303:
separate scores for appearance (erythema and ulceration) and function (pain and ability to eat solids, liquids, or nothing by mouth), the WHO score combines both elements into a single score that grades the severity of the condition from 0 (no oral mucositis) to 4 (swallowing not possible such that patient needs supplementary nutrition). Another scale developed in 1999, the Oral
Mucositis Assessment Scale (OMAS) has been shown to be highly reproducible between observers, responsive over time, and accurate in recording symptoms associated with mucositis. The OMAS provides an objective assessment of oral mucositis based on assessment of the appearance and extent of redness and ulceration in various areas of the mouth.
53:
29:
176:, or an alteration in taste perception, is common, especially for those who are receiving concomitant radiation therapy to the neck and mouth area. "Taste blindness", or an altered sense of taste, is a temporary condition that occurs because of effects on taste buds that are mostly located in the tongue. Sometimes, only partial recovery of taste occurs. Common complaints are of food tasting too sweet or too bitter or of a continuous metallic taste.
1102:
407:, that is designed to form a protective hydrogel coating over the oral mucosa while a patient is undergoing chemotherapy and/or radiotherapy cancer treatments to the head and neck. Additionally, the efficacy of MuGard for the prevention or treatment of mucositis has been tested by a prospective, randomized clinical trial in which 43% of head and neck cancer patients using MuGard prophylactically never got oral mucositis.
420:
cavity mucosa to coat and soothe inflammation and ulcerations, and blanket painful lesions. In a multicenter, randomized, double-blind, single-dose study involving 38 head and neck cancer patients with oral mucositis (WHO grades 2-3) undergoing radiation therapy, episil clinically demonstrated fast-acting relief that lasted up to 8 hours. Episil oral liquid is marketed in the US by
427:
In a 2012 randomized controlled pilot study involving pediatric patients, topical application of honey was found to reduce recovery time compared to benzocaine gel in grade 2 and 3 chemotherapy-induced oral mucositis to a degree that was statistically significant. In grade 3 oral mucositis, honey was
140:
is associated with severe GI mucositis in over 20% of patients. Seventy-five to eighty percent of bone marrow transplantation recipients experience mucositis, of which oral mucositis is the most common and most debilitating, especially when melphalan is used. In grade 3 oral mucositis, the patient is
336:
Water-soluble jellies can be used to lubricate the mouth. Salt mouthwash can soothe the pain and keep food particles clear so as to avoid infection. Patients are also encouraged to drink plenty of liquids, at least three liters a day, and avoid alcohol. Citrus fruits, alcohol, and foods that are hot
316:
treatment for solid cancers. The evidence also indicates a reduction of oral mucositis in adults receiving high-dose melphalan-based cancer treatment prior to haematopoietic stem cell transplantation, although there is uncertainty regarding the size of the reduction in this instance. No evidence was
526:
Rubenstein, Edward B.; Peterson, Douglas E.; Schubert, Mark; Keefe, Dorothy; McGuire, Deborah; Epstein, Joel; Elting, Linda S.; Fox, Philip C.; Cooksley, Catherine; Sonis, Stephen T.; Mucositis Study
Section of the Multinational Association for Supportive Care in Cancer.; International Society for
169:
is usually present. Ulcers may range from 0.5 cm to greater than 4 cm. Oral mucositis can be severely painful. The degree of pain is usually related to the extent of the tissue damage. Pain is often described as a burning sensation accompanied by reddening. Due to pain, the patient may
160:
patients undergoing chemotherapy usually become symptomatic four to five days after beginning treatment, reaching a peak at around day 10, and then slowly improving over the course of a few weeks. Mucositis associated with radiotherapy usually appears at the end of the second week of treatment and
144:
Radiotherapy to the head and neck or to the pelvis or abdomen is associated with Grade 3 and Grade 4 oral or GI mucositis, respectively, often exceeding 50% of patients. Among patients undergoing head and neck radiotherapy, pain and decreased oral function may persist long after the conclusion of
419:
oral liquid for the management and relief of pain of oral lesions with various etiologies, including oral mucositis/stomatitis which may be caused by chemotherapy or radiation therapy. The transformative mechanism of action of episil creates a lipid membrane that mechanically bonds to the oral
302:
The severity of oral mucositis can be evaluated using several different assessment tools. Two of the most commonly used are the World Health
Organization (WHO) Oral Toxicity score and the National Cancer Institute Common Toxicity Criteria (NCI-CTC) for Oral Mucositis. While the NCI system has
411:
is an FDA-cleared calcium phosphate mouth rinse that has been shown in an open-label, observational registry trial to prevent and reduce the severity of oral mucositis caused by radiation and high-dose chemotherapy. In the trial, 56% of the radiotherapy patients reported 0 (WHO score) or no
431:
Clinical research is ongoing in oral mucositis. A recent phase 2 exploratory trial in oral mucositis reported that dusquetide, a unique innate immune modulator with a mechanism that potentially addresses each of the phases of OM pathophysiology, is able to reduce the duration of severe oral
412:
mucositis, which is significantly lower than historical rates. Another super saturated calcium phosphate rinse on the market and cleared by the FDA is the US based SalivaMAX. The Mayo Clinic has been testing the antidepressant doxepin in a mouthwash to help treat symptoms.
164:
As a result of cell death in reaction to chemo- or radio-therapy, the mucosal lining of the mouth becomes thin, may slough off and then become red, inflamed and ulcerated. The ulcers may become covered by a yellowish-white fibrin clot called a pseudomembrane. Peripheral
885:
Elad, Sharon; Cohen, Galit; Zylber-Katz, Ester; Findler, Moti; Galili, Dan; Garfunkel, Adi A.; Or, Reuven (2007-02-27). "Systemic absorption of lidocaine after topical application for the treatment of oral mucositis in bone marrow transplantation patients".
998:
Abdulrhman, Mamdouh; Samir
Elbarbary, Nancy; Ahmed Amin, Dina; Saeid Ebrahim, Rania (2012). "Honey and a Mixture of Honey, Beeswax, and Olive Oil–Propolis Extract in Treatment of Chemotherapy-Induced Oral Mucositis: A Randomized Controlled Pilot Study".
1148:
272:, which causes further production of pro-inflammatory cytokines. In addition, bacteria-mediated immune signalling via Toll-like receptors (TLRs) ambiguously shapes chemotherapy-induced genotoxic damage in the gastrointestinal tract.
371:
is a human KGF (keratinocyte growth factor) that has shown to enhance epithelial cell proliferation, differentiation, and migration. Experimental therapies have been reported, including the use of cytokines and other modifiers of
311:
A 2015 Cochrane systematic review assessing the prevention of chemotherapy-induced oral mucositis concluded that oral cryotherapy leads to large reductions in the incidence of oral mucositis of all severities in adults receiving
200:(especially in immunosuppressed patients). Therefore, oral mucositis can be a dose-limiting condition, disrupting a patient’s optimal cancer treatment plan and consequentially decreasing their chances of survival.
196:. Pain and loss of taste perception makes it more difficult to eat, which leads to weight loss. Ulcers may act as a site for local infection and a portal of entry for oral flora that, in some instances, may cause
635:
Sonis, Stephen T.; Elting, Linda S.; Keefe, Dorothy; Peterson, Douglas E.; Schubert, Mark; Hauer-Jensen, Martin; Bekele, B. Nebiyou; Raber-Durlacher, Judith; Donnelly, J. Peter; Rubenstein, Edward B. (2004).
797:
Sonis, Stephen T.; Eilers, June P.; Epstein, Joel B.; Leveque, Francis G.; Liggett, William H.; Mulagha, Mary T.; Peterson, Douglas E.; Rose, Ann H.; Schubert, Mark M.; Spijkervet, Frederik K.;
278:
Signalling from the extracellular matrix of the submucosa results in epithelial proliferation and differentiation, and thus a thickening of the epithelium. The local oral flora are reinstated.
1042:
North, John R.; Takenaka, Shunsuke; Rozek, Annett; Kielczewska, Agnieszka; Opal, Steven; Morici, Lisa A.; Finlay, B.Brett; Schaber, Christopher J.; Straube, Richard; Donini, Oreola (2016).
129:
receiving radiotherapy, and a wide range of patients receiving chemotherapy. Alimentary tract mucositis increases mortality and morbidity and contributes to rising health care costs.
145:
therapy. Fractionated radiation dosage increases the risk of mucositis to > 70% of patients in most trials. Oral mucositis is particularly profound and prolonged among
317:
found for use of this preventive measure in children. Oral cryotherapy involves the placement of rounded ice chips in the mouth, which cools the oral tissues and causes
118:
refers to the particular inflammation and ulceration that occurs in the mouth. Oral mucositis is a common and often debilitating complication of cancer treatment.
464:
428:
as effective as a mixture of honey, olive oil and propolis, while both treatments were found to reduce recovery time compared to the benzocaine control.
333:
is the mainstay of treatment; patients are encouraged to clean their mouth every four hours and at bedtime, more often if the mucositis becomes worse.
1205:
801:(1999). "Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy".
146:
122:
254:
loops involving some of the molecules in the previous phase can exacerbate or prolong tissue injury. For example, the pro-inflammatory cytokine
212:
of mucositis is complex and multifactorial. Currently, Sonis' five phase model is the accepted explanation for the process. The 5 stages are:
391:
Symptomatic relief of the pain of oral mucositis may be provided by barrier protection agents such as concentrated oral gel products (e.g.
814:
778:
World Health
Organization. Handbook for reporting results of cancer treatment. Geneva, Switzerland: World Health Organization; 1979:15-22.
321:. This decreases blood flow to the region and, hence, also restricts the amounts of the chemotherapy drugs delivered to the tissues.
475:
529:"Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis"
584:
583:
Riley, Philip; Glenny, Anne-Marie; Worthington, Helen V; Littlewood, Anne; Clarkson, Jan E; McCabe, Martin G (2015-12-23).
244:. The consequence of this is mucosal destruction, caused by thinning of the epithelium due to tissue injury and cell death.
399:
is a mouth rinse which has been shown to prevent and treat oral mucositis caused by radiation and high-dose chemotherapy.
287:
Diagnosis is based on the symptoms the patient is experiencing and the appearance of the tissues of the mouth following
1044:"A novel approach for emerging and antibiotic resistant infections: Innate defense regulators as an agnostic therapy"
929:
461:
968:
Tiberg, F; et al. (2009). "Treatment of oral mucositis pain by a bioadhesive barrier forming lipid solution".
836:
Yamashita, Soichiro; Sato, Shigehito; Kakiuchi, Yoshihiro; Miyabe, Masayuki; Yamaguchi, Hiroshi (November 2002).
228:
Chemotherapy, radiotherapy and free radicals all contribute to the activation of transcription factors, such as
1167:
241:
233:
693:
Cario E (2016). "Toll-like receptors in the pathogenesis of chemotherapy-induced gastrointestinal toxicity".
342:
1122:
Medical journal articles, guidelines, recommendations, and slides and videos from conference presentations.
585:"Interventions for preventing oral mucositis in patients with cancer receiving treatment: Oral cryotherapy"
121:
Oral and gastrointestinal (GI) mucositis affects almost all patients undergoing high-dose chemotherapy and
358:
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114:
treatment for cancer. Mucositis can occur anywhere along the gastrointestinal (GI) tract, but
41:
357:
has a potential toxicity; when it was tested on patients with oral mucositis who underwent a
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1008:
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unable to eat solid food, and in grade 4, the patient is unable to consume liquids as well.
99:
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468:
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103:
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can positively feedback on NF-κB thus inducing more pro-inflammatory cytokine production.
1161:
1157:
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612:
854:
299:. Red burn-like sores or ulcers throughout the mouth is enough to diagnose mucositis.
1199:
472:
765:
722:
679:
562:
1028:
838:"Lidocaine Toxicity During Frequent Viscous Lidocaine Use for Painful Tongue Ulcer"
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603:
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111:
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95:
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For most cancer treatment, about 5–15% of patients get mucositis. However, with 5-
1172:
1012:
749:
706:
385:
292:
197:
157:
1183:
349:
for relief of pain. However, care should be taken as the high doses of viscous
441:
377:
368:
269:
137:
907:
863:
815:
10.1002/(SICI)1097-0142(19990515)85:10<2103::AID-CNCR2>3.0.CO;2-0
787:
National Cancer
Institute Common Toxicity Criteria. Version 2.0, June 1, 1999
663:
362:
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1077:
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136:(5-FU), up to 40% get mucositis, and 10–15% get grade 3–4 oral mucositis.
396:
392:
381:
255:
237:
229:
189:
166:
1140:
1119:
637:
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545:
528:
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264:
Bacteria colonise ulcers and their cell wall products infiltrate the
193:
736:
Villa A, Sonis ST (2015). "Mucositis: pathobiology and management".
1120:
Mucositis
Resource Center of the MASCC/ISOO Mucositis Study Group.
185:
222:
are produced due to DNA damage caused by chemo- or radiotherapy.
170:
experience trouble speaking, eating, or even opening the mouth.
404:
403:
is a FDA-cleared mucoadhesive oral protectant, developed by
954:
408:
432:
mucositis, as well as reducing the incidence of infection
492:
Sonis, S. T. (2004). "Oral mucositis in cancer therapy".
471:
in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds)
400:
337:
are all known to aggravate mucositis lesions. Medicinal
1091:
https://chem.sis.nlm.nih.gov/chemidplus/name/dusquetide
638:"Perspectives on cancer therapy-induced mucosal injury"
1130:
1134:
70:
60:
40:
21:
66:Red burn-like sores or ulcers throughout the mouth
353:my cause adverse effects. A study reported that
36:Illustration of the human gastrointestinal tract
473:Cancer Management: A Multidisciplinary Approach
149:recipients who receive total-body irradiation.
329:Treatment of mucositis is mainly supportive.
8:
521:
519:
517:
515:
184:Sores or ulcerations can become infected by
1131:
51:
27:
18:
1067:
853:
653:
611:
544:
955:"Episil current prescribing information"
888:Journal of Oral Pathology & Medicine
983:Tiberg, F; et al. "Data on file".
592:Cochrane Database of Systematic Reviews
460:Ridge JA, Glisson BS, Lango MN, et al.
453:
365:was found to be systemically absorbed.
123:hematopoietic stem cell transplantation
842:Journal of Pain and Symptom Management
232:. This results in the upregulation of
7:
578:
576:
574:
572:
380:supplementation (e.g., glutamine),
106:, usually as an adverse effect of
900:10.1111/j.1600-0714.1999.tb02018.x
695:Curr. Opin. Support. Palliat. Care
494:The Journal of Supportive Oncology
14:
1001:Pediatric Hematology and Oncology
161:may last for six to eight weeks.
1206:Gastrointestinal tract disorders
376:(e.g., IL-1, IL-11, TGF-beta3),
604:10.1002/14651858.cd011552.pub2
384:, colony-stimulating factors,
268:. This leads to activation of
1:
1060:10.1016/j.jbiotec.2016.03.032
855:10.1016/S0885-3924(02)00498-0
125:(HSCT), 80% of patients with
1013:10.3109/08880018.2012.669026
750:10.1097/CCO.0000000000000180
707:10.1097/SPC.0000000000000202
405:Access Pharmaceuticals, Inc.
127:cancers of the head and neck
1222:
234:pro-inflammatory cytokines
415:In 2011, the FDA cleared
242:matrix metalloproteinases
35:
26:
1048:Journal of Biotechnology
930:"'MuGard Clinical Data'"
226:Primary damage response.
527:Oral Oncology. (2004).
361:, lidocaine anesthetic
343:Chlorhexidine gluconate
462:"Head and Neck Tumors"
359:bone marrow transplant
388:, and laser therapy.
248:Signal amplification.
539:(9 Suppl): 2026–46.
341:may be used such as
970:Support Cancer Care
240:, nitric oxide and
655:10.1002/cncr.20162
546:10.1002/cncr.20163
500:(6 Suppl 3): 3–8.
478:2013-10-04 at the
467:2009-07-20 at the
270:tissue macrophages
153:Signs and symptoms
1193:
1192:
738:Curr. Opin. Oncol
648:(S9): 1995–2025.
252:negative feedback
217:Initiation phase.
85:
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16:Medical condition
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932:. Archived from
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799:Wittes, Janet P.
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598:(12): CD011552.
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100:mucous membranes
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480:Wayback Machine
469:Wayback Machine
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295:transplants or
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210:pathophysiology
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204:Pathophysiology
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104:digestive tract
90:is the painful
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1135:Classification
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1127:External links
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482:. 11 ed. 2008.
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374:inflammation
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345:and viscous
335:
331:Oral hygiene
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297:radiotherapy
289:chemotherapy
286:
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250:Positive or
247:
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134:fluorouracil
131:
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115:
112:radiotherapy
108:chemotherapy
92:inflammation
87:
86:
79:radiotherapy
75:chemotherapy
386:cryotherapy
339:mouthwashes
293:bone marrow
262:Ulceration.
198:septicaemia
158:Oral cancer
102:lining the
1179:DiseasesDB
972:(17): 918.
940:2010-12-11
448:References
442:Stomatitis
378:amino acid
369:Palifermin
307:Prevention
138:Irinotecan
96:ulceration
1054:: 24–34.
908:0904-2512
864:0885-3924
664:0008-543X
409:NeutraSal
363:mouthwash
355:lidocaine
351:lidocaine
347:Lidocaine
325:Treatment
283:Diagnosis
266:submucosa
174:Dysgeusia
88:Mucositis
81:treatment
42:Specialty
22:Mucositis
1200:Category
1078:27015977
1021:22475306
916:10235370
872:12547053
823:10326686
766:38338695
758:25774860
723:39249409
715:26986508
680:20155854
672:15108222
622:26695736
563:24313893
555:15108223
506:15605918
476:Archived
465:Archived
436:See also
397:Caphosol
393:Gelclair
382:vitamins
276:Healing.
238:ceramide
190:bacteria
167:erythema
62:Symptoms
1173:D052016
1069:4867239
1029:1604567
985:Camurus
613:8915172
422:Cangene
98:of the
1162:528.01
1158:528.00
1076:
1066:
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803:Cancer
764:
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678:
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642:Cancer
620:
610:
561:
553:
533:Cancer
504:
417:episil
401:MuGard
194:fungus
71:Causes
49:
1184:29692
1025:S2CID
762:S2CID
719:S2CID
676:S2CID
588:(PDF)
559:S2CID
256:TNF-α
230:NF-κB
186:virus
1168:MeSH
1153:9-CM
1074:PMID
1017:PMID
912:PMID
904:ISSN
868:PMID
860:ISSN
819:PMID
754:PMID
711:PMID
668:PMID
660:ISSN
618:PMID
596:2016
551:PMID
502:PMID
314:5-FU
208:The
147:HSCT
110:and
94:and
77:and
1149:ICD
1064:PMC
1056:doi
1052:226
1009:doi
896:doi
850:doi
811:doi
746:doi
703:doi
650:doi
646:100
608:PMC
600:doi
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