Oral mucositis in cancer patients

Oral mucositis or stomatitis is an inflammation of the mucosal lining of the digestive tract. The most commonly affected areas are the throat and esophagus.

This toxicity occurs in 30-50% of cancer patients treated with chemotherapy and in 90-100% of cases receiving radiation therapy, particularly if tumors close to the oral cavity are irradiated.

The symptoms of oral mucositis may range from mild reddening to the appearance of severe ulcers. Symptoms can also range from discomfort, dry mouth, burning, tingling of the lips, changes in sense of taste, to pain and inability to eat or drink liquids.

The scale most commonly used to measure the degree of oral mucositis is that described by the World Health Organization (WHO), which takes into account anatomical, functional and symptomatic aspects. This scale is broken down into grades 0, 1, 2, 3, 4, with 0 being the absence of lesions to 4 being the impossibility of oral alimentation by the patient, requiring enteral or parenteral support.

Several general care strategies are available to prevent this complication:

• The cancer patient should maintain good oral hygiene with daily brushing of teeth, tongue and gums after meals and at bedtime. We recommend using a non-irritating toothpaste and a soft-bristled toothbrush.

• It is also important to perform oral rinses with mouthwashes because they remove food particles that can accumulate and cause bacterial growth.

• After oral hygiene practices, rinse out your mouth with an infusion of thyme or chamomile or with water mixed with a teaspoon of baking soda. 

• Keep your lips moisturized with cocoa butter-based lip balms, hydrating creams or olive oil. Avoid using petroleum jelly or glycerin due to their dehydrating effects on labial tissue.

In addition to these guidelines, there are other specific recommendations for patients already suffering mucositis:

• Increase the frequency of the oral rinses with baking soda or saline solution, or both, to every 2-4 hours.
• Do not use rinses containing alcohol or abrasive toothpastes.
• Avoid foods that can be painful, such as those that are acidic, spicy or hot in temperature.
• Try to eat a soft diet.
• Increase fluid intake: the colder, the better.
• Abstain from irritants, such as alcohol and smoking.

In order to promote an improvement in patient quality of life at the pharmacotherapy level, multiple combinations of active ingredients are used for the topical treatment of mucositis. The most commonly used are local anesthetics (lidocaine), oral antiseptics (chlorhexidine, benzydamine), antifungals (nystatin) and mucosal protective agents (sucralfate).

With the combination of these active ingredients, pharmacy services often prepare a wide variety of specific tailor-made master formulas. Examples include oral solutions of artificial saliva, an oral solution of lidocaine viscous, an herbal tea made with Plantago major and other oral solutions for mucositis containing different active ingredients. Most of these formulas are given as mouthwash, but they can be swallowed, if necessary, if involvement is beyond the oropharyngeal area.