eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Chemotherapy-Induced Oral Mucositis: Follow-up

Author: Nathaniel S Treister, DMD, DMSc, Assistant Professor, Harvard School of Dental Medicine; Consulting Staff, Division of Oral and Maxillofacial Surgery, Oral Medicine And Dentistry, Brigham and Women's Hospital and Dana Farber Cancer Institute
Coauthor(s): Sook-Bin Woo, DMD, MS, BDS, MMSc, Associate Professor, Chief, Division of Oral Medicine, Department of Oral Medicine and Diagnostic Services, Harvard School of Dental Medicine; Consulting Staff, Brigham and Women's Hospital, Dana Farber Cancer Institute, Beth Israel/Deaconess Medical Center
Contributor Information and Disclosures

Updated: Oct 31, 2008

Follow-up

Further Inpatient Care

  • Oral mucositis (OM) is self-limiting in most patients. If lesions persist or secondary complications occur, consider other etiologies and treatments as discussed above.

Deterrence/Prevention

  • Although oral mucositis cannot be effectively prevented, measures discussed in Treatment may help to reduce the severity of lesions and the risk of developing septicemia.

Complications

  • A wide range of complications are associated with oral mucositis, including, but not limited to, the following:
    • Increased risk of local and systemic infection
    • Poor nutrition
    • Dehydration
    • Interruption of cytoreductive therapy
    • Increased length of hospitalization
    • Increased cost of treatment

Prognosis

  • Oral mucositis is self-limiting.

Patient Education

  • The patient should understand the predisposing factors and the natural course of oral mucositis. Adherence to an oral hygiene regimen during hospitalization helps to minimize the risk of infection or the exacerbation of lesions.
  • For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education article Cancer of the Mouth and Throat.

Miscellaneous

Medicolegal Pitfalls

  • A high index of suspicion of secondary or concomitant infection in lesions of oral mucositis is imperative. Cultures should be obtained to rule out such infections. Effective antimicrobial treatments are available for herpetic infections or secondary bacterial infections. The failure to make the diagnosis and, therefore, to treat such conditions may lead to dissemination of infection or unnecessary and prolonged pain and suffering.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.



More on Chemotherapy-Induced Oral Mucositis

Overview: Chemotherapy-Induced Oral Mucositis
Differential Diagnoses & Workup: Chemotherapy-Induced Oral Mucositis
Treatment & Medication: Chemotherapy-Induced Oral Mucositis
Follow-up: Chemotherapy-Induced Oral Mucositis
Multimedia: Chemotherapy-Induced Oral Mucositis
References
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References

  1. Ruescher TJ, Sodeifi A, Scrivani SJ, Kaban LB, Sonis ST. The impact of mucositis on alpha-hemolytic streptococcal infection in patients undergoing autologous bone marrow transplantation for hematologic malignancies. Cancer. Jun 1 1998;82(11):2275-81. [Medline].

  2. Bochud PY, Calandra T, Francioli P. Bacteremia due to viridans streptococci in neutropenic patients: a review. Am J Med. Sep 1994;97(3):256-64. [Medline].

  3. Stiff PJ, Erder H, Bensinger WI, Emmanouilides C, Gentile T, Isitt J, et al. Reliability and validity of a patient self-administered daily questionnaire to assess impact of oral mucositis (OM) on pain and daily functioning in patients undergoing autologous hematopoietic stem cell transplantation (HSCT). Bone Marrow Transplant. Feb 2006;37(4):393-401. [Medline].

  4. Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, et al. Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer. Mar 1 2007;109(5):820-31. [Medline].

  5. Spielberger R, Stiff P, Bensinger W, Gentile T, Weisdorf D, Kewalramani T, et al. Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med. Dec 16 2004;351(25):2590-8. [Medline].

  6. Barasch A, Peterson DE. Risk factors for ulcerative oral mucositis in cancer patients: unanswered questions. Oral Oncol. Feb 2003;39(2):91-100. [Medline].

  7. Epstein JB, Schubert MM. Oral mucositis in myelosuppressive cancer therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Sep 1999;88(3):273-6. [Medline].

  8. Peterson DE. Research advances in oral mucositis. Curr Opin Oncol. Jul 1999;11(4):261-6. [Medline].

  9. Plevová P. Prevention and treatment of chemotherapy- and radiotherapy-induced oral mucositis: a review. Oral Oncol. Sep 1999;35(5):453-70. [Medline].

  10. Rapoport AP, Miller Watelet LF, Linder T, Eberly S, Raubertas RF, Lipp J, et al. Analysis of factors that correlate with mucositis in recipients of autologous and allogeneic stem-cell transplants. J Clin Oncol. Aug 1999;17(8):2446-53. [Medline].

  11. Sonis ST. Mucositis as a biological process: a new hypothesis for the development of chemotherapy-induced stomatotoxicity. Oral Oncol. Jan 1998;34(1):39-43. [Medline].

  12. Sonis ST. Oral complications. Cancer Med. 2000;5:2371-9.

  13. Sonis ST. Oral mucositis in cancer therapy. J Support Oncol. Nov-Dec 2004;2(6 Suppl 3):3-8. [Medline].

  14. Spijkervet FK, Sonis ST. New frontiers in the management of chemotherapy-induced mucositis. Curr Opin Oncol. Aug 1998;10 Suppl 1:S23-7. [Medline].

  15. Wilkes JD. Prevention and treatment of oral mucositis following cancer chemotherapy. Semin Oncol. Oct 1998;25(5):538-51. [Medline].

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Further Reading

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Keywords

oral mucositis, OM, hairy tongue, chemotherapy complications, ulceration of the oral mucosa, ulcers in the mouth, alpha-hemolytic streptococcal infection, viridans streptococci, septicemia, leukoedema, atrophy of the mucosa, chemotherapy-related oral ulcers, ulcerative OM, ulcerative oral mucositis, HSV infection

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Contributor Information and Disclosures

Author

Nathaniel S Treister, DMD, DMSc, Assistant Professor, Harvard School of Dental Medicine; Consulting Staff, Division of Oral and Maxillofacial Surgery, Oral Medicine And Dentistry, Brigham and Women's Hospital and Dana Farber Cancer Institute
Nathaniel S Treister, DMD, DMSc is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association
Disclosure: Nothing to disclose.

Coauthor(s)

Sook-Bin Woo, DMD, MS, BDS, MMSc, Associate Professor, Chief, Division of Oral Medicine, Department of Oral Medicine and Diagnostic Services, Harvard School of Dental Medicine; Consulting Staff, Brigham and Women's Hospital, Dana Farber Cancer Institute, Beth Israel/Deaconess Medical Center
Sook-Bin Woo, DMD, MS, BDS, MMSc is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

Medical Editor

Ponciano D Cruz Jr, MD, Vice-Chair, JB Shelmire Professor, Department of Dermatology, University of Texas Southwestern Medical Center
Ponciano D Cruz Jr, MD is a member of the following medical societies: Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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