Management of Oral Mucositis – ESMO Practice Guidelines

Incidence of oral mucositis in patients receiving high-dose head and neck radiation.

Incidence of World Health Organization (WHO) grade 3 or 4 oral mucositis in patients receiving high-dose head and neck radiation approaches 100%.

Mucositis is one of the prime limiting factors of chemoradiation for advanced head and neck carcinoma, leading frequently to enteral nutritional support and use of morphinomimetics with the objective of maintaining dose intensity throughout the entire radiation regimen.

Oral mucositis management guidelines

Oral mucositis management guidelines are mainly based on a basic oral care and good clinical practice.

  • Multidisciplinary development and evaluation of oral care protocols, and patient and staff education in the use of such protocols is recommended for reduction of severity of oral mucositis from chemotherapy and/or radiation therapy.
  • Interdisciplinary development of systematic oral care protocols is suggested. As part of the protocols, the use of a soft toothbrush that is replaced on a regular basis is also suggested consistent with good clinical practice.
  • Patient-controlled analgesia with morphine is recommended as the treatment of choice for oral mucositis pain in patients undergoing HSCT Regular oral pain assessment using validated instruments for self-reporting is essential.
  • In addition to the evidence-based recommendations and suggestions published by the Multinat.Assoc.of Supp.Care in Cancer and the Int.Soc.Oral Oncology (MASCC/ISOO), it is relevant to note that topical agent and  anesthetics can provide short-term pain relief for oral mucositis on an empiric basis.

Guidelines Work Gr – Annals of Oncology – Vol. 21 2010
Petersen D.E., Bensadoun R.J., Roila F. - ESMO