Mucositis

Mucositis means inflammation and injury of the mucous membranes. Mucous membranes are the soft, moist linings inside the mouth, throat, esophagus (food pipe), stomach, intestines, and some other body openings. When these linings are inflamed, they become red (erythematous), sore, and may develop ulcers (open sores).
Most people use the word for oral mucositis (inside the mouth and throat), especially during cancer treatment (chemotherapy or radiation). But mucositis can also happen in the esophagus and gut.

Mucositis means inflammation and ulceration of the lining (“mucosa”) of your mouth, throat, and/or gut. It happens because cancer treatments (like chemo, radiation, some targeted drugs, and transplant conditioning) injure fast-dividing lining cells. That damage triggers a chain reaction: early injury → inflammatory signals ramp up → the response amplifies → painful open sores form → then healing. This “five-phase” model explains why pain and sores can appear days after treatment starts and why good oral care and anti-inflammatory measures help. PubMed+2PubMed+2

Most often in the mouth (oral mucositis) during head-and-neck radiotherapy or chemo, and after high-dose transplant regimens; it also occurs in the esophagus/intestines (GI mucositis). Severity can interrupt cancer therapy and nutrition, so prevention and early treatment really matter. BioMed Central

Why does mucositis happen?

• The mucous membrane is made of fast-growing cells. Chemotherapy, radiation, strong infections, or irritants can damage these fast-growing cells.

• Damage triggers inflammation (the body’s alarm system). Inflammation releases signals (like cytokines), which make the area red, swollen, and painful.

• The natural barrier breaks down. Tiny ulcers (open wounds) appear. Germs can enter these breaks more easily and cause secondary infection.

• Pain makes eating and drinking difficult, which can lead to weight loss, dehydration, and delays in treatment if severe.

Who gets mucositis more often?

• People on chemotherapy (especially drugs that strongly affect dividing cells).

• People receiving radiation to the head and neck or chest.

• Patients after stem-cell or bone-marrow transplant.

• Those with low white blood cell counts (neutropenia), poor oral hygiene, dry mouth (xerostomia), smoking, heavy alcohol use, dehydration, or malnutrition.

• People with ill-fitting dentures, braces, or sharp teeth that rub the lining.

• Anyone with viral, fungal, or bacterial infections of the mouth or throat.

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Types of mucositis

1. By location

   • Oral mucositis: lips, cheeks, tongue, floor of mouth, gums, soft palate, and throat (oropharynx).

   • Esophageal mucositis (esophagitis): inflammation in the food pipe; swallowing is painful.

   • Gastrointestinal (GI) mucositis: stomach and intestines; may cause cramps and diarrhea.

2. By cause

   • Chemotherapy-induced

   • Radiation-induced

   • Combined chemo-radiation–induced

   • Transplant-associated (conditioning therapy; may overlap with GVHD—graft-versus-host disease)

   • Infection-related (fungal, viral, bacterial)

   • Trauma/irritant-related (physical, thermal, chemical)

   • Autoimmune-related (immune system attacks mucosa)

   • Medication-related (non-chemo) (some targeted or immune drugs)

3. By severity (easy words)

   • Mild: redness, mild soreness, can eat solid food.

   • Moderate: painful sores, may need soft food or liquids.

   • Severe: large ulcers, severe pain, trouble swallowing saliva, often needs liquid nutrition, strong pain control, or hospital care.

   • Doctors often grade severity using WHO / NCI-CTCAE / OMAS scales (explained below in the “diagnostic tests” section).

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Causes of mucositis

1. Chemotherapy (many types)
   Chemo targets fast-growing cells. The mucosa grows fast, so it gets injured. Drugs like methotrexate, 5-fluorouracil, doxorubicin, cytarabine, melphalan, platinum agents are common triggers.

2. Radiation therapy to head, neck, chest, or total body
   Radiation damages DNA in mucosal cells. The effect builds over weeks, causing dry mouth and ulcers.

3. Combined chemo + radiation
   The two treatments add up, so mucositis risk and severity increase.

4. Stem-cell / bone-marrow transplant conditioning
   High-dose chemo ± radiation before transplant strips the lining cells, causing diffuse mouth and gut sores.

5. Graft-versus-host disease (GVHD) after transplant
   The donor immune system attacks the patient’s mucosa. It looks like mucositis and may come with skin rash and liver changes.

6. Targeted therapies (e.g., mTOR inhibitors, EGFR inhibitors, VEGF inhibitors)
   These newer drugs can disturb cell repair and mucosal healing, causing sore mouth and changes in taste.

7. Immune checkpoint inhibitors (e.g., PD-1, PD-L1, CTLA-4 blockers)
   They boost immunity and sometimes cause autoimmune-like inflammation of mucosa, leading to ulcers.

8. Fungal infection (Candida—thrush)
   White curd-like plaques that can be wiped away, leaving a red, sore base. Often appears when immunity is low or after antibiotics.

9. Viral infection (HSV, VZV, CMV, Coxsackie)
   Cold sore virus (HSV) can cause painful clusters of ulcers. Hand-foot-mouth disease (Coxsackie) causes oral sores in children.

10. Bacterial infection
    Less common as a primary cause, but secondary infection of damaged mucosa can worsen redness, pain, and pus.

11. Mechanical trauma
    Ill-fitting dentures, braces, sharp teeth, or lip/cheek biting rub and tear the lining, making open sores.

12. Thermal and chemical burns
    Very hot food/drinks, spicy acids, strong mouthwashes, or caustic chemicals can burn the mucosa.

13. Dry mouth (xerostomia)
    Low saliva reduces natural protection. Saliva helps wash germs, buffer acids, and heal tissues.

14. Poor oral hygiene and heavy plaque
    Plaque holds bacteria and irritants close to the mucosa, which fuels inflammation.

15. Smoking and alcohol
    Tobacco and alcohol directly irritate the lining and slow healing.

16. Nutritional problems
    Protein-calorie malnutrition or low vitamins/minerals (especially B12, folate, iron, zinc) weaken repair and immunity.

17. Autoimmune diseases
    Oral lichen planus, pemphigus vulgaris, pemphigoid, Behçet’s disease, SLE can inflame the mucosa and form ulcers.

18. Gastroesophageal reflux (GERD) and pill esophagitis
    Stomach acid or pills stuck in the esophagus can burn the mucosa, causing esophagitis (a type of mucositis).

19. Antibiotic-associated changes
    Broad antibiotics can disrupt normal flora, letting Candida overgrow and cause sore mucosa.

20. Dental procedures or surgery trauma
    Extractions, rough impressions, or sharp sutures can injure mucosa; usually short-lived, but painful.

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Common symptoms and signs

1. Mouth pain (stomatodynia)
   Aching, burning, or sharp pain that worsens with speaking, eating, or brushing.

2. Redness (erythema)
   The lining looks bright red or beefy due to increased blood flow from inflammation.

3. Ulcers (open sores)
   Shallow or deep craters with yellow-white coating and red edges; very tender.

4. Swelling (edema)
   The tissue looks puffy; lips or cheeks may feel thick.

5. Bleeding
   The surface is fragile and may bleed with light touch or brushing.

6. Painful swallowing (odynophagia)
   Pain travels down the throat or chest during swallowing.

7. Trouble swallowing (dysphagia)
   Feeling of sticking or delay when moving food or liquids.

8. Dry mouth (xerostomia)
   Sticky or cotton-mouth feeling, thick saliva, or stringy secretions.

9. Taste changes (dysgeusia)
   Food tastes metallic, bland, or bitter; sometimes loss of taste.

10. Bad breath (halitosis)
    Caused by bacteria and dead cells on ulcer surfaces.

11. Cracking at the corners (angular cheilitis)
    Red splits at the mouth corners; often Candida plus moisture irritation.

12. Speech difficulty
    Pain and swelling make clear speech hard; tongue and lips move less freely.

13. Drooling or avoiding saliva swallowing
    Saliva stings when swallowed; some people spit to avoid pain.

14. Poor appetite and weight loss
    Eating hurts, so people eat less, risking weight loss and weakness.

15. Fever or signs of infection
    Fever, pus, or worsening pain may mean secondary infection in ulcers.

16. Malnutrition and dehydration from not eating or drinking.

17. Infections, especially when white blood cells are low.

18. Hospital stays, IV fluids, or feeding tubes may be needed in severe cases.

19. Cancer treatment delays or dose cuts, which can affect treatment success.

20. Lower quality of life due to constant pain and poor sleep.

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Diagnostic tests/ How doctors evaluate mucositis

1. Listen to your story: timing with chemo/radiation, new medicines, diet, dental devices, smoking/alcohol, and hygiene.

2. Look carefully: full oral exam with a light and tongue depressor; check throat if safe.

3. Check severity: use a grading scale to track progress.

4. Search for triggers: infection, trauma, reflux, autoimmune disease, or medication side effects.

5. Order tests only when needed: to rule out infection, assess nutrition, or exclude mimics (like oral cancer, GVHD, or autoimmune blistering diseases).

A) Physical examination–based assessments

1. Direct oral and throat inspection
   The clinician uses light, tongue depressor, and gloves to see redness, ulcers, white plaques, bleeding points, and saliva quality. This basic exam often gives the main diagnosis.

2. Palpation (gentle pressing) of mucosa and neck
   Light touch checks tenderness, firmness, or fluctuance (possible pus). Neck palpation looks for swollen lymph nodes that suggest infection.

3. Vital signs and hydration check
   Temperature (fever), heart rate, blood pressure, dry tongue, sunken eyes, and low urine help judge infection and dehydration risk.

4. WHO / NCI-CTCAE grading
   Doctors assign a grade from mild to severe based on pain, ability to eat, and ulcer size/number. This grade guides treatment and tracks healing.

5. OMAS (Oral Mucositis Assessment Scale)
   A structured scoring of redness and ulcers in nine mouth sites. Gives a number to compare visits and measure response to care.

B) Manual bedside/clinic tests

6. Mouth opening measurement (inter-incisal distance)
   Using a ruler or calipers, the distance between upper and lower front teeth is measured. Small numbers suggest trismus (tight jaw) from pain or muscle spasm.

7. 3-ounce water swallow screen (simple swallow test)
   The patient drinks water while the clinician watches for coughing, throat clearing, or wet voice. This quickly checks for swallow safety.

8. Pain scoring (VAS/NRS)
   You rate pain from 0 to 10. This simple score helps plan pain control and follow progress.

9. Unstimulated and stimulated salivary flow (sialometry)
   You spit into a collection cup for 5 minutes (resting) and again while chewing paraffin (stimulated). Low flow suggests dry mouth that worsens mucositis.

10. Oral moisture or pH check
    A handheld meter or simple pH paper can show dryness and acidic environment, which slow healing.

C) Laboratory and pathological tests

11. Complete blood count (CBC) with differential
    Looks at white cells, neutrophils, hemoglobin, and platelets. Neutropenia (low infection-fighting cells) increases infection risk in mucositis.

12. Inflammation markers (CRP, ESR)
    Higher numbers suggest active inflammation or infection needing attention.

13. Bacterial culture and Gram stain (oral/throat swab or ulcer swab)
    Finds harmful bacteria and guides antibiotic choice if infection is suspected.

14. Fungal tests (KOH prep, fungal culture for Candida)
    Detects thrush (Candida). Shows yeast forms under the microscope or grows the fungus in the lab.

15. Viral testing (PCR/culture for HSV, VZV, CMV, Coxsackie when indicated)
    Confirms viral causes of painful clusters of ulcers or widespread sores, especially in immunocompromised patients.

16. Biopsy or cytology of unusual lesions
    A small tissue sample rules out oral cancer, autoimmune blistering disease, GVHD, or deep fungal infection when the picture is atypical or not healing.

D) Electrodiagnostic / electrical-based assessments (rarely needed)

These are not routine for mucositis. They may be used in research or special cases to document function changes.

17. Electrogustometry (taste threshold testing)
    A tiny, safe electrical stimulus is applied to the tongue to measure the lowest current you can taste. Helps track taste loss from mucosal injury.

18. Surface EMG of chewing muscles (masseter/temporalis) during opening/chewing
    Electrodes on the skin record muscle activity. Can document muscle guarding or trismus-related changes when mouth pain is severe.

E) Imaging and visualization tests

19. Upper endoscopy (EGD) for esophageal/gastric mucositis
    A flexible camera looks directly at the esophagus and stomach to see redness, erosions, and ulcers when swallowing pain is severe or bleeding is suspected.

20. Videofluoroscopic swallow study (VFSS) or barium swallow
    Real-time X-ray while you swallow contrast shows movement problems, aspiration risk, and helps plan safe diets.

Non-pharmacological treatments

1. Professional pre-treatment dental visit and cleaning.
   Purpose: lower infection risk and mucosal trauma during therapy.
   Mechanism: removes plaque, fixes sharp teeth/dentures, optimizes oral hygiene before radiation/chemo. Nature

2. Daily basic oral-care protocol (all patients).
   Purpose: prevent/worsen fewer sores.
   Mechanism: soft-bristle brushing, gentle flossing as platelets allow, frequent bland rinses; reduces plaque/inflammation. MASCC endorses this broadly. mascc.memberclicks.net

3. Bland rinses (salt/sodium bicarbonate in water) 5–6×/day.
   Purpose: cleanses, buffers acids, keeps tissues moist.
   Mechanism: bicarbonate/saline reduce irritants and maintain neutral pH. Mount Sinai Health System

4. Avoid alcohol-containing and strong-flavor mouthwashes.
   Purpose: reduce stinging and dryness.
   Mechanism: alcohol and strong flavoring irritate inflamed mucosa. oralcancerfoundation.org

5. Photobiomodulation (PBM; “low-level laser”) when available.
   Purpose: prevent severe mucositis in high-risk settings (HSCT; head-and-neck RT or chemoradiation).
   Mechanism: light at specific parameters modulates inflammation and promotes healing. MASCC/ISOO recommends intraoral PBM for prevention in these settings. PMC

6. Oral cryotherapy (ice chips) during certain infusions.
   Purpose: prevent mucositis with short-half-life drugs (e.g., bolus 5-FU; high-dose melphalan).
   Mechanism: cold reduces blood flow and drug exposure to oral mucosa during infusion; 30 minutes is typical. (Avoid with oxaliplatin due to cold sensitivity.) ACS Publicationsonf.ons.org

7. Natural honey (medical-grade where possible) in head-and-neck RT/CRT.
   Purpose: possibly reduce severity and help healing; may also aid nutrition/weight maintenance.
   Mechanism: antimicrobial, anti-inflammatory, and barrier effects; evidence supports a suggestion for prevention. The ASCO Post

8. Hydration and room humidification.
   Purpose: reduce dryness and friction that aggravate sores.
   Mechanism: moisture protects mucosal surfaces and improves comfort. Cancer.gov

9. Nutrition support & early dietitian involvement.
   Purpose: maintain calories/protein to heal and to stay on-treatment.
   Mechanism: soft, high-protein, non-acidic foods and supplements; weight/PO intake monitoring. PMC

10. Speech/swallow therapy (H&N patients).
    Purpose: preserve swallowing function, reduce aspiration risk, and keep nutrition up.
    Mechanism: targeted exercises and safe-swallow strategies. (Supported as part of multidisciplinary care.) Nature

11. Saliva support (sips of water, sugar-free gum, saliva substitutes).
    Purpose: relieve dryness/xerostomia that worsens mucosal injury.
    Mechanism: lubrication decreases friction and pain. Cancer.gov

12. Gentle lip care.
    Purpose: prevent fissures/cracks that seed infection and worsen pain.
    Mechanism: regular, non-irritating moisturizers protect the vermilion border. oralcancerfoundation.org

13. Cool/soft foods and temperature control.
    Purpose: reduce pain with eating.
    Mechanism: room-temp or chilled foods (not hot) limit thermal irritation. Mayo Clinic

14. Avoid irritants (spicy, acidic, sharp, very hot foods; alcohol/tobacco).
    Purpose: limit direct chemical/thermal trauma.
    Mechanism: fewer triggers → less inflammation and pain. Cancer.govAmerican Cancer Society

15. Regular “rinse, rest, protect” routine before meals.
    Purpose: make eating possible.
    Mechanism: bland rinse → optional anesthetic (see drugs) → coat with a barrier gel/device → eat.

16. Bioadherent barrier gels/films (medical devices).
    Purpose: short-term pain relief by forming a protective coating.
    Mechanism: physical barrier reduces exposure of nerve endings; evidence is mixed but commonly used as adjuncts. MASCC

17. Careful plaque control; targeted antiseptic only when needed.
    Purpose: decrease secondary infection while avoiding irritants.
    Mechanism: CHX is not for prevention of RT-induced mucositis, but may be considered if plaque/infection risk is high. PMCSpringerLink

18. Pain-coping skills & sleep hygiene.
    Purpose: improve tolerance of symptoms and nutrition.
    Mechanism: behavioral strategies lessen distress and help adherence to mouth-care routines.

19. Early escalation to nutritional support (NG/PEG) when needed.
    Purpose: maintain treatment intensity and prevent weight loss/dehydration.
    Mechanism: temporary alternate feeding route during peak mucositis. PMC

20. Close follow-up during high-risk weeks.
    Purpose: catch infection, dehydration, or severe pain early.
    Mechanism: scheduled reviews with oncology/dental teams lower complication risk. Nature

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Drug treatments

Doses here are typical study/label ranges—always individualize with the treating team.

1. Benzydamine mouthwash (topical anti-inflammatory).
   Dose/time: 0.15% rinse, 15 mL swish 30–60 sec, spit, 3–8×/day during head-and-neck radiotherapy; start day 1 and continue through RT.
   Purpose: prevent and reduce severity of oral mucositis with H&N RT (esp. moderate dose) and during CRT.
   Mechanism: local NSAID-like & analgesic actions (TNF-α/IL-1β/prostaglandins).
   Side effects: taste change, numbness, mild stinging. PMC+1

2. Doxepin mouthwash (topical anesthetic/analgesic).
   Dose/time: 25 mg/5 mL solution; typically 5–10 mL swish for 1 min then spit; repeat up to q3–4h, especially before meals.
   Purpose: treat pain from mucositis during RT/CRT.
   Mechanism: tricyclic with local anesthetic/antipruritic effects on mucosal nerves.
   Side effects: drowsiness, burning taste, numbness, rare dizziness. Proven in randomized trials. PMC

3. Viscous lidocaine 2% (topical anesthetic).
   Dose/time: 5–10 mL swish/spit (or carefully swallow for pharyngeal pain) before meals, up to every 3–4 h.
   Purpose: short-term analgesia to enable eating/oral care.
   Mechanism: sodium-channel blockade decreases nociception.
   Side effects: numb tongue/throat, risk of aspiration if swallowed; avoid overuse. NCBI

4. Morphine mouthwash (topical opioid).
   Dose/time: commonly 0.2% solution, 10–15 mL swish & spit q3–4h PRN.
   Purpose: treat mucositis pain when topical anesthetics aren’t enough.
   Mechanism: local μ-opioid receptor action reduces mucosal pain without systemic dose.
   Side effects: bitter taste, mild local numbness; minimal systemic effects if spit. ACS Publicationsonf.ons.org

5. Systemic opioids (e.g., oral morphine/oxycodone; PCA in HSCT).
   Dose/time: individualized (e.g., morphine IR 5–10 mg PO q4h PRN) or PCA for severe pain.
   Purpose: allow nutrition and uninterrupted cancer therapy.
   Mechanism: central μ-opioid analgesia.
   Side effects: constipation, nausea, sedation; monitor closely. (PCA for mucositis pain is guideline-supported in HSCT.) mascc.memberclicks.net

6. Palifermin (IV keratinocyte growth factor-1).
   Dose/time (label): 60 mcg/kg/day IV bolus for 3 days before and 3 days after myelotoxic therapy requiring HSCT support (first post-treatment dose on the day of stem-cell infusion, per label).
   Purpose: prevent severe mucositis in hematologic malignancies undergoing HSCT conditioning.
   Mechanism: stimulates epithelial growth and repair.
   Side effects: tongue/oral changes (thickening/tingling), rash, taste alteration. (Not established for non-hematologic cancers.) FDA Access Data+1

7. Dexamethasone mouthwash (0.5 mg/5 mL) with mTOR inhibitors.
   Dose/time: 10 mL (0.5 mg/5 mL) swish & spit QID during the first 8 weeks of everolimus therapy (then as needed).
   Purpose: prevent and lessen mTOR-inhibitor–associated stomatitis (common with everolimus).
   Mechanism: local anti-inflammatory/glucocorticoid effect.
   Side effects: oral candidiasis risk (rinse after use). Proven benefit in the SWISH study. PubMedThe ASCO Post

8. Antifungals for secondary thrush (e.g., nystatin, fluconazole).
   Dose/time: nystatin 100,000 U/mL, 4–6 mL swish & swallow QID; or fluconazole per protocol if severe.
   Purpose: treat Candida overgrowth that worsens pain/healing.
   Mechanism: ergosterol pathway inhibition.
   Side effects: nystatin—nausea; fluconazole—drug interactions/QT issues; use only when infection is present. NCBI

9. Antivirals for suspected HSV reactivation (e.g., acyclovir/valacyclovir).
   Dose/time: acyclovir 400 mg PO TID ×7–10 days (typical); adjust for renal function.
   Purpose: treat herpetic ulcers mimicking/worsening mucositis in immunosuppressed patients.
   Mechanism: viral DNA polymerase inhibition.
   Side effects: GI upset, renal dose adjustment. NCBI

10. Gabapentin as an analgesic adjunct (select cases).
    Dose/time: often titrated 300 mg TID up to 3,600 mg/day if tolerated.
    Purpose: co-analgesic for severe mucositis pain (especially H&N RT).
    Mechanism: α2δ calcium-channel modulation reduces neuropathic components.
    Side effects: sedation, dizziness; evidence is mixed (some trials negative for symptom improvement, while observational work suggests opioid-sparing at higher doses). PubMedscholarlycommons.henryford.comJAMA Network

Not recommended for prevention: sucralfate mouthwash; chlorhexidine for RT mucositis prevention; “magic mouthwash” lacks strong evidence vs. proven options. ACS PublicationsPMCOncology Nursing Society

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Dietary & supportive supplements

(Evidence strength varies; check interactions with your oncology team. MASCC suggests honey for H&N RT/CRT and, with caution, oral glutamine for RT-chemo in H&N. Others below have emerging or mixed evidence.) The ASCO PostACS Publications+1

1. Oral L-glutamine — 10 g powder in water, 2–3×/day during CRT.
   Function: may lessen severity/duration.
   Mechanism: fuel for enterocytes; supports mucosal repair. (Guideline suggestion with caution in H&N RT-chemo.) ACS Publications

2. Natural honey (apply then swallow) — 1 teaspoon 3–6×/day, esp. before/after RT sessions.
   Function: reduce ulcer severity, support weight maintenance.
   Mechanism: antimicrobial/osmotic barrier + anti-inflammatory polyphenols. The ASCO Post

3. Zinc sulfate — 50 mg elemental zinc daily (e.g., 220 mg zinc sulfate ≈ 50 mg elemental) during RT.
   Function: may reduce severity; results inconsistent.
   Mechanism: antioxidant cofactor; supports epithelial repair. PubMedjmatonline.com

4. Vitamin D (repletion to sufficiency) — dose per labs (often 1,000–2,000 IU/day if low).
   Function: immune modulation, epithelial health.
   Mechanism: VDR-mediated effects on mucosal immunity/barrier.

5. Vitamin E (alpha-tocopherol) — 200–400 IU/day short term.
   Function: antioxidant support; mixed data.
   Mechanism: membrane lipid protection from ROS.

6. Omega-3 (EPA/DHA) — 1–2 g/day.
   Function: anti-inflammatory; may aid weight/tolerance.
   Mechanism: resolvins ↓ pro-inflammatory mediators.

7. Curcumin — up to 1–3 g/day or as oral rinse/gel in studies.
   Function: anti-inflammatory/antioxidant adjunct.
   Mechanism: NF-κB/TNF-α modulation.

8. Green tea (EGCG) rinse or beverage (non-hot).
   Function: soothing, antioxidant polyphenols.
   Mechanism: catechins with anti-inflammatory effects.

9. Propolis (bee resin) oral rinse/capsule — pilot data in chemo.
   Function: adjunct symptom relief.
   Mechanism: antimicrobial/anti-inflammatory. PMC

10. Probiotics (e.g., Lactobacillus blends) — product-specific CFU dosing.
    Function: microbiome support (more data for GI side effects); oral data limited.
    Mechanism: barrier/microbial ecology effects.

11. Lactoferrin — 250–300 mg 1–2×/day.
    Function: antimicrobial/immune-modulating.
    Mechanism: iron-binding glycoprotein, reduces pathogenic growth.

12. Selenium — 100–200 mcg/day.
    Function: antioxidant enzyme cofactor (GPx).
    Mechanism: ROS quenching; data limited.

13. Aloe vera (mouth rinse/gel)
    Function: soothing barrier; evidence mixed.
    Mechanism: mucopolysaccharides coat and hydrate.

14. Chamomile rinse/tea (cooled).
    Function: mild anti-inflammatory comfort.
    Mechanism: apigenin and related flavonoids.

15. Baking soda/salt “household” rinse — see #3 for recipe.
    Function: low-cost, effective home care.
    Mechanism: pH buffering, gentle cleansing. Mount Sinai Health System

Caution: high-dose antioxidant supplements during radiation can theoretically blunt tumor-killing ROS; coordinate any supplement plan with oncology.

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Regenerative / immune-modulating / stem-cell–related” options

1. Palifermin (rHuKGF-1, IV) — standard for HSCT support regimens in hematologic malignancies; see dosing above. Strongest clinical evidence in this category. FDA Access Data

2. Topical recombinant human EGF (spray/rinse) — small RCTs/series suggest benefit in RT-induced mucositis, but not widely approved; consider only in trials/center protocols. PMCACS Publications

3. Avasopasem manganese (GC4419; SOD mimetic, IV) — phase 3 (ROMAN) showed reduced incidence/duration of severe mucositis in H&N RT; FDA did not approve in Aug 2023 (CRL). Consider investigational contexts only. PMCCancer Network

4. GM-CSF mouthwash — studied as local growth factor; MASCC suggests against routine use. mascc.memberclicks.net

5. TGF-β3 mouthwash — tested; ineffective vs placebo in trials. PMC

6. Other cytokine/growth-factor approaches (repifermin, etc.) — largely experimental/insufficient evidence; use only in clinical trials. Lippincott Journals

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Procedures/surgeries

1. Feeding-tube placement (NG or PEG).
   Why: maintain nutrition/hydration during severe mucositis so cancer treatment can continue. PMC

2. Central venous catheter (port/PICC) placement.
   Why: secure access for IV hydration, PCA opioids, parenteral nutrition if required.

3. Dental extractions or adjustments pre-RT.
   Why: remove sharp/infected teeth and optimize oral environment before mucosa is stressed. Nature

4. Biopsy/debridement of non-healing ulcers (select cases).
   Why: rule out infection, recurrence, or other pathology if sores persist beyond expected healing.

5. Tracheostomy or airway protection (rare).
   Why: very uncommon; reserved for severe airway compromise from combined therapy effects.

Most of these are supportive to get you through therapy safely; they are not “mucositis surgeries.”

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Ways to prevent mucositis

1. Pre-treatment dental assessment & cleaning; fix sharp dentures/restorations. Nature

2. Follow a daily oral-care protocol (soft brush, bland rinses). mascc.memberclicks.net

3. Use PBM (low-level laser) where offered for HSCT and H&N RT/CRT. PMC

4. Use cryotherapy with bolus 5-FU or high-dose melphalan. ACS Publications

5. Use benzydamine mouthwash during H&N RT/CRT (per guideline). PMC

6. If starting everolimus, use prophylactic dexamethasone mouthwash (first 8 weeks). PubMed

7. Avoid alcohol-mouthwashes; don’t smoke; limit alcohol. oralcancerfoundation.org

8. Prefer soft, non-acidic foods; keep well hydrated. Cancer.gov

9. Consider honey (H&N RT/CRT) as an adjunct if appropriate. The ASCO Post

10. Plan early nutrition support if weight loss or severe pain begins. PMC

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When to see a doctor urgently

• Fever ≥ 38.0 °C (100.4 °F) or chills (possible neutropenic infection).

• Inability to drink/eat or signs of dehydration (very dark urine, dizziness).

• Uncontrolled pain despite topicals/analgesics.

• Bleeding that won’t stop or numerous white patches (possible thrush).

• Ulcers not improving ~2 weeks after treatment ends, or new severe swelling.
  (Your team may need cultures, antivirals/antifungals, IV fluids, PCA, or feeding support.) Oncolink

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What to eat & what to avoid

Eat more of:

1. Soft proteins (eggs, yogurt, tofu, cottage cheese).

2. Tender fish/chicken, slow-cooked meats.

3. Smoothies, meal-replacement drinks (room temperature).

4. Cooked cereals, mashed potatoes, well-cooked pasta/rice.

5. Ripe bananas, canned peaches/pears (non-acidic).

6. Soups/blended vegetable soups (not hot/spicy).

7. Nut butters (if tolerated), hummus.

8. Custards/puddings/soft cheeses for calories.

9. Cold foods (popsicles, ice chips) to soothe.

10. Small, frequent meals; sip fluids throughout the day. Cancer.gov+1

Avoid (while sore):
– Spicy, acidic, salty, sharp/rough, very hot foods; alcohol and tobacco; carbonated/caffeinated drinks if they sting. Cancer.govAmerican Cancer Society

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FAQs

1) Is mucositis contagious?
No. It’s a treatment side effect, not an infection—though infections can complicate it. PMC

2) How long does it last?
Oral mucositis usually appears within 1–3 weeks of starting RT (earlier with some chemo) and heals over 2–4 weeks after therapy ends, assuming no infection and nutrition is maintained. NCBI

3) Can I brush and floss?
Yes—gently, with a soft brush and bland rinses. Pause flossing if platelets are very low to avoid bleeding. mascc.memberclicks.net

4) What’s the single best prevention?
There isn’t one; bundle care: oral-care protocol for everyone, plus setting-specific measures (PBM; cryotherapy for bolus 5-FU/melphalan; benzydamine in H&N RT; dexamethasone rinse with everolimus). PMC+1ACS PublicationsPubMed

5) Does “magic mouthwash” work?
Evidence is weak; better-supported options include doxepin and morphine mouthwashes for pain control. PMCACS Publications

6) Is chlorhexidine good for prevention?
Not for preventing RT-induced mucositis; it can be used selectively for plaque/infection control if your team recommends it. PMCSpringerLink

7) Is palifermin for everyone?
No—its approved role is to prevent severe mucositis in hematologic malignancy patients receiving myelotoxic therapy with HSCT support. FDA Access Data

8) Will PBM/laser “stimulate” cancer?
Guidelines recommend intraoral PBM for prevention in specific settings; centers follow validated parameters and safety considerations. Discuss with your oncologist/dentist. PMC

9) Can honey really help?
For head-and-neck RT/CRT, honey (applied then swallowed) has enough evidence for a guideline suggestion to reduce mucositis severity. Monitor sugars if diabetic. The ASCO Post

10) Should I use glutamine?
Oral glutamine has a cautious suggestion in H&N RT-chemo; intravenous glutamine is not recommended for HSCT prevention. Always coordinate with your team. ACS Publicationsmascc.memberclicks.net

11) What about zinc?
Studies are mixed; some show benefit, others do not. If used, keep to safe daily elemental zinc limits and avoid long-term excess. PubMedjmatonline.com

12) Is gabapentin useful?
Data are mixed; a phase 3 trial was negative for symptom improvement, while some real-world data suggest opioid-sparing at higher doses. It can help selected patients. PubMedJAMA Network

13) Do I need antifungals/antivirals “just in case”?
No—only when infection is suspected or confirmed (thrush; HSV), because unnecessary antimicrobials can cause issues. NCBI

14) Which foods are least painful?
Soft, cool, non-acidic, high-protein options (e.g., smoothies, yogurt, eggs, tender fish/poultry). Avoid spicy/acidic/hard/hot foods while sore. Cancer.govAmerican Cancer Society

15) When should I pause or adjust cancer treatment?
Your oncology team decides based on severity/complications (e.g., dehydration, weight loss, infection). Early reporting of pain and PO intake problems helps avoid interruptions. BioMed Central

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The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 13, 2025.

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