Management of Oral Mucositis
Prevention
- The National Comprehensive Cancer Network (NCCN) recommends magic mouthwash as a rinse that is swished in the mouth for 1-2 minutes and then either spit out or swallowed depending on the formulation for symptomatic relief of oral mucositis 1
- Oral care protocols are recommended for all cancer treatment modalities by the European Society for Medical Oncology (ESMO) 3
- Benzydamine mouthwash is recommended for patients with head and neck cancer receiving moderate dose radiation therapy (up to 50 Gy) without concomitant chemotherapy by the Multinational Association of Supportive Care in Cancer (MASCC) 4
- Oral cryotherapy is recommended for patients receiving bolus 5-fluorouracil chemotherapy by the European Society for Medical Oncology (ESMO) 3
- Low-level laser therapy is recommended for patients receiving HSCT conditioned with high-dose chemotherapy by the European Society for Medical Oncology (ESMO) 3
Treatment
- Patient-controlled analgesia with morphine is recommended for pain due to oral mucositis in patients undergoing HSCT by the European Society for Medical Oncology (ESMO) 3
- 0.2% morphine mouthwash is recommended for pain due to oral mucositis in patients receiving chemoradiation therapy for head and neck cancer by the European Society for Medical Oncology (ESMO) 5
- 0.5% doxepin mouthwash is recommended for pain due to oral mucositis by the European Society for Medical Oncology (ESMO) 3
- Transdermal fentanyl is recommended for pain due to oral mucositis in patients receiving conventional or high-dose chemotherapy by the European Society for Medical Oncology (ESMO) 3
Interventions to Avoid
- Sucralfate mouthwash is not recommended for prevention or treatment of oral mucositis by the European Society for Medical Oncology (ESMO) 9
- Chlorhexidine mouthwash is not recommended for prevention of oral mucositis in patients receiving radiation therapy for head and neck cancer by the European Society for Medical Oncology (ESMO) 9
- Iseganan antimicrobial mouthwash is not recommended for prevention of oral mucositis by the European Society for Medical Oncology (ESMO) 3
- Intravenous glutamine is not recommended for prevention of oral mucositis by the European Society for Medical Oncology (ESMO) 7