Oral mucositis is a redness of the mucous membranes that occurs in the mouth region and is often considered unpleasant. It may be localized or may spread to the entire interior of the mouth. In the following, the definition, causes, diagnosis, therapy and prevention of oral mucositis will be discussed in more detail.
What is oral mucositis?
Oral mucositis is also defined in common parlance as oral thrush, or technically as aphthous stomatitis. Because this disease is very often caused by viral infections, especially the herpes virus, the term “herpes simplex type 1″ or HSV-1 is also common. Oral mucosal infections belong to the periodontal diseases, i.e. diseases that attack the inner areas of the mouth such as the gums or just the oral mucosa.
Causes
Oral mucositis is often noticed as a concomitant of other diseases. The most common direct cause of oral thrush is from herpes viruses. It is estimated that about 95% of all people carry the herpes virus, although it remains passive until the immune system is too weakened by other diseases. Mostly HSV-1 is the cause of an illness, occasionally also HSV-2. Herpes is highly contagious and affects mainly small children, in rare cases also adults. It can be transmitted through direct skin contact or saliva. The incubation period of herpes is a maximum of 26 days, although it should be noted that the majority of all infestations with such viruses are asymptotic, i.e., there is no outbreak of oral mucositis.
Symptoms, complaints, and signs
Oral mucositis (stomatitis) has varying manifestations depending on the causative pathogen. Most often, stomatitis causes only mild to moderate discomfort and remains localized. However, complete infestation of the oral cavity cannot be ruled out and is often a consequence of weakened body defenses. General features include intense redness of the oral mucosa. Furthermore, swellings are typical, which may resemble ulcers in their manifestation. Many of the affected areas cause mild to moderate, sometimes burning pain to sufferers. Infections with involvement of the Candida yeast fungus give rise to distinctive white coatings (oral thrush). Simple scraping with a brush or spoon removes the conspicuous deposits. The surface of the oral mucosa often shows bloody tears in stomatitis. Inhibited salivation further aggravates the symptoms and slows down the healing process. The formation of vesicles (aphthae) in viral infections is often accompanied by unpleasant bad breath. These circular, red inflammatory cavities have a maximum diameter of five millimeters. At the same time, they are surrounded by a whitish coating. Herpes viruses can form a large number of small aphthae. The resulting bad breath is extremely penetrating. The inflammation of the oral mucosa then turns into oral thrush. If the disease progresses severely, those affected experience serious problems when eating. Pain, numbness and difficulty swallowing increase the suffering to the point of complete refusal of food and lead to further weakening of a patient. In addition, there is fever, general malaise with vomiting and severe fatigue.
Diagnosis and course
In those cases in which symptomatic oral mucositis actually occurs after the incubation period of between 1 and 26 days, the following symptoms should become apparent:
As the name implies, the most obvious sign of oral mucositis is the reddish swelling of the very mucosa that makes up the inner part of the mouth. However, this can also affect the deep throat, the palate and the gums. Cold sores may also form, and lesions and ulcerations may occur in the mouth and also on the lips. In addition, the lymph nodes in the neck area swell noticeably, and bad breath, increased salivation, and a slight fever are also unpleasantly noticeable. Based on this clinical picture and some laboratory chemistry tests, a doctor will be able to make a reliable diagnosis of oral mucositis.
Complications
Oral mucositis usually leads to difficulty swallowing and chewing, and subsequently to loss of appetite and limited fluid intake.This can lead to dehydration and malnutrition, among other things. The many symptoms, such as fever, increased salivation and swelling of the lymph nodes, can lead to serious complications if left untreated. In the longer term, inflammation of the oral mucosa leads to gum recession. Periodontitis leads to strong bad breath and increases the risk of serious illnesses such as heart attack or stroke in the long term. It can also lead to tooth displacement and further inflammation, which in turn lead to complications. In addition to the physical consequences, these accompanying symptoms often lead to social exclusion and thus to psychological problems. Particularly in the case of chronically ill patients, the physical and mental general condition decreases considerably. Typical complications during treatment are side effects caused by mouth rinses, painkillers and anesthetics as well as bleeding and scarring after surgery. Home remedies and natural remedies can cause additional damage to the oral mucosa. This can lead to bleeding gums, inflammation of the periodontium and other complications. Because of the severity of these secondary symptoms, a doctor should be consulted immediately if oral mucositis is suspected.
When should you see a doctor?
If the affected person suffers from changes in the mucous membranes of the mouth and throat, there is cause for concern. If the abnormalities persist unabated for several days or increase in intensity, a visit to the doctor should be made. In the case of minor inflammations, there may be a decrease in symptoms or spontaneous healing within a short period of time. In these cases, a doctor is not normally needed. However, if greater impairment occurs, medical treatment should be initiated to quickly alleviate the discomfort. In the event of a repeated taste of blood in the mouth or the formation of pus, increased caution should be exercised. Open wounds may occur, which in severe cases are the trigger for sepsis. Germs and other pathogens can enter the organism and trigger further illness or further worsen the general state of health. In case of refusal of food intake, increased body temperature as well as irritability, a visit to the doctor is advisable. If there is unwanted weight loss, bad breath or pain in the mouth, a doctor should be consulted. Aphtae or blisters in the mouth, problems with existing dentures or swelling should be examined and treated. If teeth cleaning can no longer be done due to existing discomfort, headaches or sleep disturbances occur, the person needs help.
Treatment and therapy
In the treatment of oral mucositis, a distinction is made between drug and non-drug treatment, but both are usually aimed only at combating the unpleasant symptoms. This is because the disease does not pose a fatal threat and subsides on its own over time. Various painkillers such as paracetamol or anesthetics can be prescribed to relieve the pain in the mouth area. If one decides to actively fight the viruses, nucleoside analogues are usually used, a drug that prevents the viruses from spreading further by damaging the viral DNA polymerase. Mouthwashes can also relieve irritation and pain; mixtures of diphenhydramine and antacid are recommended here. With all medications, however, it is essential to consult with a doctor to determine which medications are suitable for young children. Non-drug treatments include, first and foremost, avoidance of dehydration, which is achieved by taking fluids as well as semi-solid food (porridge, etc.), if possible. Attention must be paid to this because children do not like to take anything on their own due to the pain of eating and swallowing. Otherwise, the body usually manages to heal itself, except that the person affected by oral mucositis, especially if it is a child, should stay at home because of the high risk of infection.
Outlook and prognosis
The prognosis of oral mucositis is usually good. Stomatitis heals quickly with appropriate treatment. In most cases, the condition resolves within one to two weeks. Consequential symptoms are not expected.The prognosis improves if the treatment is followed by professional dental cleaning and oral hygiene is carried out particularly carefully from then on. The prognosis is worse in the case of chronic oral mucositis. Patients have to take medication for a longer period of time and thus expose themselves to the risk of serious side effects. In addition, the disease itself is a greater burden, as many foods and beverages may not be consumed. This can have a negative impact on the patient’s well-being and quality of life. If the symptoms do not subside, the disease may be chronic. A comprehensive examination and treatment in a specialist clinic provides information about the causes and allows targeted treatment. Stomatitis can sometimes be accompanied by symptoms such as severe pain, bleeding or infections in the mouth and throat, which must be treated. Life expectancy is not limited by oral stomatitis.
Prevention
You cannot effectively prevent oral mucositis because the herpes virus that causes it is too contagious. Vaccinations do not yet exist. One can only ensure that the rot is not transmitted further by those affected who are symptomatic of the disease. This is achieved by keeping the person affected by oral mucositis away from other people, especially children.
Follow-up
In most cases, very few and limited measures of aftercare are available to the patient with oral mucositis. In the first place, this disease must be treated very quickly and, above all, at a very early stage, so that other complications and discomfort do not occur in the further course. As a rule, self-healing cannot occur, so that those affected are always dependent on medical examination and treatment. In general, a very high standard of hygiene should be observed to prevent recurrence of oral mucositis. The affected person should also clean the oral cavity with a mouth rinse. The symptoms themselves can be alleviated relatively easily with the help of medication. The person affected should ensure that the medication is taken regularly and in the correct dosage to limit the symptoms. In the case of children in particular, parents must monitor intake. Patients should ideally keep to bed rest and not come into contact with other people so as not to infect others. Usually, no further measures of follow-up care are necessary. Oral mucositis does not reduce the life expectancy of the affected person.
What you can do yourself
Oral mucositis is usually accompanied by other diseases, and the most common triggers are herpes viruses. Because herpes pathogens are highly contagious, one of the most important self-help measures is to prevent the infection from spreading. Anyone suffering from oral mucositis should take strict care not to share glasses, cups, plates or other crockery or cutlery. Cleaning such utensils is best done in the dishwasher at a minimum of 60 degrees Celsius. In order to avoid secondary infections, it is also important to maintain proper oral hygiene. The teeth, gums and tongue should be cleaned carefully with a soft brush after each meal. A disinfecting, pain-relieving mouthwash can also be helpful. If the mucosal inflammation is accompanied by severe pain, over-the-counter painkillers from the pharmacy can be taken. If severe discomfort occurs during eating and drinking, patients often drink too little and become dehydrated. Patients should therefore make sure that they drink at least enough fluids despite the pain. Deficiency symptoms due to low food intake can be prevented by taking nutritional supplements. In this situation, multivitamin preparations also support the immune system, which is usually already under attack. If possible, patients should allow themselves a few days of bed rest. This is particularly indicated if the oral mucositis is accompanied by a cold or other flu-like infection.
