Mucositis

Mucositis is the inflammation and irritation of the mucosal surface of the digestive tract. It is very common, especially oral mucositis, which affects the entire mouth, throat, and esophagus,

Based on its manifestation, there are two types:

• Erythematous oral mucositis: Characterized by inflammation and redness.
• Ulcerative oral mucositis: Characterized by the presence of sores or mouth ulcers

Symptoms

Oral mucositis presents with the following symptoms:

• Inflammation and redness of the soft tissues in the mouth, throat, or esophagus.
• Swollen and reddened gums, which may bleed.
• Pain or burning sensation in the mouth, throat, or esophagus.
• Presence of pus patches.
• Development of ulcers of various sizes, which can be very painful. They typically appear on the tongue, inside the cheeks, lips, and soft palate.
• Dry mouth.
• Thickened saliva and increased mucus in the oral cavity.
• Significant difficulty swallowing.

According to symptom progression, the World Health Organization classifies mucositis into different grades:

• Grade 1 mucositis: Mild pain with or without erythema. No ulcers.
• Grade 2 mucositis: Erythema and small, painful ulcers. Solids can still be consumed.
• Grade 3 mucositis: Extensive, painful erythema and ulceration. Only liquids can be ingested.
• Grade 4 mucositis: Severe, extensive erythema and ulceration with gum bleeding. Oral feeding is impossible.

Causes

Oral mucositis often occurs as a side effect of cancer treatments such as radiotherapy, chemotherapy, immunotherapy, or bone marrow transplantation. These treatments release free radicals that damage the DNA of epithelial cells, triggering increased production of cytokines, which cause inflammation and subsequent ulceration.

Sin embargo, la mucositis no es exclusiva de los pacientes oncológicos, ya que puede originarse por otros motivos:

• Protein deficiency in the diet.
• Poor oral hygiene.
• Smoking.
• Infections affecting the mouth.

Risk Factors

The risk of developing mucositis increases under the following conditions:

• Chemotherapy treatment.
• Radiotherapy targeted at the head and neck region.
• Presence of infection in the body.
• Smoking.
• Age: It is more common in children and individuals over 50.
• Poor oral hygiene.

Complications

If ulcers worsen, they may lead to additional complications such as:

• Infection: The entry of viruses, bacteria, or fungi into the body is facilitated, especially in immunocompromised patients undergoing cancer therapy, potentially leading to sepsis.
• Nutritional deficiencies due to the inability to eat because of pain.
• If these complications become severe, temporary suspension of cancer treatment may be necessary, which could compromise the patient’s prognosis.

Prevention

Oral mucositis can be prevented by maintaining thorough oral hygiene, including regular brushing with fluoride, saline rinses, and flossing. It is also advisable to avoid irritants such as tobacco and alcohol and to chew sugar-free gum to stimulate saliva production.

For cancer patients, keeping the mouth cool with crushed ice, ice cream, or cold water is recommended. Cold temperatures help prevent pain and ulcer formation.

What Specialist Treats Mucositis?

Oral mucositis is assessed and treated by dental specialists.