Symptoms
Oral mucositis manifests as redness, swelling, pain, a burning sensation, aphthae, a white to yellowish coating, sores, ulceration, bleeding, and bad breath, among other symptoms. The tongue and gums may also be affected. The discomfort may increase in association with eating. Sores can be so painful that food intake is limited, which can lead to weight loss.
Causes
In stomatitis, the mucous membrane in the oral cavity is inflamed. Possible causes include: Infectious diseases:
- Viruses, e.g., herpes simplex virus 1 (oral thrush), Epstein-Barr virus (mononucleosis), hand-foot-and-mouth disease.
- Bacteria
- Fungi: and other -species (oral thrush).
Dry mouth:
- Sjögren’s syndrome
- Medications, e.g. parasympatholytics, antidepressants.
Medicines:
- Cancer therapy: cytostatics, radiotherapy.
- Antibiotics
- Immunosuppressants, glucocorticoids
Other possible causes:
- Allergies and intolerances
- Immunosuppression
- Diseases
- Physical triggers: burns (eg, hot drinks), chemical burns, injuries.
- Deficiency of vitamins, minerals and trace elements, e.g. vitamin B complex, vitamin C, iron deficiency.
- Dental diseases such as caries, plaque.
- Stimulants and intoxicants, food: alcohol, smoking, chewing tobacco, hot spices.
- Map tongue
- Inadequate or excessive oral hygiene
- Gastroesophageal reflux (acid regurgitation).
- Braces, dentures
- Dry air
Diagnosis
Diagnosis is made in medical treatment based on symptoms, patient history, with a physical examination and possibly with laboratory methods.
Drug treatment
Treatment depends on the cause. The following are medications commonly used to treat oral mucositis. Disinfectants:
- Such as chlorhexidine, octenidine, hexetidine, gentianaviolet, and povidone–iodine are effective against the causative pathogens. They are administered in the form of gels, mouth rinses, as sprays and lozenges, among others.
Antifungals:
- Such as miconazole, nystatin or amphotericin B are used for oral thrush in the form of oral gels, lozenges or as suspensions.
Herbal remedies:
- Preparations of chamomile flowers, sage leaves, mallow leaves, ratanhia roots, oak bark, myrrh and black tea (selection) have anti-inflammatory, antiseptic, soothing and tanning properties. They are used, among other things, in the form of extracts, solutions, pastilles or as tea. Also used are essential oils such as tea tree oil.
Local anesthetics:
Analgesics:
- Systemic analgesics such as acetaminophen or ibuprofen may be taken for symptomatic treatment of pain. Some NSAIDs, such as flurbiprofen, benzydamine, and salicylates such as salicylamide, are also administered locally. However, NSAIDs can also additionally irritate the mucosa.
Saliva substitute:
Anti-allergy medications:
- Such as antihistamines (e.g., cetirizine, fexofenadine) can be given locally or systemically for an allergic cause.
Topical glucocorticoids:
- Glucocorticoids are anti-inflammatory, immunosuppressive and anti-allergic. Available options include water-soluble betamethasone tablets for a mouth rinse or a paste containing triamcinolone acetonide.
Vitamins:
- Dexpanthenol promotes the regeneration of the mucosa and is commercially available as a solution.
- For deficiencies, the missing micronutrients such as iron or vitamin B complex are taken perorally.
Probiotics lozenges:
- Probiotics lozenges provide the mucous membrane of the oral cavity with “good” bacteria, which settle and multiply. The treatment is considered well tolerated.
Non-drug measures
- Rinses with cold water
- Sucking ice cubes
- Avoid spicy and irritating foods, such as recent cheese, alcohol, lemon juice, spices and tomatoes
- Avoid spicy toothpastes and mouth rinses.
- Eliminate the triggers
- Rinse the mouth with water after inhalation of glucocorticoids
- Good oral hygiene
- Sucking pastilles without active ingredients melt in the mouth
- Pureed food, drinking food