Oral mucositis


It is very common for cancer treatments to cause unwanted side effects.

The most frequent of these is oral mucositis, which is caused by chemotherapy and / or radiotherapy treatments, occurring in about 40% of patients. In the case of people who are undergoing radiotherapy for head and neck cancer, oral mucositis occurs in almost 100% of cases.

This pathology affects the mucous membranes inside the mouth, generating problems ranging from some discomfort or irritation, to severe ulcerous lesions. Patients commonly observe the appearance of canker sores, sores, ulcers or wounds, both on the oral mucosa, on the tongue and on the gums.

We can recognize this problem by observing if the inflammation and/or lesions that appear within the oral cavity are a mere nuisance or, in severe cases, a very painful injuries that directly affect the quality of life of patients.

If injuries from oral mucositis were to be severe, the patient may suffer from nutritional problems that directly influence the continuity of cancer therapy.

It helps that the patient carefully cares of his/her health and oral hygiene before, during and after cancer treatment. This will decrease the severity of the oral lesions and cancer treatment will be more bearable.


Background and facts about oral mucositis


Approximately 40% of patients treated with standard chemotherapy will develop oral mucositis during treatment.


80% of patients undergoing high-dose chemotherapy prior to hematopoietic stem cell transplant (bone marrow transplant) are likely to suffer the appearance of oral mucositis.


97% of patients receiving radiotherapy for cancer of the head and neck will be affected by oral mucositis.

*NCI (National Cancer Institute) USA

Scale to assess oral mucositis

The World Health Organization (WHO) has classified five different levels of oral mucositis on a scale that combines inflammatory levels of oral mucosa, pain and food intake capacity in a single composite score *.

  • Grade 0

    None (no changes are observed).

  • Grade 1

    Erythema (redness of the mucous membrane) and mild pain.

  • Grade 2

    Ulcers and pain. The pacients are able to eat solids.

  • Grade 3

    Ulcers and pain. It requires liquid diet (due to mucositis).

  • Grade 4

    Ulcers and acute pain. Feeding is not possible orally (due to mucositis).

*World Health Organization. WHO handbook for reporting results of cancer treatment. Geneva: World Health Organization; 1979. WHO offset publication 48.


Rajesh V. Lalla
D.D.S., Ph.D., C.C.R.P., D.A.B.O.M.

Ph.D., Associate Professor at the University of Connecticut.
Former Chairman of the mucositis Study Group of the Multinational Association of Cancer Supportive Care and the International Society of Oral Oncology (MASCC / ISOO).
He currently serves as Chairman of MASCC’s Guide’s Committee, and a member of MASCC’s Board of Directors and its Executive Committee.

Expert’s opinion

Oral mucositis refers to redness and ulceration of the oral mucosa, a side effect of cancer treatment. It is a common complication of chemotherapy for various cancers. It is also observed in almost all patients receiving radiotherapy for head and neck cancer.

Oral mucositis’ ulcers are very painful. Because of the pain, patients may have problems with oral food intake and may need to be fed intravenously or through a stomach tube. They also may lose weight, have healing problems and suffer from a decreased resistance to infection. If ulcers are infected, this can make them become worse, and, in some cases, the infection can spread to the blood.

For some patients with severe oral mucositis, the chemotherapy dose has to be reduced or they may need a break from radiation therapy, which could be bad for cancer control. Finally, the cost of cancer treatment is higher for patients who develop severe oral mucositis due to the need of drugs to treat the pain, special food, and hospitalizations.

Therefore, it is very important to properly control oral mucositis to avoid all these complications.

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