By Fred H. Francis, II, MD
Radiation Oncologist
Ball Memorial Hospital, Muncie, Indiana

Oral mucositis, or inflammation of the tissue lining the nose and throat, is common in patients being treated for various cancers. Cancer treatment, whether chemotherapy or radiation therapy, attacks cells when they are in the process of dividing. Those cells that divide most often are damaged, including not only cancer cells but also the healthy cells lining your mouth and esophagus. This results in diminished or thinning oral mucosa, sloughing of oral mucosa, and ulcerations. Because the mucosa acts as a barrier to pathogens, like bacteria, individuals with oral mucositis not only have difficulty tasting, eating, and drinking, but also are susceptible to opportunistic infections.

Oral mucositis is experienced by approximately 40% of all standard-dose chemotherapy patients and up to 75% of high-dose chemotherapy patients. Certain chemotherapeutic agents have a much higher incidence, such as 5-fluorouracil and methotrexate. Nearly all patients receiving radiation therapy to the head and neck will experience mucositis, appearing a few days to two weeks after the start of therapy and persisting for at least two weeks after radiation therapy is finished.

Oral mucositis has a direct impact on duration of disease, remission, cure rates, and long-term survival. Complications from oral mucositis (infection, pain, and inadequate nutritional intake due to the inability to eat and drink) can result in a delay or a halt in the patient’s cancer therapy, compromising the effectiveness of treatment. Early intervention and prompt treatment of mucositis may lessen the degree of these symptoms and potential complications.

Because eating well and drinking fluids are important to maintain good health and play a role in the healing process, it is important to take good care of the mouth and throat. Examine the mouth at least once daily and report changes to your doctor or nurse. Specifically, these changes include ulcers, pimples, sores, red areas, patches, or other changes in the mouth. Here are some things to keep in mind as well:

1. Keep the mouth clean and moist. To accomplish this, clean the teeth using a soft toothbrush or swab, being careful not to damage the mouth by brushing hard.
   
   
2. Do not floss when it causes pain or bleeding or when platelet counts are low.
   
   
3. Use dentures only during meals.
   
   
4. Refrain from using common mouthwashes. They often contain alcohol, which can irritate the mouth. Rather, rinse the mouth with salt solution or baking soda.
   

If sores develop inside the mouth, the following guidelines should help the patient feel better.

1. Avoid foods and juices that are highly acidic (oranges, tomatoes, and grapefruits).
   
   
2. Try not to use too many spices, especially salt, because they may sting the mouth.
   
   
3. Avoid cigarettes and alcohol.
   
   
4. Drink water and other fluids throughout the day. Chew sugarless gum or suck on sugarless candies.
   
   
5. Work with the doctor and nurse to control pain; have medication prescribed for the sore mouth.

Pain relievers such as liquid Tylenol^® (acetaminophen), with or without codeine, help lower the perception of pain, but have little impact on the oral manifestations of mucositis.

A new agent, Gelclair^TM (hyaluronate), exerts its pain-relieving effect by forming a protective barrier, hydrating and coating the oral mucosa without numbing or drying. This shields the exposed and sensitized nerve endings in the mucosa from overstimulation and can provide pain relief for up to seven hours in mild to moderate mucositis and up to two hours in severe mucositis.
Gelclair can be used in combination with other pain relievers.

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