Primary prevention

A variety of preventive strategies for oral mucositis (OM) have been validated and recommended.[22] Their use should be tailored to the cancer treatment regimen for each individual. For patients receiving bolus doses of chemotherapy drugs with a short half-life, such as fluorouracil and melphalan, the use of ice chips and/or ice-cold water as 'cryotherapy' can reduce the severity of OM.[23] This effect is thought to be mediated by a reduced delivery of the drug to the oral mucosa secondary to local vasoconstriction. Ice chips/iced water should be placed in the mouth, beginning 5 minutes before giving chemotherapy and replenished as needed for up to 30 minutes.[24][25]

Palifermin (recombinant keratinocyte growth factor) may be used to decrease the incidence and duration of severe OM in patients with haemotological malignancies receiving high-dose chemotherapy and total body irradiation followed by autologous stem cell transplantation (SCT).[24]​ If indicated, palifermin is administered intravenously for 3 consecutive days before and 3 consecutive days after chemoradiation. Palifermin may not be available in some countries.

Maintenance of good oral hygiene can reduce the severity of OM in patients receiving chemotherapy.[26]​ Appropriate dental care before the onset of treatment, and the use of oral care protocols during treatment, may be useful preventive strategies.[24]​​[27]​​​​ Oral care should include the use of a soft toothbrush that is replaced regularly.

In patients with metal dental restorations, the use of devices such as a dental guard, cotton roll, or wax to separate the metal from the mucosa can prevent adjacent mucositis due to radiation backscatter.[28]​​

Patients receiving high-dose chemotherapy or chemoradiation before haematopoietic SCT, and patients receiving head and neck radiotherapy without concomitant chemotherapy, may benefit from low-level laser therapy to reduce the severity of OM.​[22][24][29]​​ The mechanism of action is not well understood, but is thought to be via promotion of healing and anti-inflammatory effects.[30][31]​The Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology recommends following specific photobiomodulation protocols for optimal response.[22] 

An anti-inflammatory mouthwash may help reduce mucositis severity in patients receiving head and neck radiotherapy with or without concomitant chemotherapy.[22][32]​​​ 

All patients at risk of OM require a baseline oral and dental assessment.[33]

Secondary prevention

Secondary prevention strategies for OM are similar to those for primary prevention. These include:[22]​​[24][27]​​​

  • Maintaining daily oral care

  • Avoiding trauma to oral tissues (e.g., from sharp or hard foods, removable dentures, firm toothbrushes)

  • Continuing pain control and preventive measures as appropriate throughout the duration of treatment.

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