Designed to be given to residential aged care staff attending oral health education and traning. It is part of a suite of three Better Oral Health in Download
Oral side effects of cancer therapy are very common, and unfortunately most patients who receive head and neck radiation therapy develop oral complications.1,2 This is particularly true of patients receiving radiation and chemotherapy, as the combination compounds the risk.1,2 Mucositis is painful inflammation or ulceration of the mucous membranes anywhere along the gastrointestinal tract. Stomatitis (oral mucositis) refers to inflammation and ulceration that occur in the mouth. Stomatitis can affect any of the structures in the mouth: cheeks, gums, tongue, throat, lips, and roof or floor.2 Boxes 1 and 2 explain the causes of and medications commonly associated with stomatitis. Radiotherapy to the mouth results in substantial local oral mucosal damage in both acute and late stages. Radiation-induced stomatitis is characterized by xerostomia (dry mouth due to lack of saliva), diffuse erythema, ulceration, taste alteration, oral soreness, dysphagia, difficulty talking, and mouth odour.3 Causes of stomatitis
Medications associated with stomatitis
The treatment options for stomatitis are the same whether the patient is palliative or curative. Subtle variations depend on prognosis and life expectancy.
Many of the side effects of cancer therapy can often be prevented. The recommended approach supported by the evidence uses pretreatment oral assessment2 to identify and eliminate asymptomatic oral infections, including minor dental caries, periodontal disease, and oral infections due to prosthesis or restorations, which might irritate oral mucosa. The oral assessment should be at least 2 weeks, but preferably 3 weeks, before cancer therapy begins to allow time to address any concerns.3
Xerostomia is the most consistent and bothersome side effect of radiotherapy.2 Radiotherapy affects the serous glands, resulting in decreased salivary flow and dry mouth. Onset can be evident within 1 week of radiotherapy initiation and can have long-term repercussions. Xerostomia and the direct effect of radiotherapy and chemotherapy can lead to mucositis, initially erythema and edema of the epithelium, which might advance to ulceration. This process often starts within 2 weeks of radiotherapy and within 5 to 8 days of chemotherapy.2 Although xerostomia and taste alteration can last for prolonged periods (ie, months), the mucositis will usually settle about 2 to 3 weeks after completion of radiotherapy or chemotherapy. While practising a preventive approach to reduce the likelihood or severity of xerostomia, you still need to educate patients on current treatment strategies. These include use of saliva substitutes (eg, water or glycerin preparations) or salivary stimulants (eg, sialogogues or gum). Box 34 provides a stepwise approach to stomatitis-associated symptoms. Commonly used mouthwashes used for prevention and treatment of stomatitis include club soda, alcohol-free mouthwashes, and benzydamine hydrochloride; hydrogen peroxide is not indicated. Many pharmacies have their own formulary mouthwashes for stomatitis—often referred to as “magic mouthwash,” even though there is no magic. These mouthwashes, which can be very effective for sore mouth due to stomatitis, include various combinations of antifungals, antibacterials, steroids, and local anesthetics. It is important to encourage patients to hydrate frequently and educate them on other recommendations for general mouth care. Stepwise approach to symptoms of stomatitis
Data from Cancer Care Nova Scotia.4
BOTTOM LINE
Competing interests None declared 1. Ventafridda V, Ripamonti C, Sbanotto A, de Conno F. Mouth care. In: Doyle D, Hanks G, Cherny NI, Calman K, editors. Oxford textbook of palliative medicine. 3rd ed. New York, NY: Oxford University Press; 2005. pp. 677–87. [Google Scholar] 2. Sonis ST, Costa JW. Oral complications. In: Kufe DW, Pollock RE, Weichselbaum RR, Gansler TS, Bast RC, editors. Holland-Frei cancer medicine. 6th ed. Hamilton, ON: BC Decker Inc; 2003. pp. 1585–2598. [Google Scholar] 3. Stevenson-Moore P, Epstein JB. The management of teeth in irradiated sites. Eur J Cancer B Oral Oncol. 1993;29B(1):39–43. [PubMed] [Google Scholar] 4. Cancer Care Nova Scotia. Palliative care front-line education program [education sessions 2007] Halifax, NS: Cancer Care Nova Scotia; 2009. [Accessed 2009 Aug 12]. Available from: www.cancercare.ns.ca/en/home/healthprofessionals/education/excellence/palliativecare.aspx. [Google Scholar] |