Mucositis - what is it?
Mucositis (or: mucositis) is when the mucous membranes become acutely inflamed. This often occurs in the oral cavity (oral mucositis), especially in cancer patients. Those affected by oral mucositis usually suffer from redness in the mouth and burning pain. This can be so severe that it becomes impossible for patients to eat. In advanced phases, deep ulcers can develop in the mouth. Oral mucositis can also spread to the throat, oesophagus, gastrointestinal tract and even the anus.
Depending on the localisation, mucositis is referred to differently:
- Oesophagus: oesophagitis
- Stomach: Gastritis
- Small intestine: Ileitis
- Large intestine: colitis
- Rectum: Proctitis
- Vagina: vulvovaginitis
Important to know: Inflammation of the stomach lining (gastritis) or the intestines does not necessarily have anything to do with an original inflammation in the mouth. It can also occur separately without causing symptoms in the mouth. Gastritis, for example, is very common.
Good to know: Oral mucositis and stomatitis - a difference!
Oral mucositis is often incorrectly labelled as stomatitis. However, this is incorrect. Oral mucositis is an acute inflammation of the mucous membranes that is mainly caused by chemotherapy and radiotherapy. Stomatitis, on the other hand, refers to any inflammatory condition of the oral tissue - including, for example, allergy-related inflammation.
Types of mucositis
In the following, we will look at oral mucositis. A further distinction is made here between two forms - depending on the respective trigger:
Radiogenic mucositis
Radiogenic mucositis is a very characteristic side effect of oncological treatments: It is estimated that between 25 and 30 percent of patients undergoing tumour therapy suffer from it. This is because treatments such as chemotherapy - for example for leukaemia - and radiotherapy in the head and neck area damage the mucosa. Our oral mucosa consists of epithelial cells that regenerate every 7 to 14 days. As these cells divide very quickly, they are particularly sensitive to the above-mentioned treatments. They are - unintentionally - damaged in the same way as the cancer cells.
Peri-implant mucositis
Another form of inflammation is peri-implant mucositis. This is a bacterial inflammation that appears on the gums of a dental implant. The main cause of this inflammation is the presence of plaque in the mouth. This type of mucositis can usually be successfully prevented with very good oral hygiene and dental care.
Good to know:
Brushing your teeth properly - but how? Here you can read how to take optimum care of your gums and teeth and how much time you should plan each day for your oral hygiene.
Causes of oral mucositis
In addition to the cancer therapies mentioned above, there are other reasons why oral mucositis can develop. The following causes are referred to as direct triggers:
- Damage to the mucous membrane during dental or orthodontic procedures
- Damage caused by ill-fitting dentures
- Damage caused by procedures such as tongue or cheek piercings
- Thermal damage (food that is too hot)
- Certain tumours
In addition, there are some indirect triggers or risk factors :
- Weak immune system
- Dry mouth
- Poor general condition
- Poor dental and oral hygiene
- Chronic inflammation such as inflammation of the stomach lining (gastritis)
Oral mucositis: symptoms at a glance
Acute inflammation of the oral mucosa can feel slightly different for each person. However, there are four symptoms that are considered characteristic of oral mucositis.
Pain
In its more advanced stages, oral mucositis causes swelling, ulcers and defects to form in the mouth. This leads to pain, which is experienced to varying degrees. In general, it can be said that the pain increases as the inflammation progresses. Those affected can find it so distressing that they even stop their cancer treatments because of it. As described above, it is often no longer possible to eat.
Dry mouth
Oral mucositis can lead to a dry mouth. This can often be felt through a sore or burning sensation on the tongue or torn corners of the mouth and lips. Cancer patients undergoing radiotherapy in the head and neck area are particularly frequently affected by dry mouth. This therapy damages the salivary glands, which reduces the flow of saliva.
Good to know:
Dry mouth is not only unpleasant, but also increases the risk of developing tooth decay or oral mucositis. Read our article to find out how to prevent dry mouth:
Flavour disorders
Acute inflammation of the oral mucosa can also lead to an impaired sense of taste. Patients then have problems distinguishing between sweet and savoury foods, for example. This often results in a reduced appetite, which in turn leads to weight loss and dehydration.
Swallowing problems
Pain and dry mouth can mean that people with mucositis can no longer swallow well. The dangerous thing about such a swallowing disorder - as with the taste disorder - is that those affected lose weight and consume too little fluid as a result.
What does oral mucositis look like?
If you google "oral mucositis" on the internet, you will find many images. However, the appearance of mucositis is not uniform - it depends on how advanced the inflammation is, for example. Ultimately, only a doctor can make a reliable diagnosis. So get yourself examined early if you have unclear symptoms.
In general, different symptoms can be categorised based on the severity of the disease. Here we present the stages according to the WHO scale:
Severity 0
Those affected do not yet feel impaired. Their oral mucosa shows no visible change.
Severity 1
The oral mucosa is now reddened and swollen. Those affected feel a burning or sore sensation. However, food intake is not yet impaired.
Severity 2
Small inflammations become visible in the mouth, which can spread in patches. As a rule, patients now feel the first pain, but this is usually still bearable. Eating is only slightly affected; those affected can still eat solid food.
Severity 3
At grade 3 this is referred to as severe mucositis. Major inflammation can be seen in the mouth. Those affected now experience severe pain and can only eat liquid food.
Severity 4
In severity grade 4, the most severe form of acute inflammation is reached. Deep ulcers can be seen in the mouth and spontaneous bleeding (haemorrhagic mucositis) may occur. The pain is now perceived as downright agonising and food intake is impossible. Those affected are in a life-threatening condition and require urgent treatment.
Treatment of oral mucositis - What helps?
Unfortunately, the treatment options for mucositis are limited. Here we show you how it can be treated - primarily symptomatically.
Which rinse for mucositis?
If you have developed mucositis, the main aim is to alleviate the pain, which can be severe. The doctor can prescribe special mouthwashes or solutions for this purpose, for example. In the case of mucositis caused by radiotherapy, for example, doxepin or morphine mouthwashes have an anaesthetic effect. An over-the-counter mouthwash variant is a solution with Lidocaine - a local anaesthetic that causes a local anaesthetic. Another over-the-counter mouthwash is Glandomed. However, the use of these and other painkillers should always be discussed with the doctor in advance.
Good to know:
The Perio plus Regenerate mouthwash from Curaprox with chlorhexidine can be used to care for a sensitive or damaged oral cavity. It supports tissue regeneration after dental surgery and combats dry mouth.
In addition to mouth rinses, systemic pain therapy can be used - i.e. treatment with painkillers or infusions.
Depending on the severity of the inflammation, antibiotics or antiviral medication may also be used. If affected people are no longer able to swallow on their own, they may also need to be fed via a vein for a longer period of time.
Even if it can be difficult against a background of severe pain: Patients with oral mucositis should try to continue to take good care of their mouth. This is important to ensure that bacteria are removed as far as possible. Otherwise, they can penetrate further into the body via the wound surfaces in the mouth and trigger additional, serious infections.
Good to know:
Oral mucositis causes sore oral mucosa and, in the worst case, very painful ulcers. Despite the pain, oral care is very important. The CS Surgical Mega Soft toothbrush from Curaprox was specially developed for care after operations or inflammation and, with its 12,000 hairs, is particularly gentle on gums and teeth.
Home remedy for mucositis?
If mucositis is mild, it may help to rinse the mouth with a saline solution, sea buckthorn oil or lukewarm sage tea or camomile tea. Medications from the homeopathy range, on the other hand, have no proven effect. You should therefore not rely on alternative healing methods to heal an inflammation in the mouth. Always ask your doctor if you are unsure - he is your best advisor.
Does enzyme therapy help?
Enzyme combination preparations such as Wobe-Mucos, Wobenzym or Mulsal can also be prescribed for the treatment of oral mucositis. They contain combinations of active ingredients - including bromelain. Bromelain is the name given to enzymes extracted from the pineapple plant. The substance is said to have an anti-inflammatory effect. Products such as Wobe-Mucos are said to have a corresponding decongestant and anti-inflammatory effect. You can take them as tablets. You can obtain them from your doctor on prescription or simply buy them from the pharmacy, they are not available on prescription. Enzyme preparations are not listed in the relevant guideline for the treatment and prevention of oral mucositis; there is not yet sufficient data available for this.
Good to know:
Curaprox toothpastes contain added enzymes that promote the saliva's natural defences. The toothpastes also protect against dry mouth and are suitable for use in cases of inflammation in the mouth.
Duration of mucositis
It is not generally possible to say how long those affected will suffer from the symptoms of mucositis. If cancer treatment is the cause of the inflammation, it can take up to eight weeks for the infection to disappear in individual cases. In uncomplicated cases, the disease heals on its own. However, it may also be necessary to use antibiotics, as described above.
Preventing mucositis: prophylaxis is the be-all and end-all!
As we already know, cancer patients in particular are at risk of developing oral mucositis. As the treatment options are clear, prevention is the best protection. This is especially true for cancer patients. They should make sure that their oral mucosa is as resistant as possible before starting their treatment - this works best if their teeth and gums are healthy.
You can find out how this can be guaranteed in the S3- guideline "Supportive therapy for oncological patients". We have summarised the recommendations for you here:
- Regular mouth moisturising with mouthwashes
- Care of the teeth with a soft toothbrush
- Cleaning the interdental spaces with dental floss and/or interdental brushes
- Ongoing medical checks for lesions and pain
- Fluoridation to protect the teeth
- Close clinical monitoring and counselling during cancer treatment
- Taking zinc supplements
- Taking benzydamine during radiotherapy (anti-inflammatory, pain-relieving and antibacterial agent in the form of gargle solution, spray or lozenges)
Good to know:
Comprehensive oral hygiene includes cleaning the interdental spaces every day. With the Prime Start Mixed interdental brush set from Curaden, you can quickly and easily find out which brush size suits your teeth - for effective and injury-free cleaning.
Proper diet for oral mucositis - and for prevention
In addition to the tips mentioned above, diet plays an important role in the prevention and treatment of inflamed oral mucosa. We have summarised the most important tips for you here:
- Abstaining from alcohol and tobacco
- Avoid foods that irritate the mucous membranes, such as sour, spicy or citrus fruits
- Avoid drinks with a high sugar content
- Favour soft food (e.g. fish or mashed potatoes)
- Drink enough
- Avoid raw food
- Avoid crumbly, hard and sharp-edged foods
- Avoid sticky foods (e.g. honey, caramel, jelly babies - can stick to the teeth/mouth cavity and thus promote the growth of microorganisms that promote inflammation
Cryotherapy useful as a preventive measure?
In the context of oral mucositis, cryotherapy is the cooling of the mouth with ice cubes, ice water and ice cream. These methods are intended to help prevent mucositis from developing in cancer patients in the first place. The idea behind it: The cold contracts the blood vessels in the mouth so that less blood contaminated with chemotherapy drugs reaches the mouth and irritates the mucous membranes there. There is not yet sufficient scientific evidence as to whether this type of prophylaxis actually works, which is why the guideline does not currently make a recommendation for or against it. However, there are already studies that indicate an effect. Tip: If you want to try it with cold, you can suck ice cubes made from water or frozen, anti-inflammatory tea such as camomile or sage.
Prevent mucositis with laser therapy?
Low-level laser therapy (LLLT) is recognised and proven to be effective in the prevention of radiogenic mucositis. It is a low-energy laser treatment that does not cause any thermal damage during irradiation. The laser activates processes that have a positive effect on cell repair mechanisms. Cancer patients should seek advice from their doctor as to whether such laser treatment is a sensible prophylactic option in their individual case before starting cancer therapy.
Sources
Anwerpes,Frank: Radiogenic mucositis, on: DocCheckFlexicon.de.
CORPUS specialists for orthopaedics and orthopaedic surgery: Laser therapy (low level laser).
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German Cancer Research Centre: Mucosal inflammation in cancer: prevention and relief.
Gelclair: Oral mucositis - lesions of the oral mucosa.
IWW Institute for Science: Treating peri-implant mucositis to prevent peri-implantitis.
Mukositis-Ratgeber.de: Mucositis guide.
NetDoktor: Wobenzym.
Lower Saxony Cancer Society: Complementary treatment methods for cancer, as of July 2012.
Martin J. Hug: The agony in the mouth, on: Pharmazeutische Zeitung.
PTA Forum: Mucositis - Less sore in the mouth, status: 11.12.2017.
Riley P et al: Can cooling the mouth during cancer treatment prevent inflammation and ulceration of the oral mucosa in children and adults?, at: www.cochrane.org, as of 23 December 2015.
Stronger against cancer: mucositis in cancer.
S3 Guideline: Supportive therapy for oncological patients, status: February 2020.
Technical University of Munich: Eating and drinking with mucositis.
Von Höfe, Natascha and Waler Fiona: Peri-implant mucositis, on: DocCheckFlexicon.de.
Yiallouros, Maria: Prevention and alleviation of mucosal damage (mucositis), at: www.gpoh.de.
All websites last accessed on 15/10/2023.