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Oral Mucositis


Presentation

  • In the present study, despite the elevated number of patients that presented grade 3 mucositis (white coating) at the end of laser therapy, this finding is probably related to the healing process of the lesions, since there were no associated symptoms[scielo.br]
  • Odynophagia was present in 55.7% (n 73) of patients with glutamine and in 77.9% (n 102) of those without it (p 0.0001).[scielo.isciii.es]
  • In patients undergoing chemotherapy at standard doses, oral mucositis generally presents as grades 1 and 2 rather than grades 3 and 4.[touchoncology.com]
  • OM initially presents as erythema and soreness, followed by painful ulcerations. 1,3,6 These symptoms follow the pathophysiology, which has been described to include 5 phases: initiation, upregulation and activation of second messengers, signal amplification[cancertherapyadvisor.com]
  • Stomatitis can include oral ulceration, xerostomia, altered taste and taste loss, oral sensitivity, and oral pain with or without lesions being clinically present. r Pathophysiology Oral mucositis The mucosal lining of the mouth is a prime target for[eviq.org.au]
Anemia
  • […] and weight loss of more than 5% (60%) compared with patients without OM (6%; P .01 and 17%; P .001, respectively). 7 Severe OM that results in swallowing impairment and/or pain that prevents oral intake results in weight loss, anorexia, malnutrition, anemia[cancertherapyadvisor.com]
  • Examples for supportive care conditions are myelosuppression, anemia, oral and intestinal mucositis, thromboembolic disease, infections, nausea and vomiting, diarrhea, fatigue and pain.[karger.com]
Localized Pain
  • pain treatment for head and neck cancer patients with oral mucostis Medical condition: Oral pain due to oral mucositis in head and neck cancer patients which are undergoing radiation therapy Disease: Version SOC Term Classification Code Term Level 17.1[clinicaltrialsregister.eu]
  • Local pain therapies such as viscous lidocaine and magic mouthwash have limited benefits. 33,34 Although they provide pain relief, it is very fleeting as the lidocaine wears away after only a few minutes.[touchoncology.com]
Aphthous Ulceration
  • Like aphthous ulcers, these are confined to the nonkeratinized tissues and have a quicker onset compared with classic mucositis.[emedicine.medscape.com]
Skin Ulcer
  • Topical manuka honey for MRSA-contaminated skin ulcers. Palliat Med 2006 ; 20 : 557. van den Berg, AJ, van den Worm, E, van Ufford, HC, Halkes, SB, Hoekstra, MJ, Beukelman, CJ.[cambridge.org]
Skin Edema
  • Adverse reactions seen in the study, such as rash, pruritus (itching), erythema (redness of the skin), edema, pain, fever, arthralgia (joint pain), mouth/tongue disorders and taste alteration were primarily mild-to-moderate in severity and transient.[farmanews.com]
Skin Patch
  • For people who cannot swallow pills because of mouth sores, some medications are also available in liquids and skin patches. The pain-relieving drug seeps into the skin from the patch and enters the bloodstream, where it travels to the mouth.[cancercare.org]
Rash of the Hands and Feet
  • Hand, foot, and mouth disease causes sores in the mouth and rashes on the hands and feet. It’s most common in children under age 5. A sore mouth can make it difficult for you to eat or drink.[healthline.com]
Urinary Retention
Dysesthesia
  • The most commonly reported adverse reactions attributed to Kepivance were rash, erythema, edema, pruritus, dysesthesia, mouth/tongue thickness/discoloration and taste alteration.[farmanews.com]
  • This cannot be used with oxaliplatin, as cold related dysesthesia could be triggered (maxillar stiffness and laryngopharyngeal spasm) ( 7 ). However, 5FU seems to benefit from cryotherapy.[cco.amegroups.com]
Mental Distress
  • Hammerlid E, Ahlner-Elmqvist M, Bjordal K, Biörklund A, Evensen J, et al. (1999) A prospective multicentre study in Sweden and Norway of mental distress and psychiatric morbidity in head and neck cancer patients. Br J Cancer 80: 766–774.[journals.plos.org]

Workup

  • […] oral mucositis are the following: World Health Organization (WHO) Oral Toxicity Scale: Combines both objective and functional elements into a single score National Cancer Institute Common Toxicity Criteria (NCI CTC): Scores functional elements only See Workup[emedicine.medscape.com]

Treatment

  • And additional research showed that treating cancer patients with KGF before cancer treatment had a strong protective effect, limiting the damage cancer treatments can inflict on the rapidly dividing cells of the mouth.[cancer.gov]
  • Oral mucositis often happens around a week after you begin treatment. A sore mouth usually gets better once you finish your treatment for lymphoma and your blood counts return to the levels they were at before you had treatment.[lymphoma-action.org.uk]
  • “Most importantly, [patients] will not have to discontinue treatment,” Arany said. “People discontinue treatment because they can’t handle the oral mucositis. They are not eating well. Their overall immunity is down.[oncnursingnews.com]
  • These were evaluated in patients with different types of cancer, undergoing different types of cancer treatment. Benefits may be restricted to the disease and treatment combinations evaluated.[cochrane.org]
  • Once chemotherapy or radiation treatments have begun, this oral condition may develop within days, reaching the height of severity in two weeks. After the treatment has ended, it will often resolve. The lesions in the mouth may be mild or severe.[colgate.com]

Prognosis

  • Due to its high incidence and clinical significance in patient prognosis, several studies were conducted to investigate the treatment and prevention of oral mucositis ( 11, 18 – 20 ).[spandidos-publications.com]
  • Severe OM consequences are serious and may include: Interruption of treatment Interruptions in radiotherapy caused by severe OM can seriously compromise the otherwise good prognosis for tumor control in many of these patients.[galeratx.com]
  • Prognosis of oral mucositis The outlook for OM in the long-term is reasonably good as most lesions resolve within 2-4 weeks of stopping chemotherapy or radiation.[healthengine.com.au]
  • Prognosis Chemotherapy-induced oral mucositis is a self-limiting condition.[emedicine.medscape.com]
  • Oral mucositis is a common complication of some malignancies treatment, causing therapeutic modifications due to patient's debilitation, which often interferes with the prognosis of the disease.[scielo.br]

Etiology

  • Oral mucositis occurs independently of oral mucosal infections of viral and fungal etiology, but it may be exacerbated by such concomitant infections.[emedicine.medscape.com]
  • -Oral mucositis occurs independently of oral mucosal infections of viral and fungal etiology, but it may be exacerbated by such concomitant infections.[oralcancerfoundation.org]
  • Potential trauma may be caused by two etiologies. First one is the mechanical trauma which consists by the damages of foods, drinks, dentures or teeth, or even opening the mouth when mucous membranes are dry and stuck together.[omicsonline.org]
  • Palanianppan N, Owadally W, Evans M: Epidemiology and etiology of head and neck cancers. In Practical Clinical Oncology. 2nd Edition. Hanna L, Crosby T, Macbeth F. Cambridge University Press, UK. 2015. Reference Source 7.[f1000research.com]
  • In 2011, the FDA cleared episil oral liquid for the management and relief of pain of oral lesions with various etiologies, including oral mucositis/stomatitis which may be caused by chemotherapy or radiation therapy.[en.wikipedia.org]

Epidemiology

  • Rettig EM, D'Souza G: Epidemiology of head and neck cancer. Surg Oncol Clin N Am. 2015; 24 (3): 379–96. PubMed Abstract 6. Palanianppan N, Owadally W, Evans M: Epidemiology and etiology of head and neck cancers.[f1000research.com]
  • Epidemiology of mucositis induced by mTOR inhibitors Mucositis is one of the most common and limiting toxicities caused by mTOR inhibitors.[jomos.org]
  • These studies focus on the effects of the different treatment options for OM and are not primarily epidemiological studies or HRQoL studies of OM.[karger.com]
  • Epidemiology Frequency Some degree of oral mucositis occurs in approximately 40% of patients who receive cancer chemotherapy.[emedicine.medscape.com]
  • Perspectives on Cancer Therapy-Induced Mucosal Injury: Pathogenesis, Measurement, Epidemiology, and Consequences for Patients. Cancer. 2004; 100 (S9):1995–2025. [ PubMed ] [ Google Scholar ] 14. Sonis ST, Peterson RL, Edwards LJ, et al.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • […] demonstrated that 56% of children experienced any grade OM, and 39% and 8.3% experienced grade 2 or grade 4 OM, respectively. 5 Presentation OM initially presents as erythema and soreness, followed by painful ulcerations. 1,3,6 These symptoms follow the pathophysiology[cancertherapyadvisor.com]
  • Stomatitis can include oral ulceration, xerostomia, altered taste and taste loss, oral sensitivity, and oral pain with or without lesions being clinically present. r Pathophysiology Oral mucositis The mucosal lining of the mouth is a prime target for[eviq.org.au]
  • Because this toxicity clusters with dermatologic toxicities, rather than GI (as is the case with conventional mucositis) toxicities, this suggests that the underlying pathophysiology is likely very different.[emedicine.medscape.com]
  • Advances in molecular biology have provided greater insight into the pathophysiology of this condition.[touchoncology.com]
  • Pathophysiology Mucosal cells have a high capacity of cellular turnover which is the cause of irradiation sensitivity.[omicsonline.org]

Prevention

  • There are few clinical trials in the literature proving any kind of treatment or prevention methods to be effective.[mdpi.com]
  • Use of palifermin for the prevention of high-dose methotrexate-induced oral mucositis. Ann Oncol 2008;19:1644-9. [ Crossref ] [ PubMed ] Papas AJE, Sobel S, Olsen TO. Effects of preventive regimen on oral mucositis. J Dent Res IADR 1981;544:940.[cco.amegroups.com]
  • Different strategies are used to try and prevent this condition, and the review of trials found that some of these are effective.[cochrane.org]
  • Oral-disease prevention in children with cancer: Testing preventive protocol effectiveness. Medicina Oral 2001;6(5): 326-334. Tomlinson T, Gibson F, Treister N, Baggott C, Judd P, Hendershot E et al.[hsj.gr]
  • This new regulatory approval for gelX is the first for a medical product to be used for both the treatment and prevention of oral mucositis in cancer patients.[bmgpharma.com]

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