Oral mucositis is one of the major side effects that patients undergoing radiation therapy and/or chemotherapy for cancerous lesions located in the head and neck region experience . It is associated with a number of symptoms that affect the quality of life and can even lead to the patient discontinuing the treatment.
What Causes Oral Mucositis?
Strange as it may sound, this is not something that was discovered until recently. There were a number of theories about the role of micro-organisms, severe dryness of the mouth, physical injury and others, which have been proven to be minor components of a multi-factorial problem .
The main reason behind the occurrence of oral mucositis is the cellular damage that happens to the cells of the oral mucosa. This damage is dose dependent and thus people who are receiving higher doses or more frequent cycles of radiation are more likely to develop oral mucositis .
Treatment Options For Oral Mucositis
Good Oral Hygiene
The importance of maintaining good oral hygiene during the time patients are receiving cancer treatment has been underscored by a number of studies. Reducing the number of disease-causing micro-organisms in the mouth, getting rid of any ill-fitting dentures or other prostheses, getting any infected teeth treated or extracted and continuing a rigorous plaque removal regimen are all things that have been associated with a reduction in the incidence of oral mucositis .
However, it must be noted that after a certain point oral care during cancer treatment is not enough to prevent or reduce the recurrence of oral mucositis on its own and other measures need to be tried as well.
There is a theory that the use of popsicles or ice chips during the time chemotherapeutic agents are being infused can help reduce the amount of damage that occurs to the cells of the oral mucosa. This claim has been backed up by studies that found that the cold temperature made the blood vessels in the mouth contract and prevented the chemotherapeutic agents from circulating freely in that region .
Mucosal Protective Agents
There are a number of agents that are available over-the-counter which promise to help protect the mucosa from radiation damage. The mechanism of action of these agents seems to be unclear and is based on a belief that they have anti-inflammatory properties or that they coat the mucosa and prevent it from coming in contact with food and any other part of the oral cavity.
Chamomile is inexpensive and widely available as a mouth rinse aimed at the reduction of symptoms associated with oral mucositis but studies have found it to have the same effect as a placebo .
Benzydamine, a chemical agent that has anti-inflammatory, anesthetic and pain reducing effects, has better scientific evidence backing its claims. A number of topical gels and ointments use benzydamine in their preparation to help relieve the symptoms. At least three randomized controlled trials have found it to be effective in doing so as compared to a placebo .
Sucralfate, an aluminum salt, is probably the most effective agent that you can use in the treatment of oral mucositis symptoms. It is also used in the treatment of peptic ulcers and other gastrointestinal diseases. The mechanism of action seems to be the formation of a protective coat when it comes in contact with ulcerated mucosa .
A number of studies have found sucralfate to be effective in reducing the pain and discomfort that oral mucositis causes.
The systematic use of anti-oxidants and oxygen scavengers has been studied in an effort to estimate their effects in reversing the symptoms of oral mucositis. Vitamin E-containing gels and other topical medications are becoming popular for this purpose since it has been proven to neutralize reactive oxygen species in clinical trials.
Studies comparing the effect of Vitamin E-containing topical agents with placebos found the former to be significantly superior in treating the symptoms of oral mucositis .
This is a systemically administered drug that is cytoprotective in nature. The use of this drug has been shrouded in some controversy as some doctors believe this makes the effect of cancer-killing drugs less effective and can actually hamper the patient in the long run.
To use or avoid this drug is a decision that your doctor has to make, however, there is no doubt it helps reduce the occurrence and severity of oral mucositis when used in appropriate doses .
The fact of the matter is that even though there are plenty of options available to try and combat oral mucositis, their efficacy and overall success is limited. Steps taken to improve oral hygiene before the radiation treatment begins are probably the most important in fighting oral mucositis. Education about those needs to be increased among cancer patients as well as oncologists conferring the treatment.