CC BY-NC-ND 4.0 · European Journal of General Dentistry 2019; 8(02): 23-28
DOI: 10.4103/ejgd.ejgd_30_19
Review Article

Treatment and prevention of oral mucositis: A literature review

Paras Ahmad
Department of Oral Medicine, School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
,
Usman Akhtar
1   LIMES and Pharmaceutical Institute, University of Bonn, Bonn, Germany
,
Ahmed Chaudhry
1   LIMES and Pharmaceutical Institute, University of Bonn, Bonn, Germany
,
Usman Rashid
2   Department of Periodontology, School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
,
Sarmad Saif
2   Department of Periodontology, School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
,
Jawaad Ahmed Asif
3   Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
› Author Affiliations

Abstract

Oral health is a cardinal element of nutritional as well as systemic well-being and plays a substantial part in sustaining optimum general health condition. Various factors influence oral health including metabolic diseases such as endocrine, hematological, gastrointestinal, cutaneous, and neurological diseases. The intent of this review is to highlight the treatment as well as prevention strategies for one of the most devastating repercussions of chemotherapy (CT) and radiotherapy (RT) on the oral cavity in the form of oral mucositis (OM). A review of literature was performed using relevant key words (“Mucositis” OR “Oral Mucositis” OR “Oral Stomatitis” AND “Treatment of Mucositis” OR “Treatment of Oral Mucositis” OR “Treatment of Oral Stomatitis” AND “Prevention of Mucositis” OR “Prevention of Oral Mucositis” OR “Prevention of Oral Stomatitis“) in prominent journals pertaining to Oncology and Dentistry (CA: A Cancer Journal for Clinicians, Cancer, Frontiers in Oncology, Journal of Clinical Oncology, and Oral Oncology). It is basically sequelae of CT, RT, and radiochemotherapy in patients suffering from malignant diseases as well as those who require hematopoietic stem cell transplants. In addition to its negative effects on the oral cavity and consequently on the overall quality of life, OM may lead to delay in cancer treatment which incriminates in a poor prognosis of the disease.

Financial support and sponsorship

Nil.




Publication History

Article published online:
01 November 2021

© 2019. European Journal of General Dentistry. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Gupta A, West HJ. Mucositis (or stomatitis). JAMA Oncol 2016;2:1379.
  • 2 Peterson DE, Lalla RV. Oral mucositis: The new paradigms. Curr Opin Oncol 2010;22:318-22.
  • 3 Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 2014;120:1453-61.
  • 4 Maria OM, Eliopoulos N, Muanza T. Radiation-induced oral mucositis. Front Oncol 2017;7:89.
  • 5 Klimberg VS, Souba WW, Dolson DJ, Salloum RM, Hautamaki RD, Plumley DA, et al. Prophylactic glutamine protects the intestinal mucosa from radiation injury. Cancer 1990;66:62-8.
  • 6 Huang EY, Leung SW, Wang CJ, Chen HC, Sun LM, Fang FM, et al. Oral glutamine to alleviate radiation-induced oral mucositis: A pilot randomized trial. Int J Radiat Oncol Biol Phys 2000;46:535-9.
  • 7 Peterson DE, Jones JB, Petit RG 2nd. Randomized, placebo-controlled trial of saforis for prevention and treatment of oral mucositis in breast cancer patients receiving anthracycline-based chemotherapy. Cancer 2007;109:322-31.
  • 8 Grumetto L, Del Prete A, Ortosecco G, Barbato F, Del Prete S, Borrelli A, et al. Study on the protective effect of a new manganese superoxide dismutase on the microvilli of rabbit eyes exposed to UV radiation. Biomed Res Int 2015;2015:973197.
  • 9 LeVeque FG, Parzuchowski JB, Farinacci GC, Redding SW, Rodu B, Johnson JT, et al. Clinical evaluation of MGI 209, an anesthetic, film-forming agent for relief from painful oral ulcers associated with chemotherapy. J Clin Oncol 1992;10:1963-8.
  • 10 Sarvizadeh M, Hemati S, Meidani M, Ashouri M, Roayaei M, Shahsanai A. Morphine mouthwash for the management of oral mucositis in patients with head and neck cancer. Adv Biomed Res 2015;4:44.
  • 11 Rothwell BR, Spektor WS. Palliation of radiation-related mucositis. Spec Care Dentist 1990;10:21-5.
  • 12 Davies AN, Singer J. A comparison of artificial saliva and pilocarpine in radiation-induced xerostomia. J Laryngol Otol 1994;108:663-5.
  • 13 Dos Reis PE, Ciol MA, de Melo NS, Figueiredo PT, Leite AF, Manzi Nde M, et al. Chamomile infusion cryotherapy to prevent oral mucositis induced by chemotherapy: A pilot study. Support Care Cancer 2016;24:4393-8.
  • 14 Bardy J, Molassiotis A, Ryder WD, Mais K, Sykes A, Yap B, et al. Adouble-blind, placebo-controlled, randomised trial of active manuka honey and standard oral care for radiation-induced oral mucositis. Br J Oral Maxillofac Surg 2012;50:221-6.
  • 15 Van den Wyngaert T. Topical honey application to reduce radiation-induced oral mucositis: A therapy too sweet to ignore? J Evid Based Dent Pract 2012;12:203-5.
  • 16 Hawley P, Hovan A, McGahan CE, Saunders D. A randomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis. Support Care Cancer 2014;22:751-61.
  • 17 High KP, Legault C, Sinclair JA, Cruz J, Hill K, Hurd DD. Low plasma concentrations of retinol and alpha-tocopherol in hematopoietic stem cell transplant recipients: The effect of mucositis and the risk of infection. Am J Clin Nutr 2002;76:1358-66.
  • 18 Cohen G, Elad S, Or R, Galili D, Garfunkel AA. The use of tretinoin as oral mucositis prophylaxis in bone marrow transplantation patients: A preliminary study. Oral Dis 1997;3:243-6.
  • 19 Ferreira PR, Fleck JF, Diehl A, Barletta D, Braga-Filho A, Barletta A, et al. Protective effect of alpha-tocopherol in head and neck cancer radiation-induced mucositis: A double-blind randomized trial. Head Neck 2004;26:313-21.
  • 20 Oshitani T, Okada K, Kushima T, Suematsu T, Obayashi K, Hirata Y, et al. Clinical evaluation of sodium alginate on oral mucositis associated with radiotherapy. Nihon Gan Chiryo Gakkai Shi 1990;25:1129-37.
  • 21 Roopashri G, Jayanthi K, Guruprasad R. Efficacy of benzydamine hydrochloride, chlorhexidine, and povidone iodine in the treatment of oral mucositis among patients undergoing radiotherapy in head and neck malignancies: A drug trail. Contemp Clin Dent 2011;2:8-12.
  • 22 Berger A, Henderson M, Nadoolman W, Duffy V, Cooper D, Saberski L, et al. Oral capsaicin provides temporary relief for oral mucositis pain secondary to chemotherapy/radiation therapy. J Pain Symptom Manage 1995;10:243-8.
  • 23 Lalla RV, Pilbeam CC, Walsh SJ, Sonis ST, Keefe DM, Peterson DE. Role of the cyclooxygenase pathway in chemotherapy-induced oral mucositis: A pilot study. Support Care Cancer 2010;18:95-103.
  • 24 Kono T, Kaneko A, Matsumoto C, Miyagi C, Ohbuchi K, Mizuhara Y, et al. Multitargeted effects of hangeshashinto for treatment of chemotherapy-induced oral mucositis on inducible prostaglandin E2 production in human oral keratinocytes. Integr Cancer Ther 2014;13:435-45.
  • 25 He D, Behar S, Roberts JE, Lim HW. The effect of L-cysteine and N-acetylcysteine on porphyrin/heme biosynthetic pathway in cells treated with 5-aminolevulinic acid and exposed to radiation. Photodermatol Photoimmunol Photomed 1996;12:194-9.
  • 26 Kennedy AR. Chemopreventive agents: Protease inhibitors. Pharmacol Ther 1998;78:167-209.
  • 27 Lalla RV, Sonis ST, Peterson DE. Management of oral mucositis in patients who have cancer. Dent Clin North Am 2008;52:61-77, viii.
  • 28 Lieschke GJ, Ramenghi U, O'Connor MP, Sheridan W, Szer J, Morstyn G. Studies of oral neutrophil levels in patients receiving G-CSF after autologous marrow transplantation. Br J Haematol 1992;82:589-95.
  • 29 Köstler WJ, Hejna M, Wenzel C, and Zielinski CC. Oral mucositis complicating chemotherapy and/or radiotherapy: Options for prevention and treatment. CA Cancer J Clin 2001;51:290-315.
  • 30 Sonis ST, Lindquist L, Van Vugt A, Stewart AA, Stam K, Qu GY, et al. Prevention of chemotherapy-induced ulcerative mucositis by transforming growth factor beta 3. Cancer Res 1994;54:1135-8.
  • 31 El-Habit OH, Saada HN, Azab KS, Abdel-Rahman M, El-Malah DF. The modifying effect of beta-carotene on gamma radiation-induced elevation of oxidative reactions and genotoxicity in male rats. Mutat Res 2000;466:179-86.
  • 32 Smith MA, Parkinson DR, Cheson BD, Friedman MA. Retinoids in cancer therapy. J Clin Oncol 1992;10:839-64.
  • 33 Alfieri S, Ripamonti CI, Marceglia S, Orlandi E, Iacovelli NA, Granata R, et al. Temporal course and predictive factors of analgesic opioid requirement for chemoradiation-induced oral mucositis in oropharyngeal cancer. Head Neck 2016;38 Suppl 1:E1521-7.
  • 34 Nicolatou-Galitis O, Velegraki A, Sotiropoulou-Lontou A, Dardoufas K, Kouloulias V, Kyprianou K, et al. Effect of fluconazole antifungal prophylaxis on oral mucositis in head and neck cancer patients receiving radiotherapy. Support Care Cancer 2006;14:44-51.
  • 35 Lefebvre JL, Domenge C; Study Group of Mucositis. A comparative study of the efficacy and safety of fluconazole oral suspension and amphotericin B oral suspension in cancer patients with mucositis. Oral Oncol 2002;38:337-42.
  • 36 Spijkervet FK, Van Saene HK, Van Saene JJ, Panders AK, Vermey A, Mehta DM, et al. Effect of selective elimination of the oral flora on mucositis in irradiated head and neck cancer patients. J Surg Oncol 1991;46:167-73.
  • 37 Matthews RH, Ercal N. Prevention of mucositis in irradiated head and neck cancer patients. J Exp Ther Oncol 1996;1:135-8.
  • 38 Spijkervet FK, van Saene HK, van Saene JJ, Panders AK, Vermey A, Mehta DM, et al. Mucositis prevention by selective elimination of oral flora in irradiated head and neck cancer patients. J Oral Pathol Med 1990;19:486-9.
  • 39 Prelack MS, Patterson KR, Berger JR. Varicella zoster virus rhombencephalomyelitis following radiation therapy for oropharyngeal carcinoma. J Clin Neurosci 2016;25:164-6.
  • 40 Evans TG, Bernstein DI, Raborn GW, Harmenberg J, Kowalski J, Spruance SL, et al. Double-blind, randomized, placebo-controlled study of topical 5% acyclovir-1% hydrocortisone cream (ME-609) for treatment of UV radiation-induced herpes labialis. Antimicrob Agents Chemother 2002;46:1870-4.
  • 41 Schmidt M, Haagen J, Noack R, Siegemund A, Gabriel P, Dörr W. Effects of bone marrow or mesenchymal stem cell transplantation on oral mucositis (mouse) induced by fractionated irradiation. Strahlenther Onkol 2014;190:399-404.
  • 42 Schmidt M, Piro-Hussong A, Siegemund A, Gabriel P, Dörr W. Modification of radiation-induced oral mucositis (mouse) by adult stem cell therapy: Single-dose irradiation. Radiat Environ Biophys 2014;53:629-34.
  • 43 Al-Ansari S, Zecha JA, Barasch A, de Lange J, Rozema FR, Raber-Durlacher JE. Oral mucositis induced by anticancer therapies. Curr Oral Health Rep 2015;2:202-11.
  • 44 Lopes LD, Rodrigues AB, Brasil DR, Moreira MM, Amaral JG, Oliveira PP. Prevention and treatment of mucositis at an oncology outpatient clinic: A collective construction. Texto Contexto Enferm 2016;25:e2060014.
  • 45 Watanabe S, Suemaru K, Nakanishi M, Nakajima N, Tanaka M, Tanaka A, et al. Assessment of the hamster cheek pouch as a model for radiation-induced oral mucositis, and evaluation of the protective effects of keratinocyte growth factor using this model. Int J Radiat Biol 2014;90:884-91.
  • 46 Praetorius NP, Mandal TK. Alternate delivery route for amifostine as a radio-/chemo-protecting agent. J Pharm Pharmacol 2008;60:809-15.
  • 47 Gu J, Zhu S, Li X, Wu H, Li Y, Hua F. Effect of amifostine in head and neck cancer patients treated with radiotherapy: A systematic review and meta-analysis based on randomized controlled trials. PLoS One 2014;9:e95968.