Materiały źródłowe

• #1 Oral Mucositis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19378

  Oral mucositis is a frequent complication in patients receiving radiation therapy (RT) to the head and neck, chemotherapy for solid tumors or lymphoma, and high-dose myeloablative chemotherapy prior to hematopoietic cell transplantation. The incidence of oral mucositis varies amongst the different chemotherapy agents. Chemotherapeutic agents that affect DNA synthesis (S-phase), e.g., 5-fluorouracil, methotrexate, and cytarabine, have a high incidence of oral mucositis. Anthracyclines, mTOR inhibitors, alkylating agents, and antimetabolites also have an increased risk of oral mucositis. […] The basal epithelial layer of the oral mucosa has a rapid cellular turnover, making the oral epithelium susceptible to radiation injury. Cell death and the incapacity of the oral mucosa to heal lead to the development of oral mucositis.

• #2 Mucositis – Oral Cancer Foundation | Information and Resources about Oral Head and Neck Cancer

  https://oralcancerfoundation.org/complications/mucositis/

  Mucositis occurs when cancer treatments break down the rapidly divided epithelial cells lining the gastro-intestinal tract (which goes from the mouth to the anus), leaving the mucosal tissue open to ulceration and infection. […] Oral mucositis is probably the most common, debilitating complication of cancer treatments, particularly chemotherapy and radiation. It can lead to several problems, including pain, nutritional problems as a result of inability to eat, and increased risk of infection due to open sores in the mucosa. […] When caused by chemotherapy, mucositis is usually due to the low white blood cell count; when caused by radiation, mucositis is usually due to the necrotic and inflammatory effect of radiation energy on oral mucosa. […] Oral mucositis occurs independently of oral mucosal infections of viral and fungal etiology, but it may be exacerbated by such concomitant infections.

• #3 Mucositis: Symptoms, causes, complications and treatment

  https://www.medicalnewstoday.com/articles/mucositis

  Mucositis describes inflammation and ulceration of the digestive tract lining. It often results from cancer treatments. […] People who undergo cancer treatments, such as chemotherapy or radiation therapy, have a high risk of developing this condition. These treatments use certain drugs or radiation to destroy cancer cells. However, due to the nature of these treatments, both chemo and radiation can cause adverse reactions, such as inflammation and damage to the gastrointestinal tract. […] Cancer treatments are a common cause of mucositis. Whether or not they are targeting cancer, the following treatments frequently cause mucositis: chemotherapy, radiation of the head, chest, or neck, bone marrow transplants, stem cell transplants. […] The cells in the body’s mucous membranes divide rapidly, similar to cancer cells. Chemotherapy and radiation therapy attack cancer cells and any other rapidly dividing cells, including those of the mucous membranes.

• #4 Mucositis – Oral Cancer Foundation | Information and Resources about Oral Head and Neck Cancer

  https://oralcancerfoundation.org/complications/mucositis/

  Mucositis occurs when cancer treatments break down the rapidly divided epithelial cells lining the gastro-intestinal tract (which goes from the mouth to the anus), leaving the mucosal tissue open to ulceration and infection. […] Oral mucositis is probably the most common, debilitating complication of cancer treatments, particularly chemotherapy and radiation. It can lead to several problems, including pain, nutritional problems as a result of inability to eat, and increased risk of infection due to open sores in the mucosa. […] When caused by chemotherapy, mucositis is usually due to the low white blood cell count; when caused by radiation, mucositis is usually due to the necrotic and inflammatory effect of radiation energy on oral mucosa. […] Oral mucositis occurs independently of oral mucosal infections of viral and fungal etiology, but it may be exacerbated by such concomitant infections.

• #5 Oral Mucositis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19378

  Oral mucositis is a frequent complication in patients receiving radiation therapy (RT) to the head and neck, chemotherapy for solid tumors or lymphoma, and high-dose myeloablative chemotherapy prior to hematopoietic cell transplantation. The incidence of oral mucositis varies amongst the different chemotherapy agents. Chemotherapeutic agents that affect DNA synthesis (S-phase), e.g., 5-fluorouracil, methotrexate, and cytarabine, have a high incidence of oral mucositis. Anthracyclines, mTOR inhibitors, alkylating agents, and antimetabolites also have an increased risk of oral mucositis. […] The basal epithelial layer of the oral mucosa has a rapid cellular turnover, making the oral epithelium susceptible to radiation injury. Cell death and the incapacity of the oral mucosa to heal lead to the development of oral mucositis.

• #6 Oral Mucositis | Causes, Symptoms & Treatment – bluem®

  https://bluemcare.com/problems/oral-mucositis/?srsltid=AfmBOoptmpOWmhN3ZTgTnMa-Oup-E8Up55tcByZ-rln7gxIUZYe3MAm8

  Patients undergoing a chemotherapy often develop problems with their oral mucosa. […] Chemotherapy and radiotherapy can damage sensitive cells in mouth and throat. […] Nearly 100% of patients with tumours in the head or neck will develop oral mucositis when treated with radiotherapy. […] An alarming 89% develop this oral mucositis when treated with a combination of chemo and radiation. […] 40% of the patients treated with chemo. […] Oral mucositis is a known side-effect of chemotherapy. […] 40-75% of chemotherapy patients suffer from oral mucositis. […] Over 90% of head and neck cancer patients develop oral mucositis. […] Up to 100% of bone marrow transplant patients are affected by oral mucositis. […] Oral mucositis has a large pharmacoeconomic impact. It can cause weight loss, dehydration, malnutrition and an inability to eat or drink.

• #7 Mucositis – Oral Cancer Foundation | Information and Resources about Oral Head and Neck Cancer

  https://oralcancerfoundation.org/complications/mucositis/

  Mucositis occurs when cancer treatments break down the rapidly divided epithelial cells lining the gastro-intestinal tract (which goes from the mouth to the anus), leaving the mucosal tissue open to ulceration and infection. […] Oral mucositis is probably the most common, debilitating complication of cancer treatments, particularly chemotherapy and radiation. It can lead to several problems, including pain, nutritional problems as a result of inability to eat, and increased risk of infection due to open sores in the mucosa. […] When caused by chemotherapy, mucositis is usually due to the low white blood cell count; when caused by radiation, mucositis is usually due to the necrotic and inflammatory effect of radiation energy on oral mucosa. […] Oral mucositis occurs independently of oral mucosal infections of viral and fungal etiology, but it may be exacerbated by such concomitant infections.

• #8 Radiation therapy and chemotherapy-induced oral mucositis | Brazilian Journal of Otorhinolaryngology

  https://www.bjorl.org/en-radiation-therapy-chemotherapy-induced-oral-mucositis-articulo-S1808869415301105

  Increasing the intensity of radiation therapy and chemotherapy in the management of cancer has increased the incidence of adverse effects, especially oral mucositis. […] Mucositis is a consequence of two major mechanisms: direct toxicity due to the treatment and myelosuppression that results from therapy. […] Its pathogenesis is reduced cell renewal in the basal epithelial layers as a result of chemotherapy and radiotherapy; adequate replacement of desquamated cells becomes insufficient. […] Cell kinetics initially defines the relative sensitivity of normal tissues to anticancer therapy. Oropharyngeal, intestinal and bone marrow cells divide rapidly and are more sensitive to radiation and chemotherapy compared to cells that divide slower and senescent cells in other parts of the body.

• #9 Oral Mucositis | Causes, Symptoms & Treatment – bluem®

  https://bluemcare.com/problems/oral-mucositis/?srsltid=AfmBOoptmpOWmhN3ZTgTnMa-Oup-E8Up55tcByZ-rln7gxIUZYe3MAm8

  Patients undergoing a chemotherapy often develop problems with their oral mucosa. […] Chemotherapy and radiotherapy can damage sensitive cells in mouth and throat. […] Nearly 100% of patients with tumours in the head or neck will develop oral mucositis when treated with radiotherapy. […] An alarming 89% develop this oral mucositis when treated with a combination of chemo and radiation. […] 40% of the patients treated with chemo. […] Oral mucositis is a known side-effect of chemotherapy. […] 40-75% of chemotherapy patients suffer from oral mucositis. […] Over 90% of head and neck cancer patients develop oral mucositis. […] Up to 100% of bone marrow transplant patients are affected by oral mucositis. […] Oral mucositis has a large pharmacoeconomic impact. It can cause weight loss, dehydration, malnutrition and an inability to eat or drink.

• #10 Oral Mucositis | Causes, Symptoms & Treatment – bluem®

  https://bluemcare.com/problems/oral-mucositis/?srsltid=AfmBOoptmpOWmhN3ZTgTnMa-Oup-E8Up55tcByZ-rln7gxIUZYe3MAm8

  Patients undergoing a chemotherapy often develop problems with their oral mucosa. […] Chemotherapy and radiotherapy can damage sensitive cells in mouth and throat. […] Nearly 100% of patients with tumours in the head or neck will develop oral mucositis when treated with radiotherapy. […] An alarming 89% develop this oral mucositis when treated with a combination of chemo and radiation. […] 40% of the patients treated with chemo. […] Oral mucositis is a known side-effect of chemotherapy. […] 40-75% of chemotherapy patients suffer from oral mucositis. […] Over 90% of head and neck cancer patients develop oral mucositis. […] Up to 100% of bone marrow transplant patients are affected by oral mucositis. […] Oral mucositis has a large pharmacoeconomic impact. It can cause weight loss, dehydration, malnutrition and an inability to eat or drink.

• #11 Oral Mucositis: A Complication of Chemotherapy & Radiotherapy

  https://www.healthline.com/health/oral-mucositis

  Some kinds of chemotherapy and radiation treatments can cause oral mucositis. […] About 40 percent of people undergoing regular cancer therapy will get oral mucositis. Up to 75 percent of people with high-dose chemotherapy and up to 90 percent of people getting both chemotherapy and radiation treatments may get this condition. […] Other causes of oral mucositis include: […] A very serious case of oral mucositis is called confluent mucositis. Mucositis can lead to: […] To a certain degree there does appear to be some promising research that may soon provide definitive guidelines for prevention of mucositis caused by chemotherapy or radiation therapy. Studies have been done involving keratinocyte growth factor medications, anti-inflammatory medications, antimicrobial medications, laser therapy, and cryotherapy. In each of these categories, some studies have found ways to decrease the incidence of mucositis while undergoing cancer treatment. More research must be done to come up with reliable recommendations.

• #12 Oral Mucositis: Causes, Symptoms, and Advances in Treatment

  https://denpedia.com/oral-mucositis-causes-symptoms-and-advances-in-treatment/

  Oral mucositis is most commonly associated with cancer therapies, particularly chemotherapy and radiation therapy, but it can also be caused by other factors such as stem cell transplants, immunosuppressive therapies, and certain infections. […] Certain chemotherapeutic agents are more likely to cause oral mucositis due to their effects on rapidly dividing cells in the oral mucosa. […] Radiation therapy directed at the head and neck region can directly damage the oral mucosa, leading to mucositis. […] Patients undergoing hematopoietic stem cell transplants (HSCT) are at risk of developing oral mucositis due to the conditioning regimens, which often include high-dose chemotherapy and total body irradiation. […] Newer cancer treatments such as targeted therapies (e.g., tyrosine kinase inhibitors) and immunotherapies (e.g., checkpoint inhibitors) can also cause oral mucositis.

• #13 Your mouth and cancer drugs | Treatment for cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/treatment/cancer-drugs/side-effects/your-mouth

  Some drugs can change the cells in the lining of your mouth and make it sore (mucositis). […] A sore mouth happens because some cancer drugs kill not only the quickly dividing cancer cells but also the cells that make up the lining of your mouth. These cells also divide quickly. […] Mucositis means inflammation of the lining of the mouth. The inside of your mouth might become red and swollen with white patches. These areas can turn into ulcers. […] Targeted cancer drugs and immunotherapy can also cause a sore mouth. […] Cancer drugs that can cause a dry mouth are some types of chemotherapy, immunotherapy, anti sickness, and painkillers. […] Some cancer drugs can make your mouth dry. This is also called xerostomia. It happens because the drugs affect the spit glands (saliva).

• #14 Mucositis – Oral Cancer Foundation | Information and Resources about Oral Head and Neck Cancer

  https://oralcancerfoundation.org/complications/mucositis/

  Mucositis occurs when cancer treatments break down the rapidly divided epithelial cells lining the gastro-intestinal tract (which goes from the mouth to the anus), leaving the mucosal tissue open to ulceration and infection. […] Oral mucositis is probably the most common, debilitating complication of cancer treatments, particularly chemotherapy and radiation. It can lead to several problems, including pain, nutritional problems as a result of inability to eat, and increased risk of infection due to open sores in the mucosa. […] When caused by chemotherapy, mucositis is usually due to the low white blood cell count; when caused by radiation, mucositis is usually due to the necrotic and inflammatory effect of radiation energy on oral mucosa. […] Oral mucositis occurs independently of oral mucosal infections of viral and fungal etiology, but it may be exacerbated by such concomitant infections.

• #15 Radiation therapy and chemotherapy-induced oral mucositis | Brazilian Journal of Otorhinolaryngology

  https://www.bjorl.org/en-radiation-therapy-chemotherapy-induced-oral-mucositis-articulo-S1808869415301105

  Increasing the intensity of radiation therapy and chemotherapy in the management of cancer has increased the incidence of adverse effects, especially oral mucositis. […] Mucositis is a consequence of two major mechanisms: direct toxicity due to the treatment and myelosuppression that results from therapy. […] Its pathogenesis is reduced cell renewal in the basal epithelial layers as a result of chemotherapy and radiotherapy; adequate replacement of desquamated cells becomes insufficient. […] Cell kinetics initially defines the relative sensitivity of normal tissues to anticancer therapy. Oropharyngeal, intestinal and bone marrow cells divide rapidly and are more sensitive to radiation and chemotherapy compared to cells that divide slower and senescent cells in other parts of the body.

• #16 Mucositis – Wikipedia

  https://en.wikipedia.org/wiki/Mucositis

  The pathophysiology of mucositis is complex and multifactorial. Currently, Sonis’ five phase model is the accepted explanation for the process. […] The 5 stages are: Initiation phase, Primary damage response, Signal amplification, Ulceration, Healing. […] Therefore, oral mucositis can be a dose-limiting condition, disrupting a patients optimal cancer treatment plan and consequentially decreasing their chances of survival.

• #17 Mucositis – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/mucositis/

  Mucositis is an inflammatory-like process of the oral mucosa due to radiation in head-neck oncology patients or chemotherapy. […] Mucositis is considered to be an inevitable but transient side effect of anti-neoplastic therapies. […] Mucositis is basically a tissue reaction to the trauma of radiation or chemotherapy. Total dose, radiation portals, fractionation schedule, and type of ionising radiation as well as dose and type of chemotherapy agents affect the occurrence and severity of mucositis. […] The pathogenesis of mucositis, being similar but not identical in both chemotherapy and radiation, is not fully understood. […] The hypothesis proposed for the development of radiation- and chemotherapy-induced mucositis consider four consecutive phases: (1) inflammatory/vascular phase (free radicals and cytokines are released); (2) epithelial phase (reduced epithelial renewal-atrophy); (3) ulcerative/bacterial phase (colonisation by mixed flora, causing release of endotoxins, with further tissue damage by stimulation of cytokines). An interplay between the radiation- or chemotherapy-induced epithelial ulceration and bacterial flora is implied in this phase; (4) healing phase.

• #18 Mucositis – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/mucositis/

  Factors that may contribute to the development of mucositis include the increase in inflammatory mediators, platelet activating factor in saliva, leukocyte adhesion to E-selectin or endothelial intercellular adhesion molecule-1 (ICAM-1) which promotes the radiation-induced inflammatory response in squamous epithelium, a decrease in the level of salivary epidermal growth factor and loss of protective salivary constituents. […] A marked increase in the carriage rate of Gram-negative bacilli in the oropharynx (a/o. Enterobacteriaceae, Pseudomonaceae) has particularly been shown as a possible aggravating factor in the development of oral mucositis. […] The most common infection in the oral cavity during or shortly after radiotherapy and chemotherapy is candidosis. […] The direct toxic effect of cytostatic agents on rapidly dividing cells of the oral epithelium result in atrophy, erythema and ulceration. Indirect stomatotoxic effects are caused by release of inflammatory mediators, loss of protective salivary constituents, and therapy induced neutropenia, in combination with the colonisation of bacteria, fungi and viruses on damaged mucosa which can result in secondary infections. Neutropenia, in chemotherapy, increases the risk for secondary infections.

• #19 Oral Mucositis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19378

  Oral mucositis is a frequent complication in patients receiving radiation therapy (RT) to the head and neck, chemotherapy for solid tumors or lymphoma, and high-dose myeloablative chemotherapy prior to hematopoietic cell transplantation. The incidence of oral mucositis varies amongst the different chemotherapy agents. Chemotherapeutic agents that affect DNA synthesis (S-phase), e.g., 5-fluorouracil, methotrexate, and cytarabine, have a high incidence of oral mucositis. Anthracyclines, mTOR inhibitors, alkylating agents, and antimetabolites also have an increased risk of oral mucositis. […] The basal epithelial layer of the oral mucosa has a rapid cellular turnover, making the oral epithelium susceptible to radiation injury. Cell death and the incapacity of the oral mucosa to heal lead to the development of oral mucositis.

• #20 Mucositis: Causes, Symptoms, and Treatments – Laboratorios KIN

  https://www.kin.es/en/patologias/mucositis/

  The risk of developing mucositis in children receiving cancer treatment has been found to be higher than in adults. An increased susceptibility to severe and long-lasting mucositis has also been observed in people over 50 years of age; this may be due, in part, to decreased renal excretion of drugs used in chemotherapy. […] Oral mucositis is one of the most frequent complications associated with chemotherapy and/or radiotherapy treatment of the head and neck. Chemotherapeutic agents such as methotrexate, fluorouracil (5-FU) and etoposide are particularly stomatotoxic. These drugs inhibit the reproductive capacity of basal epithelial cells, resulting in a weakening of the oral mucosa, which becomes atrophic and prone to ulceration.

• #21 Chemotherapy induced oral mucositis: prevention is possible – Cidon – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/17197/html

  It has also been described a loss of epithelial growth factors (keratinocyte growth factor), leading to apoptosis of fibroblasts and vascular endothelial cells which results in submucosal injury. […] OM is dependent on the kind of tumor, patient age (more frequent in young), grade of oral hygiene and health, nutritional status, renal and hepatic functions, CM agent (antimetabolites such as 5-fluorouracil (5-FU) or purine analogs as cytarabine) or combination CM, concurrent administration with RT in head and neck tumors etc. […] It is well known that drugs such as methotrexate and etoposide are secreted in saliva, which increases the chances of OM. […] Although there are several treatments to alleviate the pain and improve patients nutrition, the ideal aim would be prevention. So far, no definite measure has shown to be able to prevent it effectively and recurrent episodes of OM, will double the likelihood of DR and unplanned treatment breaks.

• #22 Stomatitis (Oral Mucositis): Types, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/stomatitis-oral-mucositis

  Stomatitis can have many causes, including viral infections, mouth injuries and immune system conditions among others […] Infections: The most common infectious disease that causes stomatitis is HSV-1, the herpes virus that causes cold sores. But other viral infections, as well as bacterial and fungal infections, can also cause stomatitis. […] Mouth injuries: Most anything that damages the delicate mucous membrane inside your mouth triggers your body’s healing response, causing inflammation. Causes range from ill-fitting dentures that scrape the inside of your mouth to heat damage from smoking cigarettes. […] Allergic reactions or mouth irritation: Substances that you’re allergic to or that irritate your mouth can cause oral mucositis. Causes may include ingredients in dental products (like mouthwash), cosmetics (like lipstick) or spicy foods.

• #23 Mucositis: causes and treatment | CURAPROX

  https://curaprox.us/blog/post/treating-and-preventing-mucositis?srsltid=AfmBOooERBtdbbIOj5r4PQ_3mLG3Ry2j62xb8RL-ecZmZEYlAXeBmqJs

  Mucositis is a very painful acute inflammation of the mucous membranes that can occur in the mouth, throat, oesophagus, stomach or intestines. […] Cancer patients in particular often struggle with oral mucositis, i.e. inflammation of the mucous membranes in the mouth. […] Oral mucositis is an acute inflammation of the mucous membranes that is mainly caused by chemotherapy and radiotherapy. […] 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. […] 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).

• #24 Mucositis: causes and treatment | CURAPROX

  https://curaprox.in/blog/post/treating-and-preventing-mucositis?srsltid=AfmBOopQKMMsYnqIfkFDWmXAYf2Fw6DZWcRoVmLruucCPz9WGeWG-EOP

  Mucositis is a very painful acute inflammation of the mucous membranes that can occur in the mouth, throat, oesophagus, stomach or intestines. […] Cancer patients in particular often struggle with oral mucositis, i.e. inflammation of the mucous membranes in the mouth. […] Oral mucositis is an acute inflammation of the mucous membranes that is mainly caused by chemotherapy and radiotherapy. […] 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.

• #25 Mucositis – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/mucositis/

  Factors that may contribute to the development of mucositis include the increase in inflammatory mediators, platelet activating factor in saliva, leukocyte adhesion to E-selectin or endothelial intercellular adhesion molecule-1 (ICAM-1) which promotes the radiation-induced inflammatory response in squamous epithelium, a decrease in the level of salivary epidermal growth factor and loss of protective salivary constituents. […] A marked increase in the carriage rate of Gram-negative bacilli in the oropharynx (a/o. Enterobacteriaceae, Pseudomonaceae) has particularly been shown as a possible aggravating factor in the development of oral mucositis. […] The most common infection in the oral cavity during or shortly after radiotherapy and chemotherapy is candidosis. […] The direct toxic effect of cytostatic agents on rapidly dividing cells of the oral epithelium result in atrophy, erythema and ulceration. Indirect stomatotoxic effects are caused by release of inflammatory mediators, loss of protective salivary constituents, and therapy induced neutropenia, in combination with the colonisation of bacteria, fungi and viruses on damaged mucosa which can result in secondary infections. Neutropenia, in chemotherapy, increases the risk for secondary infections.

• #26 Stomatitis (Oral Mucositis): Types, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/stomatitis-oral-mucositis

  Stomatitis can have many causes, including viral infections, mouth injuries and immune system conditions among others […] Infections: The most common infectious disease that causes stomatitis is HSV-1, the herpes virus that causes cold sores. But other viral infections, as well as bacterial and fungal infections, can also cause stomatitis. […] Mouth injuries: Most anything that damages the delicate mucous membrane inside your mouth triggers your body’s healing response, causing inflammation. Causes range from ill-fitting dentures that scrape the inside of your mouth to heat damage from smoking cigarettes. […] Allergic reactions or mouth irritation: Substances that you’re allergic to or that irritate your mouth can cause oral mucositis. Causes may include ingredients in dental products (like mouthwash), cosmetics (like lipstick) or spicy foods.

• #27 Mucositis: causes and treatment | CURAPROX

  https://curaprox.in/blog/post/treating-and-preventing-mucositis?srsltid=AfmBOopQKMMsYnqIfkFDWmXAYf2Fw6DZWcRoVmLruucCPz9WGeWG-EOP

  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). […] 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. […] 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.

• #28 Peri-Implant Mucositis: Causes, Symptoms and Treatment

  https://cliniquemaxillo.com/en/blogue/what-is-peri-implant-mucositis-how-to-prevent-it/

  The causes of peri-implant mucositis can vary. Nevertheless, it can easily be avoided if you maintain good oral hygiene. On its own, its a fairly benign problem, but the risk of peri-implant mucositis developing into peri-implantitis shouldnt be taken lightly. […] The main factor causing peri-implant mucositis is the accumulation of plaque between the implant and the gums. Brushing your teeth after each meal and daily flossing are therefore recommended. […] Smoking is another possible cause of this condition. If you are a smoker, we recommend being extra vigilant and periodically having the condition of your dental implant checked. […] It is also advisable to visit a dental expert at least once a year so that they can remove any plaque from the implant.

• #29 Stomatitis (Oral Mucositis): Types, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/stomatitis-oral-mucositis

  Treatments: Oral mucositis is a common cancer treatment side effect. Treatments like chemotherapy and radiation therapy kill cancer cells, but they can damage healthy cells in the process. The cells in the mucous membranes lining your mouth are particularly vulnerable. […] Medications: Certain types of medications associated with oral mucositis include beta-blockers, immunosuppressants and nonsteroidal anti-inflammatory drugs (NSAIDs). […] Systemic conditions: Conditions that impact entire body systems can cause stomatitis. These include inflammatory diseases, like Behçet’s disease and celiac disease. Skin conditions, like Bullous pemphigoid and lichen planus, can also cause stomatitis. […] Nutritional deficiencies: Not getting enough of the nutrients your body needs to repair damaged mucosa in your mouth can lead to stomatitis. This includes deficiencies in folate, iron, vitamins B12 and C, and zinc.

• #30 Understanding the Pathophysiology of Mucositis: Causes, Symptoms, and Treatments | VITROBIO Medical Devices

  https://www.vitrobio.com/blog/scientific-news-1/understanding-the-pathophysiology-of-mucositis-causes-symptoms-and-treatments-25

  A range of lifestyle factors also contribute to the development of mucositis. Poor oral or dental hygiene, smoking, and excessive alcohol consumption can exacerbate the condition. Additionally, consuming hot or spicy foods can irritate the already sensitive mucosal tissues. […] Systemic health conditions like diabetes, kidney disease, and HIV/AIDS further complicate the situation. These diseases compromise overall health and weaken the body’s defenses, making the mucosal lining more susceptible to inflammation and infection. […] There are also genetic factors at play. Certain individuals may have a genetic predisposition that makes them more vulnerable to developing mucositis when exposed to the triggering factors, such as cancer treatments and lifestyle choices.

• #31 Stomatitis (Oral Mucositis): Types, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/stomatitis-oral-mucositis

  Treatments: Oral mucositis is a common cancer treatment side effect. Treatments like chemotherapy and radiation therapy kill cancer cells, but they can damage healthy cells in the process. The cells in the mucous membranes lining your mouth are particularly vulnerable. […] Medications: Certain types of medications associated with oral mucositis include beta-blockers, immunosuppressants and nonsteroidal anti-inflammatory drugs (NSAIDs). […] Systemic conditions: Conditions that impact entire body systems can cause stomatitis. These include inflammatory diseases, like Behçet’s disease and celiac disease. Skin conditions, like Bullous pemphigoid and lichen planus, can also cause stomatitis. […] Nutritional deficiencies: Not getting enough of the nutrients your body needs to repair damaged mucosa in your mouth can lead to stomatitis. This includes deficiencies in folate, iron, vitamins B12 and C, and zinc.

• #32 Hina Khan suffering from Mucositis: Causes, symptoms and treatment options of this side effect of chemo

  https://www.moneycontrol.com/health-and-fitness/hina-khan-suffering-from-mucositis-causes-symptoms-and-treatment-options-of-this-side-effect-of-chemo-article-12816337.html

  Systemic Diseases: Chronic conditions such as lupus and systemic sclerosis can cause widespread inflammation, including in the mucosal lining of the GI tract. These autoimmune diseases lead to persistent immune responses that target the body’s tissues, including the mucosa, resulting in painful and recurrent episodes of mucositis. […] Vitamin Deficiency: A lack of essential vitamins, particularly vitamin C and folic acid, can impair the body’s ability to maintain healthy mucosal tissue. This deficiency, often caused by poor dietary intake of green leafy vegetables and citrus fruits, weakens the mucosal barrier, making it more susceptible to inflammation and infection. […] Smoking: Smoking contributes to mucositis by weakening the mucosal barrier and depleting immune cells. The harmful chemicals in tobacco smoke directly damage mucosal tissues, leading to chronic inflammation. Additionally, smoking reduces the body’s ability to repair these tissues, increasing the risk of persistent mucositis.

• #33 Mucositis: Symptoms, causes, complications and treatment

  https://www.medicalnewstoday.com/articles/mucositis

  Some evidence suggests that 35-40% of people who receive chemotherapy may develop mucositis to some extent. The risk is much greater for people who also receive cancer treatment for head and neck cancers. […] Several factors can also increase the risk of mucositis. They include: being female, young age, having received cancer treatment, experiencing dry mouth before and during cancer treatment, being dehydrated, having a chronic condition, such as kidney disease or diabetes, having poor oral health and hygiene, chewing or smoking tobacco, drinking alcohol.

• #34 Mucositis: Causes, Symptoms, and Treatments – Laboratorios KIN

  https://www.kin.es/en/patologias/mucositis/

  Mucositis is an inflammation of the mucosa of the mouth and pharynx. This disorder is one of the most common side effects of cancer therapies (particularly chemotherapy and radiotherapy), which can alter the integrity of the oropharyngeal tissues. In addition, factors such as nutritional deficiencies, poor oral hygiene and smoking may also influence the onset and/or severity of symptoms. […] The etiopathogenesis of mucositis is still not entirely clear, but it seems that the inflammatory process of the epithelium is preceded by damage to the vascular and connective component of the submucosa. In addition to chemo- and radiotherapy, other factors may favor the appearance of the inflammatory process or influence its extension. […] Mucositis can be complicated in the presence of local factors that can affect the oral mucosal lining, such as periodontal infections, ill-fitting dentures and fractured or sharp dental elements.

• #35 Chemotherapy-Related Mucositis | 5-Minute Clinical Consult

  https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816938/all/Chemotherapy_Related_Mucositis?q=Abdominal+pain

  A condition affecting any part of the alimentary tract (most commonly the oral cavity), associated with chemotherapy. […] Mucositis causes significant pain sometimes treatable with local therapies but often requiring parenteral opioids. […] The type(s) and dose of chemotherapeutic agents and underlying genetic factors determine the frequency and severity of mucositis. […] Many chemotherapeutic agents cause mucositis. Cytotoxic agents such as 5-fluorouracil, capecitabine, and cisplatin are most common. […] Genetic polymorphisms have been identified that may predispose individuals to methotrexate-induced mucositis; other genetic factors under investigation. […] Type, dose, and duration of chemotherapeutic agent. […] Genetic predispositions are not fully understood.

• #36 Plasma Cell Mucositis — DermNet

  https://dermnetnz.org/topics/plasma-cell-mucositis

  Plasma cell mucositis is a rare, benign, inflammatory disorder of the upper aerodigestive tract that shares clinical and histologic features with plasma cell (Zoon) balanitis/vulvitis. […] The cause of plasma cell mucositis is unknown. It has been postulated that an immune response may develop in susceptible individuals to an as-yet-unidentified infectious trigger (eg, Candida albicans, herpes simplex virus), actinic damage (of the lips), or contact sensitisation. […] Since the early 2000s, an association between khat (qat) chewing and plasma cell mucositis has been observed. […] Plasma cell gingivitis appears to be a distinct variant presenting as a localised hypersensitivity reaction of the gingivae to flavouring agents (typically cinnamon and cinnamaldehydes) in toothpaste and chewing gums.

• #37 Mucositis – Wikipedia

  https://en.wikipedia.org/wiki/Mucositis

  Mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer. […] Oral and gastrointestinal (GI) mucositis affects almost all patients undergoing high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT), 80% of patients with cancers of the head and neck receiving radiotherapy, and a wide range of patients receiving chemotherapy. […] For most cancer treatment, about 5-15% of patients get mucositis. However, with 5-fluorouracil (5-FU), up to 40% get mucositis, and 10-15% get grade 3-4 oral mucositis. […] Irinotecan is associated with severe GI mucositis in over 20% of patients. […] Radiotherapy to the head and neck or to the pelvis or abdomen is associated with Grade 3 and Grade 4 oral or GI mucositis, respectively, often exceeding 50% of patients.

• #38 Oral Mucositis: What are the Causes, Symptoms and Treatments?

  https://www.bluemshop.co.uk/oral-mucositis/

  Oral mucositis is when the oral mucosa the mucous membrane lining the inside of the mouth becomes sore and inflamed. The condition, which can be painful, is common amongst cancer patients and is often the result of intense chemotherapy or radiotherapy. […] Undergoing rigorous cancer treatment, such as chemotherapy and radiotherapy, can damage the delicate cells in the mouth and throat. As a result, the area can become inflamed with white or grey sores. […] Almost all patients with tumours in the head or neck will develop oral mucositis when treated with radiotherapy, while around 89 per cent will develop the condition when treated with a combination of chemo and radiation. Its estimated that 40 per cent of patients treated with chemotherapy develop oral mucositis. […] Other causes of oral mucositis include undergoing bone marrow and stem cell transplants. Several factors that increase your chances of developing the condition include: Drinking alcohol, Chewing or smoking tobacco, Poor oral health, Dehydration, Suffering from diabetes.

• #39 UCSD Mucositis Trial → Treatment of Radiation and Cisplatin Induced Toxicities with Tempol

  https://clinicaltrials.ucsd.edu/trial/NCT03480971

  Nearly all (90% to 97%) participants receiving radiotherapy in the head and neck will develop some degree of mucositis. Of these participants treated with radiotherapy with or without chemotherapy, 34% to 43% will present severe mucositis. As a result, the participant’s quality of life is affected, hospital admittance rates are higher, the use of total parenteral nutrition is increased and interruption of treatment is more frequent, all of which compromise tumor control. Mucositis causes 9% to 19% of chemotherapy and radiotherapy interruption. […] Tempol protects normal cells from radiation and cisplatin-induced damage; however, in cancerous or tumor cells, Tempol is reduced to its hydroxylamine form that does not and cannot protect the cells from radiation and cisplatin induced damage. […] This compound has the potential to prevent many of the toxicities associated with cisplatin and radiation treatment including the prevention of mucositis, nephrotoxicity, and ototoxicity.

• #40 Oral mucositis induced by chemotherapy: A challenge in the treatment of patients with breast cancer – Ego Journal

  https://egojournal.eu/journal/2023-03/oral-mucositis-induced-by-chemotherapy-a-challenge-in-the-treatment-of-patients-with-breast-cancer/

  Mucositis is a well-known side effect of chemotherapy that may affect patient’s ability to eat, causing pain, and, sometimes, leading to chemotherapy interruption with the resultant risk to patients life. […] There are few studies related to mucositis in breast cancer, which is paradoxical considering the high incidence of this cancer in women. […] Mucositis is a multifactorial disease affecting 20-40 percent of patients receiving conventional-dose cytotoxic CT. […] Oral mucosa injuries caused by chemotherapy are the result of a biochemical complex reaction. […] Mucositis limits food consumption due to pain and discomfort to chew and/or swallow. […] Mucositis is associated with increased morbidity and mortality besides significant additional hospital costs. […] The best therapeutic option for treating oral mucositis is still unknown and there is still controversy over which treatment can heal oral mucositis. […] More studies about oral mucositis focusing on breast cancer are needed since there is no established treatment for the prevention or management of stomatitis.

• #41 Radiation therapy and chemotherapy-induced oral mucositis | Brazilian Journal of Otorhinolaryngology

  https://www.elsevier.es/en-revista-brazilian-journal-otorhinolaryngology-english-edition–497-articulo-radiation-therapy-chemotherapy-induced-oral-mucositis-S1808869415301105

  Increasing the intensity of radiation therapy and chemotherapy in the management of cancer has increased the incidence of adverse effects, especially oral mucositis. […] Mucositis is a consequence of two major mechanisms: direct toxicity due to the treatment and myelosuppression that results from therapy. […] Its pathogenesis is reduced cell renewal in the basal epithelial layers as a result of chemotherapy and radiotherapy; adequate replacement of desquamated cells becomes insufficient. […] Cell kinetics initially defines the relative sensitivity of normal tissues to anticancer therapy. […] Both radiation and chemotherapy cause cell death by interfering on their growth and differentiation mechanisms. […] Cells in the oral mucosa have high mitotic, cell renewal and epithelial maturation rates.

• #42 Radiation therapy and chemotherapy-induced oral mucositis | Brazilian Journal of Otorhinolaryngology

  https://www.elsevier.es/en-revista-brazilian-journal-otorhinolaryngology-english-edition–497-articulo-radiation-therapy-chemotherapy-induced-oral-mucositis-S1808869415301105

  Increasing the intensity of radiation therapy and chemotherapy in the management of cancer has increased the incidence of adverse effects, especially oral mucositis. […] Mucositis is a consequence of two major mechanisms: direct toxicity due to the treatment and myelosuppression that results from therapy. […] Its pathogenesis is reduced cell renewal in the basal epithelial layers as a result of chemotherapy and radiotherapy; adequate replacement of desquamated cells becomes insufficient. […] Cell kinetics initially defines the relative sensitivity of normal tissues to anticancer therapy. […] Both radiation and chemotherapy cause cell death by interfering on their growth and differentiation mechanisms. […] Cells in the oral mucosa have high mitotic, cell renewal and epithelial maturation rates.

• #43 Radiation therapy and chemotherapy-induced oral mucositis | Brazilian Journal of Otorhinolaryngology

  https://www.elsevier.es/en-revista-brazilian-journal-otorhinolaryngology-english-edition–497-articulo-radiation-therapy-chemotherapy-induced-oral-mucositis-S1808869415301105

  The non-specific effects of cytotoxic drugs used in therapy reduces the rate of epithelial cell renewal, leading to muscle atrophy, localized or diffuse mucosal ulcers and inflammation. […] According to Adamietz et al. the origin of cancer radiotherapy-induced mucosal lesions is radiobiological or toxic, although infection may further development. […] Damage to the oral mucosa may lead to infection, which is maintained by immune unbalances, in particular leukopenia. […] Chemotherapy-induced damage differs from that of radiation in that radiation damage is considered as permanent risk areas throughout the patients life.

• #44 Mucositis and Infection in Hematology Patients

  https://www.mdpi.com/1422-0067/24/11/9592

  Mucositis of the mouth is clinically characterized by pain, erythema, oedema and ulcerations and mucositis of the alimentary tract by pain, bowel cramps, nausea, vomiting and diarrhea. This both results in anorexia, weight loss and reduced quality of life, delay of effective anticancer treatments and sometimes even ICU transfer and death. The pathogenesis of mucositis is complex, dynamic and intricate, and the precise role of microorganisms is still the subject of debate. Injury to the mucosa induced by chemotherapy or irradiation is definitely the most substantial and earliest breach in the host defenses against microorganisms. However, other components of the physical and functional barrier, i.e., mucus layer, neuroendocrine feedback signaling, the immune system itself and the vascular system are injured as well by the chemotherapy or irradiation. As mentioned, the process of mucositis is more complex than just the direct effect of cytotoxic therapy on cells with a high mitotic index, such as epithelial cells of mouth and gastrointestinal tract resulting in apoptosis and a maturation blockade for many days. The postulation of Sonis about the pathobiology of oral mucositis involving five sequential and partially overlapping phases has never really been challenged. The initiation phase involves free radical generation, induction of apoptotic cell death induced by both DNA and non-DNA damage and activation of the innate immune response. In addition, generated (radical oxygen species) ROS lead to lipid peroxidation, sphingomyelinase activation, and the hydrolysis of membrane sphingomyelin to yield ceramide. Although ceramide is considered a proapoptotic molecule, its accumulation is a signal for increased membrane permeability and ultimately break of the epithelial cells. The following phase is crucial during which the master transcription factor, nuclear factor kappa B (NF-κB), leads to the upregulation of several genes, resulting in the production of the proinflammatory cytokines (tumor necrosis factor-α [TNF-α], IL-1β, IL-4, IL-6 and IL-18) and also cyclooxygenase 2 and cell adhesion molecules. These proinflammatory cytokines turn on a cascade of reinforced signal amplification. Simultaneously connective tissue fibrinolysis and the stimulation of tissue-damaging matrix metalloproteinases further damage the extracellular matrix. The net result of apoptosis, maturation blockade, necrosis and inflammation is the ulceration phase, in which microorganisms and microbe-associated molecular patterns such as peptidoglycans and lipopolysaccharides can translocate the damaged mucosal barrier more easily and microorganisms can cause systemic infections, especially in the absence of circulating neutrophils and monocytes. Damage-associated molecular patterns, including endogenous ligands, the alarmins, high-mobility box group-1, ATP, and heat shock proteins released as a result of mucosal damage, in addition to (translocated) microorganisms and microbe-associated molecular patterns, are able to further activate tissue macrophages to produce even more proinflammatory cytokines, all contributing to profound inflammation and mucosal tissue damage. Cross-talk between all of the active elements of the physical and functional gut barrier is intense and multidirectional. Inflammation not only mitigates infections but initiates tissue repair. The same pro-inflammatory cytokines IL-6 and TNF-α promote regeneration of the intestinal mucosa. Epithelial stem cells are capable of repopulating the mucosa in the healing phase and the return of neutrophils will clear up damaged cells and infected tissue. As a result of the ulcerative surfaces, the oral flora undergoes a shift towards more pathogenic bacteria as will be discussed later in more detail. Although a few studies have established changes in microbiome composition or relative proportions, it is unclear how these influence the course of OM, as all five stages can coexist to a variable degree across the oral mucosa. To hypothesize, the oral microbiome may play a role in exacerbating or protecting against mucosal injury during the five stages of mucositis. Such an impact may be determined by changes in the microbial expressome and interactome, species adhesion properties, or colonization activities, which are concomitant to or followed by inflammation and ulceration. In the absence of microbes, tissue damage and cell death still evoke sterile inflammation. To summarize, there is no evidence suggesting that microorganisms by themselves induce chemotherapy-induced mucositis although microbial colonization might be an important factor in the propagation or amelioration of the inflammatory response seen in mucositis.

• #45 Mucositis explained | Blood Cancer UK

  https://bloodcancer.org.uk/understanding-blood-cancer/treatment/side-effects/mucositis/mucositis-explained/

  Mucositis is a condition which affects the gastrointestinal tract in your digestive system. The gastrointestinal, or GI, tract is a long tube that runs from your mouth to your anus. It includes your mouth, oesophagus (food pipe), stomach and bowels. […] Mucositis causes the lining of your GI tract to become thin, making it sore and causing ulcers. This can happen after chemotherapy or radiotherapy. […] Cancer treatments target cells that multiply quickly. This includes cancer cells, but also fast-growing healthy cells such as hair cells, skin cells and the cells in your GI tract. Thats why having chemotherapy or radiotherapy can make your hair fall out, increase your risk of sunburn and cause mouth or gut problems. […] Mucositis happens when cancer treatments kill healthy cells in the GI tract. The lining of the GI tract gets thinner and becomes inflamed (sore and swollen).

• #46 Mucositis and Infection in Hematology Patients

  https://www.mdpi.com/1422-0067/24/11/9592

  Mucositis of the mouth is clinically characterized by pain, erythema, oedema and ulcerations and mucositis of the alimentary tract by pain, bowel cramps, nausea, vomiting and diarrhea. This both results in anorexia, weight loss and reduced quality of life, delay of effective anticancer treatments and sometimes even ICU transfer and death. The pathogenesis of mucositis is complex, dynamic and intricate, and the precise role of microorganisms is still the subject of debate. Injury to the mucosa induced by chemotherapy or irradiation is definitely the most substantial and earliest breach in the host defenses against microorganisms. However, other components of the physical and functional barrier, i.e., mucus layer, neuroendocrine feedback signaling, the immune system itself and the vascular system are injured as well by the chemotherapy or irradiation. As mentioned, the process of mucositis is more complex than just the direct effect of cytotoxic therapy on cells with a high mitotic index, such as epithelial cells of mouth and gastrointestinal tract resulting in apoptosis and a maturation blockade for many days. The postulation of Sonis about the pathobiology of oral mucositis involving five sequential and partially overlapping phases has never really been challenged. The initiation phase involves free radical generation, induction of apoptotic cell death induced by both DNA and non-DNA damage and activation of the innate immune response. In addition, generated (radical oxygen species) ROS lead to lipid peroxidation, sphingomyelinase activation, and the hydrolysis of membrane sphingomyelin to yield ceramide. Although ceramide is considered a proapoptotic molecule, its accumulation is a signal for increased membrane permeability and ultimately break of the epithelial cells. The following phase is crucial during which the master transcription factor, nuclear factor kappa B (NF-κB), leads to the upregulation of several genes, resulting in the production of the proinflammatory cytokines (tumor necrosis factor-α [TNF-α], IL-1β, IL-4, IL-6 and IL-18) and also cyclooxygenase 2 and cell adhesion molecules. These proinflammatory cytokines turn on a cascade of reinforced signal amplification. Simultaneously connective tissue fibrinolysis and the stimulation of tissue-damaging matrix metalloproteinases further damage the extracellular matrix. The net result of apoptosis, maturation blockade, necrosis and inflammation is the ulceration phase, in which microorganisms and microbe-associated molecular patterns such as peptidoglycans and lipopolysaccharides can translocate the damaged mucosal barrier more easily and microorganisms can cause systemic infections, especially in the absence of circulating neutrophils and monocytes. Damage-associated molecular patterns, including endogenous ligands, the alarmins, high-mobility box group-1, ATP, and heat shock proteins released as a result of mucosal damage, in addition to (translocated) microorganisms and microbe-associated molecular patterns, are able to further activate tissue macrophages to produce even more proinflammatory cytokines, all contributing to profound inflammation and mucosal tissue damage. Cross-talk between all of the active elements of the physical and functional gut barrier is intense and multidirectional. Inflammation not only mitigates infections but initiates tissue repair. The same pro-inflammatory cytokines IL-6 and TNF-α promote regeneration of the intestinal mucosa. Epithelial stem cells are capable of repopulating the mucosa in the healing phase and the return of neutrophils will clear up damaged cells and infected tissue. As a result of the ulcerative surfaces, the oral flora undergoes a shift towards more pathogenic bacteria as will be discussed later in more detail. Although a few studies have established changes in microbiome composition or relative proportions, it is unclear how these influence the course of OM, as all five stages can coexist to a variable degree across the oral mucosa. To hypothesize, the oral microbiome may play a role in exacerbating or protecting against mucosal injury during the five stages of mucositis. Such an impact may be determined by changes in the microbial expressome and interactome, species adhesion properties, or colonization activities, which are concomitant to or followed by inflammation and ulceration. In the absence of microbes, tissue damage and cell death still evoke sterile inflammation. To summarize, there is no evidence suggesting that microorganisms by themselves induce chemotherapy-induced mucositis although microbial colonization might be an important factor in the propagation or amelioration of the inflammatory response seen in mucositis.

• #47 Mucositis – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/mucositis/

  Mucositis is an inflammatory-like process of the oral mucosa due to radiation in head-neck oncology patients or chemotherapy. […] Mucositis is considered to be an inevitable but transient side effect of anti-neoplastic therapies. […] Mucositis is basically a tissue reaction to the trauma of radiation or chemotherapy. Total dose, radiation portals, fractionation schedule, and type of ionising radiation as well as dose and type of chemotherapy agents affect the occurrence and severity of mucositis. […] The pathogenesis of mucositis, being similar but not identical in both chemotherapy and radiation, is not fully understood. […] The hypothesis proposed for the development of radiation- and chemotherapy-induced mucositis consider four consecutive phases: (1) inflammatory/vascular phase (free radicals and cytokines are released); (2) epithelial phase (reduced epithelial renewal-atrophy); (3) ulcerative/bacterial phase (colonisation by mixed flora, causing release of endotoxins, with further tissue damage by stimulation of cytokines). An interplay between the radiation- or chemotherapy-induced epithelial ulceration and bacterial flora is implied in this phase; (4) healing phase.

• #48 Chemotherapy induced oral mucositis: prevention is possible – Cidon – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/17197/html

  Oral mucositis (OM) is an inflammation of the oral mucosa which occurs in 20-40% of patients receiving conventional chemotherapy (CM). […] Oral mucositis (OM) is the inflammation of the oral mucosa induced by oncological treatments. Radiotherapy (RT) seem to produce it in 80% of the patients, chemotherapy (CM) in 20-80% depending on the regimen and 75% of patients undergoing bone marrow transplantation will suffer from this side-effect. […] It is well known that chemotherapeutic drugs target rapidly multiplying healthy cells such as the oral mucosa. This damages the mucosal lining of the mouth leading to atrophy and ulcers. […] Inflammatory cytokines and reactive oxygen species are released in the mucosa. These will activate transcription factors (nuclear factor kappa B) and over-regulate genes (tumor necrosis factor, IL-6, and IL-1) which will activate apoptosis.

• #49 Mucositis – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/mucositis/

  Factors that may contribute to the development of mucositis include the increase in inflammatory mediators, platelet activating factor in saliva, leukocyte adhesion to E-selectin or endothelial intercellular adhesion molecule-1 (ICAM-1) which promotes the radiation-induced inflammatory response in squamous epithelium, a decrease in the level of salivary epidermal growth factor and loss of protective salivary constituents. […] A marked increase in the carriage rate of Gram-negative bacilli in the oropharynx (a/o. Enterobacteriaceae, Pseudomonaceae) has particularly been shown as a possible aggravating factor in the development of oral mucositis. […] The most common infection in the oral cavity during or shortly after radiotherapy and chemotherapy is candidosis. […] The direct toxic effect of cytostatic agents on rapidly dividing cells of the oral epithelium result in atrophy, erythema and ulceration. Indirect stomatotoxic effects are caused by release of inflammatory mediators, loss of protective salivary constituents, and therapy induced neutropenia, in combination with the colonisation of bacteria, fungi and viruses on damaged mucosa which can result in secondary infections. Neutropenia, in chemotherapy, increases the risk for secondary infections.

• #50 Mucositis and Infection in Hematology Patients

  https://www.mdpi.com/1422-0067/24/11/9592

  Mucositis of the mouth is clinically characterized by pain, erythema, oedema and ulcerations and mucositis of the alimentary tract by pain, bowel cramps, nausea, vomiting and diarrhea. This both results in anorexia, weight loss and reduced quality of life, delay of effective anticancer treatments and sometimes even ICU transfer and death. The pathogenesis of mucositis is complex, dynamic and intricate, and the precise role of microorganisms is still the subject of debate. Injury to the mucosa induced by chemotherapy or irradiation is definitely the most substantial and earliest breach in the host defenses against microorganisms. However, other components of the physical and functional barrier, i.e., mucus layer, neuroendocrine feedback signaling, the immune system itself and the vascular system are injured as well by the chemotherapy or irradiation. As mentioned, the process of mucositis is more complex than just the direct effect of cytotoxic therapy on cells with a high mitotic index, such as epithelial cells of mouth and gastrointestinal tract resulting in apoptosis and a maturation blockade for many days. The postulation of Sonis about the pathobiology of oral mucositis involving five sequential and partially overlapping phases has never really been challenged. The initiation phase involves free radical generation, induction of apoptotic cell death induced by both DNA and non-DNA damage and activation of the innate immune response. In addition, generated (radical oxygen species) ROS lead to lipid peroxidation, sphingomyelinase activation, and the hydrolysis of membrane sphingomyelin to yield ceramide. Although ceramide is considered a proapoptotic molecule, its accumulation is a signal for increased membrane permeability and ultimately break of the epithelial cells. The following phase is crucial during which the master transcription factor, nuclear factor kappa B (NF-κB), leads to the upregulation of several genes, resulting in the production of the proinflammatory cytokines (tumor necrosis factor-α [TNF-α], IL-1β, IL-4, IL-6 and IL-18) and also cyclooxygenase 2 and cell adhesion molecules. These proinflammatory cytokines turn on a cascade of reinforced signal amplification. Simultaneously connective tissue fibrinolysis and the stimulation of tissue-damaging matrix metalloproteinases further damage the extracellular matrix. The net result of apoptosis, maturation blockade, necrosis and inflammation is the ulceration phase, in which microorganisms and microbe-associated molecular patterns such as peptidoglycans and lipopolysaccharides can translocate the damaged mucosal barrier more easily and microorganisms can cause systemic infections, especially in the absence of circulating neutrophils and monocytes. Damage-associated molecular patterns, including endogenous ligands, the alarmins, high-mobility box group-1, ATP, and heat shock proteins released as a result of mucosal damage, in addition to (translocated) microorganisms and microbe-associated molecular patterns, are able to further activate tissue macrophages to produce even more proinflammatory cytokines, all contributing to profound inflammation and mucosal tissue damage. Cross-talk between all of the active elements of the physical and functional gut barrier is intense and multidirectional. Inflammation not only mitigates infections but initiates tissue repair. The same pro-inflammatory cytokines IL-6 and TNF-α promote regeneration of the intestinal mucosa. Epithelial stem cells are capable of repopulating the mucosa in the healing phase and the return of neutrophils will clear up damaged cells and infected tissue. As a result of the ulcerative surfaces, the oral flora undergoes a shift towards more pathogenic bacteria as will be discussed later in more detail. Although a few studies have established changes in microbiome composition or relative proportions, it is unclear how these influence the course of OM, as all five stages can coexist to a variable degree across the oral mucosa. To hypothesize, the oral microbiome may play a role in exacerbating or protecting against mucosal injury during the five stages of mucositis. Such an impact may be determined by changes in the microbial expressome and interactome, species adhesion properties, or colonization activities, which are concomitant to or followed by inflammation and ulceration. In the absence of microbes, tissue damage and cell death still evoke sterile inflammation. To summarize, there is no evidence suggesting that microorganisms by themselves induce chemotherapy-induced mucositis although microbial colonization might be an important factor in the propagation or amelioration of the inflammatory response seen in mucositis.

• #51 Mucositis and Infection in Hematology Patients

  https://www.mdpi.com/1422-0067/24/11/9592

  Mucositis of the mouth is clinically characterized by pain, erythema, oedema and ulcerations and mucositis of the alimentary tract by pain, bowel cramps, nausea, vomiting and diarrhea. This both results in anorexia, weight loss and reduced quality of life, delay of effective anticancer treatments and sometimes even ICU transfer and death. The pathogenesis of mucositis is complex, dynamic and intricate, and the precise role of microorganisms is still the subject of debate. Injury to the mucosa induced by chemotherapy or irradiation is definitely the most substantial and earliest breach in the host defenses against microorganisms. However, other components of the physical and functional barrier, i.e., mucus layer, neuroendocrine feedback signaling, the immune system itself and the vascular system are injured as well by the chemotherapy or irradiation. As mentioned, the process of mucositis is more complex than just the direct effect of cytotoxic therapy on cells with a high mitotic index, such as epithelial cells of mouth and gastrointestinal tract resulting in apoptosis and a maturation blockade for many days. The postulation of Sonis about the pathobiology of oral mucositis involving five sequential and partially overlapping phases has never really been challenged. The initiation phase involves free radical generation, induction of apoptotic cell death induced by both DNA and non-DNA damage and activation of the innate immune response. In addition, generated (radical oxygen species) ROS lead to lipid peroxidation, sphingomyelinase activation, and the hydrolysis of membrane sphingomyelin to yield ceramide. Although ceramide is considered a proapoptotic molecule, its accumulation is a signal for increased membrane permeability and ultimately break of the epithelial cells. The following phase is crucial during which the master transcription factor, nuclear factor kappa B (NF-κB), leads to the upregulation of several genes, resulting in the production of the proinflammatory cytokines (tumor necrosis factor-α [TNF-α], IL-1β, IL-4, IL-6 and IL-18) and also cyclooxygenase 2 and cell adhesion molecules. These proinflammatory cytokines turn on a cascade of reinforced signal amplification. Simultaneously connective tissue fibrinolysis and the stimulation of tissue-damaging matrix metalloproteinases further damage the extracellular matrix. The net result of apoptosis, maturation blockade, necrosis and inflammation is the ulceration phase, in which microorganisms and microbe-associated molecular patterns such as peptidoglycans and lipopolysaccharides can translocate the damaged mucosal barrier more easily and microorganisms can cause systemic infections, especially in the absence of circulating neutrophils and monocytes. Damage-associated molecular patterns, including endogenous ligands, the alarmins, high-mobility box group-1, ATP, and heat shock proteins released as a result of mucosal damage, in addition to (translocated) microorganisms and microbe-associated molecular patterns, are able to further activate tissue macrophages to produce even more proinflammatory cytokines, all contributing to profound inflammation and mucosal tissue damage. Cross-talk between all of the active elements of the physical and functional gut barrier is intense and multidirectional. Inflammation not only mitigates infections but initiates tissue repair. The same pro-inflammatory cytokines IL-6 and TNF-α promote regeneration of the intestinal mucosa. Epithelial stem cells are capable of repopulating the mucosa in the healing phase and the return of neutrophils will clear up damaged cells and infected tissue. As a result of the ulcerative surfaces, the oral flora undergoes a shift towards more pathogenic bacteria as will be discussed later in more detail. Although a few studies have established changes in microbiome composition or relative proportions, it is unclear how these influence the course of OM, as all five stages can coexist to a variable degree across the oral mucosa. To hypothesize, the oral microbiome may play a role in exacerbating or protecting against mucosal injury during the five stages of mucositis. Such an impact may be determined by changes in the microbial expressome and interactome, species adhesion properties, or colonization activities, which are concomitant to or followed by inflammation and ulceration. In the absence of microbes, tissue damage and cell death still evoke sterile inflammation. To summarize, there is no evidence suggesting that microorganisms by themselves induce chemotherapy-induced mucositis although microbial colonization might be an important factor in the propagation or amelioration of the inflammatory response seen in mucositis.

• #52 Mucositis – Oral Cancer Foundation | Information and Resources about Oral Head and Neck Cancer

  https://oralcancerfoundation.org/complications/mucositis/

  Mucositis occurs when cancer treatments break down the rapidly divided epithelial cells lining the gastro-intestinal tract (which goes from the mouth to the anus), leaving the mucosal tissue open to ulceration and infection. […] Oral mucositis is probably the most common, debilitating complication of cancer treatments, particularly chemotherapy and radiation. It can lead to several problems, including pain, nutritional problems as a result of inability to eat, and increased risk of infection due to open sores in the mucosa. […] When caused by chemotherapy, mucositis is usually due to the low white blood cell count; when caused by radiation, mucositis is usually due to the necrotic and inflammatory effect of radiation energy on oral mucosa. […] Oral mucositis occurs independently of oral mucosal infections of viral and fungal etiology, but it may be exacerbated by such concomitant infections.

• #53 Mucositis and Infection in Hematology Patients

  https://www.mdpi.com/1422-0067/24/11/9592

  The occurrence of bloodstream infections (bacteremia) during neutropenia increases the risk of admission to the intensive care unit as well as non-relapse mortality. Infections are associated with graft-versus-host disease (GvHD) and due to the use of antibiotics, there is an increased risk of antimicrobial resistance as well as disturbance of the microbiota (dysbiosis) as mentioned before. The paradigm of ‘febrile neutropenia’ was the foundation for the strategy of prompt starting of antimicrobial therapy as soon as fever occurs during neutropenia, in order to reduce the risk of sepsis and death. […] These findings suggest that the severity of mucosal damage in chemotherapy treated patients better defines the risk period of bacteremia than neutropenia.

• #54 Mucositis and Infection in Hematology Patients

  https://www.mdpi.com/1422-0067/24/11/9592

  The occurrence of bloodstream infections (bacteremia) during neutropenia increases the risk of admission to the intensive care unit as well as non-relapse mortality. Infections are associated with graft-versus-host disease (GvHD) and due to the use of antibiotics, there is an increased risk of antimicrobial resistance as well as disturbance of the microbiota (dysbiosis) as mentioned before. The paradigm of ‘febrile neutropenia’ was the foundation for the strategy of prompt starting of antimicrobial therapy as soon as fever occurs during neutropenia, in order to reduce the risk of sepsis and death. […] These findings suggest that the severity of mucosal damage in chemotherapy treated patients better defines the risk period of bacteremia than neutropenia.

• #55 Radiation therapy and chemotherapy-induced oral mucositis | Brazilian Journal of Otorhinolaryngology

  https://www.elsevier.es/en-revista-brazilian-journal-otorhinolaryngology-english-edition–497-articulo-radiation-therapy-chemotherapy-induced-oral-mucositis-S1808869415301105

  The non-specific effects of cytotoxic drugs used in therapy reduces the rate of epithelial cell renewal, leading to muscle atrophy, localized or diffuse mucosal ulcers and inflammation. […] According to Adamietz et al. the origin of cancer radiotherapy-induced mucosal lesions is radiobiological or toxic, although infection may further development. […] Damage to the oral mucosa may lead to infection, which is maintained by immune unbalances, in particular leukopenia. […] Chemotherapy-induced damage differs from that of radiation in that radiation damage is considered as permanent risk areas throughout the patients life.

• #56 Patients and Mucositis – Mucosamin

  https://mucosamin.com/patients-mucositis/

  Mucositis is an acute inflammatory and ulcerative complication of the mucosal membrane that commonly occurs during cancer therapy. It is one of the more significant side-effects of cancer treatment. It can result from systemic chemotherapy, from radiation therapy, or a combination of the two. […] Mucositis occurs when cancer treatments break down the rapidly divided epithelial cells lining the gastro-intestinal tract, leaving the mucosal tissue open to ulceration and infection. […] The primary morbidity of OM is the intense pain, which is usually associated with ulcerative lesions. […] Chemotherapy-induced OM is regarded as an acute condition, with ulceration normally occurring 1-2 weeks after treatment, and resolving within 3 weeks of treatment. […] Oral mucositis is probably the most common, debilitating complication of cancer treatments, particularly chemotherapy and radiation. It can lead to several problems, including pain, nutritional problems as a result of inability to eat, and increased risk of infection due to open sores in the mucosa.

• #57 Oral Complications of Cancer Therapies – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq

  Oral complications are common in cancer patients, especially those with head and neck cancer. […] Cancer treatment can cause mouth and throat problems. […] Oral complications may be caused by the treatment itself (directly) or by side effects of the treatment (indirectly). […] Mucositis may be caused by either radiation therapy or chemotherapy. […] Oral mucositis is an inflammation of mucous membranes in the mouth. […] Mucositis caused by chemotherapy will heal by itself, usually in 2 to 4 weeks if there is no infection. […] Mucositis caused by radiation therapy usually lasts 6 to 8 weeks, depending on how long the treatment was. […] Mucositis may cause the following problems: Pain, Infection, Bleeding, in patients receiving chemotherapy. […] Oral pain in cancer patients may be caused by the cancer. […] Oral pain may be a side effect of treatments. […] Oral mucositis is the most common side effect of radiation therapy and chemotherapy.

• #58 Radiation therapy and chemotherapy-induced oral mucositis | Brazilian Journal of Otorhinolaryngology

  https://www.elsevier.es/en-revista-brazilian-journal-otorhinolaryngology-english-edition–497-articulo-radiation-therapy-chemotherapy-induced-oral-mucositis-S1808869415301105

  The non-specific effects of cytotoxic drugs used in therapy reduces the rate of epithelial cell renewal, leading to muscle atrophy, localized or diffuse mucosal ulcers and inflammation. […] According to Adamietz et al. the origin of cancer radiotherapy-induced mucosal lesions is radiobiological or toxic, although infection may further development. […] Damage to the oral mucosa may lead to infection, which is maintained by immune unbalances, in particular leukopenia. […] Chemotherapy-induced damage differs from that of radiation in that radiation damage is considered as permanent risk areas throughout the patients life.

• #59 Oral Complications of Cancer Therapies – NCIFacebookFollow on XInstagramYoutubeLinkedin

  https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq

  Oral complications are common in cancer patients, especially those with head and neck cancer. […] Cancer treatment can cause mouth and throat problems. […] Oral complications may be caused by the treatment itself (directly) or by side effects of the treatment (indirectly). […] Mucositis may be caused by either radiation therapy or chemotherapy. […] Oral mucositis is an inflammation of mucous membranes in the mouth. […] Mucositis caused by chemotherapy will heal by itself, usually in 2 to 4 weeks if there is no infection. […] Mucositis caused by radiation therapy usually lasts 6 to 8 weeks, depending on how long the treatment was. […] Mucositis may cause the following problems: Pain, Infection, Bleeding, in patients receiving chemotherapy. […] Oral pain in cancer patients may be caused by the cancer. […] Oral pain may be a side effect of treatments. […] Oral mucositis is the most common side effect of radiation therapy and chemotherapy.

• #60 Radiation therapy and chemotherapy-induced oral mucositis | Brazilian Journal of Otorhinolaryngology

  https://www.elsevier.es/en-revista-brazilian-journal-otorhinolaryngology-english-edition–497-articulo-radiation-therapy-chemotherapy-induced-oral-mucositis-S1808869415301105

  The non-specific effects of cytotoxic drugs used in therapy reduces the rate of epithelial cell renewal, leading to muscle atrophy, localized or diffuse mucosal ulcers and inflammation. […] According to Adamietz et al. the origin of cancer radiotherapy-induced mucosal lesions is radiobiological or toxic, although infection may further development. […] Damage to the oral mucosa may lead to infection, which is maintained by immune unbalances, in particular leukopenia. […] Chemotherapy-induced damage differs from that of radiation in that radiation damage is considered as permanent risk areas throughout the patients life.

• #61 Mucositis: Causes, Symptoms, and Treatments – Laboratorios KIN

  https://www.kin.es/en/patologias/mucositis/

  Mucositis is an inflammation of the mucosa of the mouth and pharynx. This disorder is one of the most common side effects of cancer therapies (particularly chemotherapy and radiotherapy), which can alter the integrity of the oropharyngeal tissues. In addition, factors such as nutritional deficiencies, poor oral hygiene and smoking may also influence the onset and/or severity of symptoms. […] The etiopathogenesis of mucositis is still not entirely clear, but it seems that the inflammatory process of the epithelium is preceded by damage to the vascular and connective component of the submucosa. In addition to chemo- and radiotherapy, other factors may favor the appearance of the inflammatory process or influence its extension. […] Mucositis can be complicated in the presence of local factors that can affect the oral mucosal lining, such as periodontal infections, ill-fitting dentures and fractured or sharp dental elements.

• #62 Mucositis – Oral Cancer Foundation | Information and Resources about Oral Head and Neck Cancer

  https://oralcancerfoundation.org/complications/mucositis/

  Mucositis occurs when cancer treatments break down the rapidly divided epithelial cells lining the gastro-intestinal tract (which goes from the mouth to the anus), leaving the mucosal tissue open to ulceration and infection. […] Oral mucositis is probably the most common, debilitating complication of cancer treatments, particularly chemotherapy and radiation. It can lead to several problems, including pain, nutritional problems as a result of inability to eat, and increased risk of infection due to open sores in the mucosa. […] When caused by chemotherapy, mucositis is usually due to the low white blood cell count; when caused by radiation, mucositis is usually due to the necrotic and inflammatory effect of radiation energy on oral mucosa. […] Oral mucositis occurs independently of oral mucosal infections of viral and fungal etiology, but it may be exacerbated by such concomitant infections.

• #63 Dental Researchers Get at Root Causes of Cancer Patients’ Mouth Sores – UConn Today

  https://today.uconn.edu/2019/04/dental-researchers-get-root-causes-cancer-patients-mouth-sores/

  Oral mucositis, a common side effect of chemotherapy, is associated with detrimental changes in the oral microbiome, says new School of Dental Medicine research. […] Oral mucositis, a common side effect of chemotherapy, is triggered by chemotherapeutic drugs breaking down the mucous membrane lining in the mouth the oral mucosa. This breakdown induces the painful lesions. […] While this chemotherapy complication has not been widely researched, it has been suggested that the oral microbiome plays a role in inducing the responses that lead to mucositis. […] The researchers found that oral mucositis is associated with detrimental changes in the oral microbiome. Patients who developed the most severe oral mucositis lesions showed suppression of beneficial mouth bacteria and outgrowth of harmful ones.

• #64 Mucositis – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/mucositis/

  Factors that may contribute to the development of mucositis include the increase in inflammatory mediators, platelet activating factor in saliva, leukocyte adhesion to E-selectin or endothelial intercellular adhesion molecule-1 (ICAM-1) which promotes the radiation-induced inflammatory response in squamous epithelium, a decrease in the level of salivary epidermal growth factor and loss of protective salivary constituents. […] A marked increase in the carriage rate of Gram-negative bacilli in the oropharynx (a/o. Enterobacteriaceae, Pseudomonaceae) has particularly been shown as a possible aggravating factor in the development of oral mucositis. […] The most common infection in the oral cavity during or shortly after radiotherapy and chemotherapy is candidosis. […] The direct toxic effect of cytostatic agents on rapidly dividing cells of the oral epithelium result in atrophy, erythema and ulceration. Indirect stomatotoxic effects are caused by release of inflammatory mediators, loss of protective salivary constituents, and therapy induced neutropenia, in combination with the colonisation of bacteria, fungi and viruses on damaged mucosa which can result in secondary infections. Neutropenia, in chemotherapy, increases the risk for secondary infections.

• #65 Dental Researchers Get at Root Causes of Cancer Patients’ Mouth Sores – UConn Today

  https://today.uconn.edu/2019/04/dental-researchers-get-root-causes-cancer-patients-mouth-sores/

  Oral mucositis, a common side effect of chemotherapy, is associated with detrimental changes in the oral microbiome, says new School of Dental Medicine research. […] Oral mucositis, a common side effect of chemotherapy, is triggered by chemotherapeutic drugs breaking down the mucous membrane lining in the mouth the oral mucosa. This breakdown induces the painful lesions. […] While this chemotherapy complication has not been widely researched, it has been suggested that the oral microbiome plays a role in inducing the responses that lead to mucositis. […] The researchers found that oral mucositis is associated with detrimental changes in the oral microbiome. Patients who developed the most severe oral mucositis lesions showed suppression of beneficial mouth bacteria and outgrowth of harmful ones.

• #66 Oral Mucositis: Causes, Symptoms, and Advances in Treatment

  https://denpedia.com/oral-mucositis-causes-symptoms-and-advances-in-treatment/

  Poor oral hygiene, dental infections, or pre-existing oral diseases such as periodontitis or gingivitis can increase the risk of mucositis. […] Elderly patients tend to have slower mucosal healing and may be at higher risk. […] Malnutrition or deficiencies in essential nutrients such as vitamins and minerals can impair the body’s ability to heal mucosal tissues. […] These habits can exacerbate mucosal damage and slow healing. […] Some individuals may have genetic predispositions that make them more susceptible to mucositis.

• #67 Mucositis: Causes, Symptoms, and Treatments – Laboratorios KIN

  https://www.kin.es/en/patologias/mucositis/

  Mucositis is an inflammation of the mucosa of the mouth and pharynx. This disorder is one of the most common side effects of cancer therapies (particularly chemotherapy and radiotherapy), which can alter the integrity of the oropharyngeal tissues. In addition, factors such as nutritional deficiencies, poor oral hygiene and smoking may also influence the onset and/or severity of symptoms. […] The etiopathogenesis of mucositis is still not entirely clear, but it seems that the inflammatory process of the epithelium is preceded by damage to the vascular and connective component of the submucosa. In addition to chemo- and radiotherapy, other factors may favor the appearance of the inflammatory process or influence its extension. […] Mucositis can be complicated in the presence of local factors that can affect the oral mucosal lining, such as periodontal infections, ill-fitting dentures and fractured or sharp dental elements.

• #68 Mucositis (Mouth Sores) & Oral Care Tip Sheet | OncoLink

  https://www.oncolink.org/support/side-effects/gastrointestinal-side-effects/mucositis/mucositis-mouth-sores-oral-care-tip-sheet

  Mucositis can be a red, sore mouth and/or gums, or very painful open sores. These sores can make it hard for you to eat. […] Radiation therapy to your head and neck or chemotherapy may cause mucositis. Other causes of mucositis are: Infection. Dehydration (not enough water in your body). Poor mouth care. Oxygen therapy. Drinking too much alcohol. Using tobacco. Not having enough protein in your diet. […] Mucositis can cause pain, problems with nutrition and being unable to eat, and a higher chance of infection because of open sores. It can affect your quality of life. Your provider may need to lower your chemotherapy dose so that the sores can heal (called a dose-limiting effect).

• #69 Mucositis: Causes, Symptoms, and Treatments – Laboratorios KIN

  https://www.kin.es/en/patologias/mucositis/

  Mucositis is an inflammation of the mucosa of the mouth and pharynx. This disorder is one of the most common side effects of cancer therapies (particularly chemotherapy and radiotherapy), which can alter the integrity of the oropharyngeal tissues. In addition, factors such as nutritional deficiencies, poor oral hygiene and smoking may also influence the onset and/or severity of symptoms. […] The etiopathogenesis of mucositis is still not entirely clear, but it seems that the inflammatory process of the epithelium is preceded by damage to the vascular and connective component of the submucosa. In addition to chemo- and radiotherapy, other factors may favor the appearance of the inflammatory process or influence its extension. […] Mucositis can be complicated in the presence of local factors that can affect the oral mucosal lining, such as periodontal infections, ill-fitting dentures and fractured or sharp dental elements.

• #70 Radiation-induced oral mucositis — radiation-induced oral mucositis: pathogenesis, risk factors, clinical manifestations, prevention, and treatment – Legeza – Bulletin of the Russian Military Medical Academy

  https://journals.eco-vector.com/1682-7392/article/view/65173

  This study presents the modern concepts of pathogenesis, risk factors, etiology, clinical manifestations, prevention, and treatment of oropharyngeal mucositis, one of the main complications of radiation therapy for head and neck region cancer. […] The main risk factors for mucositis include the localization and size of the tumor, the amount of radiation dose to the oral region, and individual body characteristics (young age, pernicious habits, metal structures of dentures, a history of periodontal disease, etc.). […] The most important components of the etiopathogenetic therapy of the disease include antiviral drugs (acyclovir and valacyclovir) and fungicides (clotrimazole, fluconazole, and itraconazole).

• #71 Mucositis: Causes, Symptoms, and Treatments – Laboratorios KIN

  https://www.kin.es/en/patologias/mucositis/

  Mucositis is an inflammation of the mucosa of the mouth and pharynx. This disorder is one of the most common side effects of cancer therapies (particularly chemotherapy and radiotherapy), which can alter the integrity of the oropharyngeal tissues. In addition, factors such as nutritional deficiencies, poor oral hygiene and smoking may also influence the onset and/or severity of symptoms. […] The etiopathogenesis of mucositis is still not entirely clear, but it seems that the inflammatory process of the epithelium is preceded by damage to the vascular and connective component of the submucosa. In addition to chemo- and radiotherapy, other factors may favor the appearance of the inflammatory process or influence its extension. […] Mucositis can be complicated in the presence of local factors that can affect the oral mucosal lining, such as periodontal infections, ill-fitting dentures and fractured or sharp dental elements.

• #72 Oral Mucositis: What are the Causes, Symptoms and Treatments?

  https://www.bluemshop.co.uk/oral-mucositis/

  Oral mucositis is when the oral mucosa the mucous membrane lining the inside of the mouth becomes sore and inflamed. The condition, which can be painful, is common amongst cancer patients and is often the result of intense chemotherapy or radiotherapy. […] Undergoing rigorous cancer treatment, such as chemotherapy and radiotherapy, can damage the delicate cells in the mouth and throat. As a result, the area can become inflamed with white or grey sores. […] Almost all patients with tumours in the head or neck will develop oral mucositis when treated with radiotherapy, while around 89 per cent will develop the condition when treated with a combination of chemo and radiation. Its estimated that 40 per cent of patients treated with chemotherapy develop oral mucositis. […] Other causes of oral mucositis include undergoing bone marrow and stem cell transplants. Several factors that increase your chances of developing the condition include: Drinking alcohol, Chewing or smoking tobacco, Poor oral health, Dehydration, Suffering from diabetes.

• #73 Understanding the Pathophysiology of Mucositis: Causes, Symptoms, and Treatments | VITROBIO Medical Devices

  https://www.vitrobio.com/blog/scientific-news-1/understanding-the-pathophysiology-of-mucositis-causes-symptoms-and-treatments-25

  A range of lifestyle factors also contribute to the development of mucositis. Poor oral or dental hygiene, smoking, and excessive alcohol consumption can exacerbate the condition. Additionally, consuming hot or spicy foods can irritate the already sensitive mucosal tissues. […] Systemic health conditions like diabetes, kidney disease, and HIV/AIDS further complicate the situation. These diseases compromise overall health and weaken the body’s defenses, making the mucosal lining more susceptible to inflammation and infection. […] There are also genetic factors at play. Certain individuals may have a genetic predisposition that makes them more vulnerable to developing mucositis when exposed to the triggering factors, such as cancer treatments and lifestyle choices.

• #74 Mucositis (Mouth Sores) & Oral Care Tip Sheet | OncoLink

  https://www.oncolink.org/support/side-effects/gastrointestinal-side-effects/mucositis/mucositis-mouth-sores-oral-care-tip-sheet

  Mucositis can be a red, sore mouth and/or gums, or very painful open sores. These sores can make it hard for you to eat. […] Radiation therapy to your head and neck or chemotherapy may cause mucositis. Other causes of mucositis are: Infection. Dehydration (not enough water in your body). Poor mouth care. Oxygen therapy. Drinking too much alcohol. Using tobacco. Not having enough protein in your diet. […] Mucositis can cause pain, problems with nutrition and being unable to eat, and a higher chance of infection because of open sores. It can affect your quality of life. Your provider may need to lower your chemotherapy dose so that the sores can heal (called a dose-limiting effect).

• #75 Mucositis: Symptoms, causes, complications and treatment

  https://www.medicalnewstoday.com/articles/mucositis

  Some evidence suggests that 35-40% of people who receive chemotherapy may develop mucositis to some extent. The risk is much greater for people who also receive cancer treatment for head and neck cancers. […] Several factors can also increase the risk of mucositis. They include: being female, young age, having received cancer treatment, experiencing dry mouth before and during cancer treatment, being dehydrated, having a chronic condition, such as kidney disease or diabetes, having poor oral health and hygiene, chewing or smoking tobacco, drinking alcohol.

• #76 Mucositis: causes and treatment | CURAPROX

  https://curaprox.in/blog/post/treating-and-preventing-mucositis?srsltid=AfmBOopQKMMsYnqIfkFDWmXAYf2Fw6DZWcRoVmLruucCPz9WGeWG-EOP

  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). […] 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. […] 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.

• #77 Understanding the Pathophysiology of Mucositis: Causes, Symptoms, and Treatments | VITROBIO Medical Devices

  https://www.vitrobio.com/blog/scientific-news-1/understanding-the-pathophysiology-of-mucositis-causes-symptoms-and-treatments-25

  A range of lifestyle factors also contribute to the development of mucositis. Poor oral or dental hygiene, smoking, and excessive alcohol consumption can exacerbate the condition. Additionally, consuming hot or spicy foods can irritate the already sensitive mucosal tissues. […] Systemic health conditions like diabetes, kidney disease, and HIV/AIDS further complicate the situation. These diseases compromise overall health and weaken the body’s defenses, making the mucosal lining more susceptible to inflammation and infection. […] There are also genetic factors at play. Certain individuals may have a genetic predisposition that makes them more vulnerable to developing mucositis when exposed to the triggering factors, such as cancer treatments and lifestyle choices.

• #78 Stomatitis (Oral Mucositis): Types, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/stomatitis-oral-mucositis

  Treatments: Oral mucositis is a common cancer treatment side effect. Treatments like chemotherapy and radiation therapy kill cancer cells, but they can damage healthy cells in the process. The cells in the mucous membranes lining your mouth are particularly vulnerable. […] Medications: Certain types of medications associated with oral mucositis include beta-blockers, immunosuppressants and nonsteroidal anti-inflammatory drugs (NSAIDs). […] Systemic conditions: Conditions that impact entire body systems can cause stomatitis. These include inflammatory diseases, like Behçet’s disease and celiac disease. Skin conditions, like Bullous pemphigoid and lichen planus, can also cause stomatitis. […] Nutritional deficiencies: Not getting enough of the nutrients your body needs to repair damaged mucosa in your mouth can lead to stomatitis. This includes deficiencies in folate, iron, vitamins B12 and C, and zinc.

• #79 Mucositis – Oral Cancer Foundation | Information and Resources about Oral Head and Neck Cancer

  https://oralcancerfoundation.org/complications/mucositis/

  The use of methotrexate for chronic GVHD prophylaxis may exacerbate lesions of oral mucositis, although this is less of a concern with newer prophylaxis regimens. […] Mucositis is further complicated by the nausea and vomiting that often occur with treatment. […] Chemotherapy and radiation therapy can affect the ability of cells to reproduce, slowing healing of the oral mucosa, often extending the duration of present mucositis. […] Patients with oral mucositis and neutropenia (a type of white blood cell deficiency) have a relative risk of septicemia (a systemic, toxic illness caused by the invasion of the bloodstream by virulent bacteria coming from a local infection) more than 4 times that of patients with neutropenia only. […] In March 2007, the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology announced their latest guidelines for preventing mucositis.

• #80 Managing Oral Mucositis: Symptoms, Causes, and Treatments – Clove Dental

  https://clovedental.in/blog/general-dentistry/oral-mucositis-symptoms-causes-treatment

  Oral mucositis is a very common, usually painful condition that generally affects the mucous membranes lining the oral cavity. Usually, this condition relates to various cancer treatments, especially chemotherapy and radiation therapy. […] Among the popular treatments of cancers, chemotherapy and radiation therapy kill not only the rapidly dividing tumor cells but also the rapidly dividing cells of oral mucosa, leading to mucositis. […] Those patients undergoing treatment from stem cell transplant also show oral mucositis due to the side effects of the treatment process. […] There are some drugs, such as certain antibiotics and also NSAIDs, which can also be a contributing factor for the development of mucositis.

• #81 Mucositis – Oral Cancer Foundation | Information and Resources about Oral Head and Neck Cancer

  https://oralcancerfoundation.org/complications/mucositis/

  The use of methotrexate for chronic GVHD prophylaxis may exacerbate lesions of oral mucositis, although this is less of a concern with newer prophylaxis regimens. […] Mucositis is further complicated by the nausea and vomiting that often occur with treatment. […] Chemotherapy and radiation therapy can affect the ability of cells to reproduce, slowing healing of the oral mucosa, often extending the duration of present mucositis. […] Patients with oral mucositis and neutropenia (a type of white blood cell deficiency) have a relative risk of septicemia (a systemic, toxic illness caused by the invasion of the bloodstream by virulent bacteria coming from a local infection) more than 4 times that of patients with neutropenia only. […] In March 2007, the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology announced their latest guidelines for preventing mucositis.

• #82 Oral and intestinal mucositis – causes and possible treatments – PubMed

  https://pubmed.ncbi.nlm.nih.gov/14616150/

  Poor oral health and existing epithelial damage predispose patients to mucositis. The elimination of dental problems or the minimization of existing damage to the alimentary tract, prior to the commencement of therapy, lowers their susceptibility. Measures that reduce the flora of the tract, before therapy, can also be helpful. Increased production of free radicals and the induction of inflammation are early events in the onset of mucositis. Prophylactic administration of scavengers or anti-inflammatories can partially counteract or limit some of these therapy-mediated effects, as can the use of cryotherapy. The regular use of mouthwashes, mouth coatings, antibiotics and analgesics is essential, prior to and during loss and ablation of the epithelial layer. Granulocyte-macrophage colony-stimulating factor/granulocyte colony-stimulating factor or the use of laser light therapy may aid restitution and repair. Glutamine supplements may be beneficial in the repair/recovery phase.

• #83 Mucositis | Quirónsalud

  https://www.quironsalud.com/en/enfermedades-sintomas/mucositis

  Mucositis is the inflammation and irritation of the mucosal surface of the digestive tract. […] 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 oncolgicos, ya que puede originarse por otros motivos: Protein deficiency in the diet. Poor oral hygiene. Smoking. Infections affecting the mouth.

• #84 Mucositis explained | Blood Cancer UK

  https://bloodcancer.org.uk/understanding-blood-cancer/treatment/side-effects/mucositis/mucositis-explained/

  Mucositis is a condition which affects the gastrointestinal tract in your digestive system. The gastrointestinal, or GI, tract is a long tube that runs from your mouth to your anus. It includes your mouth, oesophagus (food pipe), stomach and bowels. […] Mucositis causes the lining of your GI tract to become thin, making it sore and causing ulcers. This can happen after chemotherapy or radiotherapy. […] Cancer treatments target cells that multiply quickly. This includes cancer cells, but also fast-growing healthy cells such as hair cells, skin cells and the cells in your GI tract. Thats why having chemotherapy or radiotherapy can make your hair fall out, increase your risk of sunburn and cause mouth or gut problems. […] Mucositis happens when cancer treatments kill healthy cells in the GI tract. The lining of the GI tract gets thinner and becomes inflamed (sore and swollen).

• #85 Mucositis – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/mucositis/

  Mucositis is an inflammatory-like process of the oral mucosa due to radiation in head-neck oncology patients or chemotherapy. […] Mucositis is considered to be an inevitable but transient side effect of anti-neoplastic therapies. […] Mucositis is basically a tissue reaction to the trauma of radiation or chemotherapy. Total dose, radiation portals, fractionation schedule, and type of ionising radiation as well as dose and type of chemotherapy agents affect the occurrence and severity of mucositis. […] The pathogenesis of mucositis, being similar but not identical in both chemotherapy and radiation, is not fully understood. […] The hypothesis proposed for the development of radiation- and chemotherapy-induced mucositis consider four consecutive phases: (1) inflammatory/vascular phase (free radicals and cytokines are released); (2) epithelial phase (reduced epithelial renewal-atrophy); (3) ulcerative/bacterial phase (colonisation by mixed flora, causing release of endotoxins, with further tissue damage by stimulation of cytokines). An interplay between the radiation- or chemotherapy-induced epithelial ulceration and bacterial flora is implied in this phase; (4) healing phase.

• #86 Mucositis – Wikipedia

  https://en.wikipedia.org/wiki/Mucositis

  The pathophysiology of mucositis is complex and multifactorial. Currently, Sonis’ five phase model is the accepted explanation for the process. […] The 5 stages are: Initiation phase, Primary damage response, Signal amplification, Ulceration, Healing. […] Therefore, oral mucositis can be a dose-limiting condition, disrupting a patients optimal cancer treatment plan and consequentially decreasing their chances of survival.

• #87 Chemotherapy induced oral mucositis: prevention is possible – Cidon – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/17197/html

  It has also been described a loss of epithelial growth factors (keratinocyte growth factor), leading to apoptosis of fibroblasts and vascular endothelial cells which results in submucosal injury. […] OM is dependent on the kind of tumor, patient age (more frequent in young), grade of oral hygiene and health, nutritional status, renal and hepatic functions, CM agent (antimetabolites such as 5-fluorouracil (5-FU) or purine analogs as cytarabine) or combination CM, concurrent administration with RT in head and neck tumors etc. […] It is well known that drugs such as methotrexate and etoposide are secreted in saliva, which increases the chances of OM. […] Although there are several treatments to alleviate the pain and improve patients nutrition, the ideal aim would be prevention. So far, no definite measure has shown to be able to prevent it effectively and recurrent episodes of OM, will double the likelihood of DR and unplanned treatment breaks.

• #88 Chemotherapy induced oral mucositis: prevention is possible – Cidon – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/17197/html

  Our study showed a very low CM DR rate (5.8%) after this mouthwash was used which is relevant as these patients were receiving neoadjuvant or adjuvant chemotherapies, no palliative treatments. […] Several strategies have been used to try prevention but especially to treat this complication. Unfortunately, the available results are heterogeneous and inconclusive. […] Worthington et al., in their review have concluded that only some interventions (cryotherapy, G-CSF, iv glutamine, honey, KGF, sucralfate among others) offer some benefit in terms of prevention. The most relevant ones are cryotherapy, palifermin and sucralfate as those showed statistically significant benefit in preventing or reducing the severity of OM.

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