Oral mucositis: causes, symptoms and prevention

Oral mucositis manifests itself with reddened areas in different parts of the mouth, which can lead to painful ulcers. We explain why it happens and in which patients.

Last update: June 25, 2021

Oral mucositis is a inflammatory process that takes place in the lining of the mouth. This is a soft, moistened tissue that lines the inside of the oral cavity. What happens is that it becomes irritated and begins to redden.

Painful open sores often appear that cause pain and difficulty eating. Oral mucositis is a side effect that occurs in patients receiving chemotherapy or radiation therapy for cancer.

What is oral mucositis?

Oral mucositis is an inflammation that occurs in the lining of the mouth. Sometimes the throat and esophagus are also affected. In the latter case it is called esophagitis.

According to a publication of the José Carreras Foundation, what happens is that different areas of the mouth begin to redden. The sensitivity of the mucosa increases due to the inflammatory process. That is why discomfort or even pain appears when eating. Especially when food is hot or too hard.

As oral mucositis progresses very aggressive sores develop with the mucosa. Hence, it is increasingly difficult to feed. Also, the sores can spread down the throat.

Oral mucositis is considered one of the most common side effects of chemotherapy. So much so, that it is estimated that more than 40% of patients who undergo it suffer from it. It can also occur with radiation therapy or bone marrow transplantation.

What are the causes of oral mucositis?

To understand why oral mucositis occurs, it is first important to know what the mucosa is. The mucosa is an epithelium formed by cells very close to each other. These cells can be damaged by free radicals, which are molecules with a high capacity to react with others.

They occur as a result of chemotherapy or radiotherapy treatments. Free radicals damage the DNA of cells and an inflammatory process is triggered. If not stopped, the epithelium ulcerates.

This is how the painful sores that appear in oral mucositis are formed. Most often, this pathology manifests itself a few days after starting chemotherapy. In the case of radiotherapy, it is usual two weeks later.

Oral mucositis usually gets better on its own, without the need for treatment. However, ulcers of up to 4 centimeters are accompanied by difficulties in eating or swallowing. That is why a conservative approach is preferred to promote nutrition.

Radiation therapy is not without adverse effects. Among them we must count oral mucositis.

You may be interested in: The different types of chemotherapy

Risk factor's

As we have explained, oral mucositis usually appears in people undergoing chemotherapy, radiotherapy or bone marrow transplantation. However, there are other factors that can increase your risk of suffering from it.

The first of them is age. Children and the elderly are more likely. The treatment scheme also influences. For example, the higher the dose of radiation therapy, the greater the risk of oral mucositis.

If the patient is a smoker or an alcohol drinker, the same thing happens. The previous state of health and the type of tumor add to the unfavorable characteristics. Head and neck cancers most often cause this condition.

Symptoms that may appear

At the beginning of oral mucositis, what usually appears are different reddened areas with edema in the oral mucosa. These areas usually progress and become peeling. Therefore, the final stage is the appearance of painful ulcers.

The pain is usually present from the beginning. Difficulty ingesting solids and liquids is also typical.

The problem is that ulcers can lead to other complications. For example, aggregate infections are common. The most typical is oral candidiasis. In addition, as they are often patients with a weakened immune system, there is a high risk of sepsis.

According to a publication by Brigham And Women's HospitalUlcers can appear anywhere in the mouth. However, the most common locations are the tongue, the inside of the cheeks, and the lips.

It might interest you: What is sepsis or septicemia?

Treatment of oral mucositis

Oral mucositis usually heals on its own. The usual thing is that it disappears a few weeks after the cessation of chemotherapy or radiotherapy treatment.

However, in cases where it is complicated, a specific approach may be necessary. For example, lidocaine mouthwashes may be prescribed. Lidocaine is an anesthetic substance that helps relieve pain. Salt water rinses are also recommended.

If the pain is very intense, you can take common painkillers, such as ibuprofen or paracetamol. In addition, it is essential avoid acidic and spicy foods, as they can further irritate the mucosa.

Can this pathology be prevented?

In a high percentage of cases, oral mucositis can be prevented or the risk of complications lowered. Thorough oral hygiene is essential during cancer treatment.

To do this, you have to brush your teeth thoroughly, also brush your gums and do it after every meal. It is recommended that the brush have soft bristles so as not to further irritate the mucosa or injure.

Toothpaste must have fluoride. Similarly, it is indicated to use saline rinses several times a day.

To ensure proper nutrition despite pain, try to eat cold and nutritious liquids. If you can eat solid foods, it is important to chew slowly and accompany the food with plenty of hydration.

Dental hygiene during chemotherapy and radiation therapy cannot be neglected. It is a way to prevent mucositis.

A preventable side effect

Oral mucositis is a common side effect of cancer treatments. Especially in people undergoing radiation therapy for tumors in the head or neck. It is common that it gives rise to painful ulcers.

Therefore, although this pathology usually resolves on its own, proper oral hygiene must be maintained. In addition, the impact that oral mucositis may have on the patient's nutrition must be reduced.

Eating is often annoying and unappetizing. So, the ideal is to divide the meals and take them throughout the day In small quantities. Similarly, you should try to chew slowly and hydrate well.