Erythema, ulcerations, and edema of the oral cavity are symptoms of the extremely painful illness known as oral mucositis. It is a side effect of chemotherapy, chemoradiotherapy, head and neck radiation therapy, and HSCT (hematopoietic stem cell transplantation).
Pain can make it difficult to consume food orally, which in some situations may necessitate parenteral nourishment. Additionally, the oral blisters compromise the mucosa’s protective layer, which might lead to a systemic or local infection.
When chemotherapy causes serious oral mucositis, the dosage in the subsequent cycle may need to be reduced or postponed, which will worsen the prognosis and decrease the standard of life for the patient.
Epidemiology
Typically, 5 to 14 days after beginning chemotherapy, 20 percent to 40 percent of individuals with solid malignancies experience mucositis. Among chemotherapy drugs, the duration of chemotherapy cycles, the amount of chemotherapy, and from case to case, mucositis frequency and intensity vary. Oral mucositis is more common in patients who receive myeloablative treatments before hematopoietic transplants of stem cells.
According to one study, people who take high amounts of chemotherapy or receive a transplant of bone marrow are 76 percent more likely to develop mucositis. In all patients receiving changed fractionation radiotherapy for head and neck carcinoma, RIOM (radiation-induced oral mucositis) develops. Patients who have poor oral hygiene and nutritional health are more likely to develop mucositis. Oral mucositis may be more common in patients who are younger.
Anatomy
Pathophysiology
According to Sonis’ five-phase concept, the pathogenesis of oral mucositis brought on by radiotherapy, chemotherapy, or radiotherapy-chemotherapy is assumed to be the result of a complicated process that begins with tissue injury. Following each other, the 5 stages of OM brought on by RT and chemotherapy include initiating, amplifying, signaling, ulcerating, and recovering.
First, radiotherapy and chemotherapy can damage tissue by killing basal epithelial layers and producing reactive oxygen molecules in the process. Reactive oxygen molecules then directly kill cells and activate the inflammatory process, which kills more cells.
Thirdly, additional pathways, including TNF alpha, are enhanced. Fourthly, further inflammation also results in mucosa ulcerations. Finally, epithelial proliferation aids in the healing process of the epithelium.
Etiology
Patients undergoing RT (radiation therapy) to the head and neck, chemotherapeutic for lymphoma or solid cancer, or high dose myeloablative chemotherapeutic prior to hematopoietic stem cell transplantation frequently develop oral mucositis as a side effect.
Varied chemotherapy drugs have different rates of oral mucositis. Oral mucositis is a common side effect of chemotherapy drugs that impact DNA syntheses (S-phase), such as cytarabine, 5-fluorouracil, and methotrexate.
Oral mucositis risk is also raised by anthracyclines, alkylating drugs, antimetabolites, and mTOR inhibitors. The oral mucosa’s basal epithelial membrane has a high cellular turnover, leaving it vulnerable to radiation damage. Oral mucositis is caused by cell death and the oral mucosa’s inability to heal itself.
Genetics
Prognostic Factors
Uncomplicated cases of mucositis, which are typically self-limiting, may just require symptom relief and palliation. However, high-grade mucositis necessitates hospitalization and delays in treating cancer in close to 20 percent of head and neck cancer outpatients’ cytotoxic drugs. This will decrease patients’ life quality, impair their prognosis, and use more resources for healthcare.
3 times a day or as required
Indicated for Oral Irritation and pain relief on the mucosal surface of the mouth
Wash the diluted solution all around your mouth for at least a minute,
or if necessary to coat the tongue, palate, all oral tissue, inside cheeks, and throat.
Gargle and spit
Preparation
Add 15 mL of the packet and 1 tablespoon of water into a glass; if the
dilution is thick, add 1-2 spoons of water for the correct thickness
Indicated for patients with blood-related malignancies who are undergoing myelotoxic treatment and need stem cell hematopoietic support because of severe oral mucositis :
60 mcg/kg intravenous bolus 3 days before and 3 days after myelotoxic treatment (6 total doses)
Dose Adjustments
Premyelotoxic treatment
Before myelotoxic treatment, provide the first three doses.
Administer the third dosage 24 to 48 hours before starting myelotoxic treatment.
Postmyelotoxic treatment
After myelotoxic treatment has been completed, provide the last three doses.
After hematopoietic stem cell infusion and at least seven days after palifermin's 3rd pre myelotoxic dosage, administer the first of the above doses.
In head and neck cancer patients, radiation may cause severe oral mucositis (SOM), which is currently unapproved by the Food and Drug Administration (FDA).
Rinse your mouth with 15 mL (for 30 seconds, then spit it out). Every 3-4 hours
Start taking it one day before radiation therapy and keep doing it daily while getting radiation.
3 times a day or as required
Indicated for Oral Irritation and pain relief on the mucosal surface of the mouth
Wash the diluted solution all around your mouth for at least a minute,
or if necessary to coat the tongue, palate, all oral tissue, inside cheeks, and throat.
Gargle and spit
Preparation
Add 15 mL of the packet and 1 tablespoon of water into a glass; if the
dilution is thick, add 1-2 spoons of water for the correct thickness
Children more than 6 years and adults-Oral rinse
Rinse your mouth with 15 mL (for 30 seconds, then spit it out). Every 3-4 hours
Start taking it one day before radiation therapy and keep doing it daily while getting radiation.
Future Trends
Media Gallary
References
https://www.ncbi.nlm.nih.gov/books/NBK565848/
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Erythema, ulcerations, and edema of the oral cavity are symptoms of the extremely painful illness known as oral mucositis. It is a side effect of chemotherapy, chemoradiotherapy, head and neck radiation therapy, and HSCT (hematopoietic stem cell transplantation).
Pain can make it difficult to consume food orally, which in some situations may necessitate parenteral nourishment. Additionally, the oral blisters compromise the mucosa’s protective layer, which might lead to a systemic or local infection.
When chemotherapy causes serious oral mucositis, the dosage in the subsequent cycle may need to be reduced or postponed, which will worsen the prognosis and decrease the standard of life for the patient.
Typically, 5 to 14 days after beginning chemotherapy, 20 percent to 40 percent of individuals with solid malignancies experience mucositis. Among chemotherapy drugs, the duration of chemotherapy cycles, the amount of chemotherapy, and from case to case, mucositis frequency and intensity vary. Oral mucositis is more common in patients who receive myeloablative treatments before hematopoietic transplants of stem cells.
According to one study, people who take high amounts of chemotherapy or receive a transplant of bone marrow are 76 percent more likely to develop mucositis. In all patients receiving changed fractionation radiotherapy for head and neck carcinoma, RIOM (radiation-induced oral mucositis) develops. Patients who have poor oral hygiene and nutritional health are more likely to develop mucositis. Oral mucositis may be more common in patients who are younger.
According to Sonis’ five-phase concept, the pathogenesis of oral mucositis brought on by radiotherapy, chemotherapy, or radiotherapy-chemotherapy is assumed to be the result of a complicated process that begins with tissue injury. Following each other, the 5 stages of OM brought on by RT and chemotherapy include initiating, amplifying, signaling, ulcerating, and recovering.
First, radiotherapy and chemotherapy can damage tissue by killing basal epithelial layers and producing reactive oxygen molecules in the process. Reactive oxygen molecules then directly kill cells and activate the inflammatory process, which kills more cells.
Thirdly, additional pathways, including TNF alpha, are enhanced. Fourthly, further inflammation also results in mucosa ulcerations. Finally, epithelial proliferation aids in the healing process of the epithelium.
Patients undergoing RT (radiation therapy) to the head and neck, chemotherapeutic for lymphoma or solid cancer, or high dose myeloablative chemotherapeutic prior to hematopoietic stem cell transplantation frequently develop oral mucositis as a side effect.
Varied chemotherapy drugs have different rates of oral mucositis. Oral mucositis is a common side effect of chemotherapy drugs that impact DNA syntheses (S-phase), such as cytarabine, 5-fluorouracil, and methotrexate.
Oral mucositis risk is also raised by anthracyclines, alkylating drugs, antimetabolites, and mTOR inhibitors. The oral mucosa’s basal epithelial membrane has a high cellular turnover, leaving it vulnerable to radiation damage. Oral mucositis is caused by cell death and the oral mucosa’s inability to heal itself.
Uncomplicated cases of mucositis, which are typically self-limiting, may just require symptom relief and palliation. However, high-grade mucositis necessitates hospitalization and delays in treating cancer in close to 20 percent of head and neck cancer outpatients’ cytotoxic drugs. This will decrease patients’ life quality, impair their prognosis, and use more resources for healthcare.
3 times a day or as required
Indicated for Oral Irritation and pain relief on the mucosal surface of the mouth
Wash the diluted solution all around your mouth for at least a minute,
or if necessary to coat the tongue, palate, all oral tissue, inside cheeks, and throat.
Gargle and spit
Preparation
Add 15 mL of the packet and 1 tablespoon of water into a glass; if the
dilution is thick, add 1-2 spoons of water for the correct thickness
Indicated for patients with blood-related malignancies who are undergoing myelotoxic treatment and need stem cell hematopoietic support because of severe oral mucositis :
60 mcg/kg intravenous bolus 3 days before and 3 days after myelotoxic treatment (6 total doses)
Dose Adjustments
Premyelotoxic treatment
Before myelotoxic treatment, provide the first three doses.
Administer the third dosage 24 to 48 hours before starting myelotoxic treatment.
Postmyelotoxic treatment
After myelotoxic treatment has been completed, provide the last three doses.
After hematopoietic stem cell infusion and at least seven days after palifermin's 3rd pre myelotoxic dosage, administer the first of the above doses.
In head and neck cancer patients, radiation may cause severe oral mucositis (SOM), which is currently unapproved by the Food and Drug Administration (FDA).
Rinse your mouth with 15 mL (for 30 seconds, then spit it out). Every 3-4 hours
Start taking it one day before radiation therapy and keep doing it daily while getting radiation.
3 times a day or as required
Indicated for Oral Irritation and pain relief on the mucosal surface of the mouth
Wash the diluted solution all around your mouth for at least a minute,
or if necessary to coat the tongue, palate, all oral tissue, inside cheeks, and throat.
Gargle and spit
Preparation
Add 15 mL of the packet and 1 tablespoon of water into a glass; if the
dilution is thick, add 1-2 spoons of water for the correct thickness
Children more than 6 years and adults-Oral rinse
Rinse your mouth with 15 mL (for 30 seconds, then spit it out). Every 3-4 hours
Start taking it one day before radiation therapy and keep doing it daily while getting radiation.
https://www.ncbi.nlm.nih.gov/books/NBK565848/
medtigo
Oral Mucositis
Updated :
August 17, 2023
Erythema, ulcerations, and edema of the oral cavity are symptoms of the extremely painful illness known as oral mucositis. It is a side effect of chemotherapy, chemoradiotherapy, head and neck radiation therapy, and HSCT (hematopoietic stem cell transplantation).
Pain can make it difficult to consume food orally, which in some situations may necessitate parenteral nourishment. Additionally, the oral blisters compromise the mucosa’s protective layer, which might lead to a systemic or local infection.
When chemotherapy causes serious oral mucositis, the dosage in the subsequent cycle may need to be reduced or postponed, which will worsen the prognosis and decrease the standard of life for the patient.
Typically, 5 to 14 days after beginning chemotherapy, 20 percent to 40 percent of individuals with solid malignancies experience mucositis. Among chemotherapy drugs, the duration of chemotherapy cycles, the amount of chemotherapy, and from case to case, mucositis frequency and intensity vary. Oral mucositis is more common in patients who receive myeloablative treatments before hematopoietic transplants of stem cells.
According to one study, people who take high amounts of chemotherapy or receive a transplant of bone marrow are 76 percent more likely to develop mucositis. In all patients receiving changed fractionation radiotherapy for head and neck carcinoma, RIOM (radiation-induced oral mucositis) develops. Patients who have poor oral hygiene and nutritional health are more likely to develop mucositis. Oral mucositis may be more common in patients who are younger.
According to Sonis’ five-phase concept, the pathogenesis of oral mucositis brought on by radiotherapy, chemotherapy, or radiotherapy-chemotherapy is assumed to be the result of a complicated process that begins with tissue injury. Following each other, the 5 stages of OM brought on by RT and chemotherapy include initiating, amplifying, signaling, ulcerating, and recovering.
First, radiotherapy and chemotherapy can damage tissue by killing basal epithelial layers and producing reactive oxygen molecules in the process. Reactive oxygen molecules then directly kill cells and activate the inflammatory process, which kills more cells.
Thirdly, additional pathways, including TNF alpha, are enhanced. Fourthly, further inflammation also results in mucosa ulcerations. Finally, epithelial proliferation aids in the healing process of the epithelium.
Patients undergoing RT (radiation therapy) to the head and neck, chemotherapeutic for lymphoma or solid cancer, or high dose myeloablative chemotherapeutic prior to hematopoietic stem cell transplantation frequently develop oral mucositis as a side effect.
Varied chemotherapy drugs have different rates of oral mucositis. Oral mucositis is a common side effect of chemotherapy drugs that impact DNA syntheses (S-phase), such as cytarabine, 5-fluorouracil, and methotrexate.
Oral mucositis risk is also raised by anthracyclines, alkylating drugs, antimetabolites, and mTOR inhibitors. The oral mucosa’s basal epithelial membrane has a high cellular turnover, leaving it vulnerable to radiation damage. Oral mucositis is caused by cell death and the oral mucosa’s inability to heal itself.
Uncomplicated cases of mucositis, which are typically self-limiting, may just require symptom relief and palliation. However, high-grade mucositis necessitates hospitalization and delays in treating cancer in close to 20 percent of head and neck cancer outpatients’ cytotoxic drugs. This will decrease patients’ life quality, impair their prognosis, and use more resources for healthcare.
https://www.ncbi.nlm.nih.gov/books/NBK565848/
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