Radiation and chemotherapy-induced mucositis causes pain, difficulty swallowing, and decreased oral intake.

Prevention and general treatment

Oral care
- At least two weeks prior to the start of radiation to the head and neck region, or the use of chemotherapy that is expected to cause severe and prolonged neutropenia (e.g., acute leukemia), patients should undergo a thorough oral/dental exam with appropriate dental extraction and repair or removal of dental prostheses.
- Patients should be educated on maintaining good oral hygiene including daily brushing with a soft bristle tooth brush, flossing, use of fluoride plaques and avoiding denture use. Mouth rinses that contain a mixture of baking soda, salt, and water can prevent the buildup of bacterial overgrowth and remove dead cells.
- Patients should avoid caustic and drying agents: alcoholic beverages, mouth rinses with alcohol, hot beverages, and acidic foods.

Radiation therapy technique
Advanced radiotherapy techniques, such as 3D-conformal therapy and intensity modulated therapy (IMRT), decrease radiation toxicity by limiting doses to the normal oral mucosa. Other modifications of XRT that decrease toxicity include using shields to block normal tissues, decreasing the radiation fraction size, and shorter overall treatment time.
Severe mucositis may require a 5- to 7-day radiation treatment break to allow for tissue recovery. However, a prolonged break in treatment is associated with inferior local control rates and survival.

Treatment of infection
Prophylactic use of antifungal, antibacterial, or antiviral medications does not decrease the incidence of mucositis.
However, clinicians should consider potential super-infection, and have a low threshold to obtain cultures, especially for fungal and viral infections. Viral infections such as herpes may not present with classic physical examination findings.

Pain management
Local anesthetics, such as lidocaine and diphenhydramine, are routinely used to relieve pain but do not provide mucosal protection nor hasten recovery. Local anesthetics decrease taste and can impact oral intake. Some patients find addition of carafate slurry or a liquid antacid to a lidocaine/diphenhydramine mixture provides temporary analgesia.
Liquid oral or parenteral opioids may be required for adequate pain management.

A number of topical agents are available to provide symptomatic relief. These include commercial and non-commercial preparation: gelclair; topical lidocaine; various mixtures of lidocaine, maalox, diphenhydramine and nystatin, etc.

Some studies have shown pain relief with the use of low power laser therapy delivered in a fractionated course three times a week. Its mechanism of action is thought to be due to anti-inflammatory effects of the laser irradiation on local tissue

Adapted from von Henson CF and Arnold R. Palliative Care Network of Wisconsin. Fast facts and concepts #130. Oral mucositis: prevention and treatment. Internet. Accessed on June 21, 2016.