guide by affected persons.
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