Management of oral mucositis
For management of oral mucositis in patients receiving palliative care, see here.
For management of oral mucositis in children, seek expert advice.
Manage oral mucositis in conjunction with a multidisciplinary team, which includes addressing the cause, symptomatic relief, oral care regimens and nutritional advice.
Initial and regular ongoing assessment of oral pain is essential. Lubricants and analgesic mouth solutions may reduce pain and inflammation. Artificial salivary products can be applied as necessary for transient relief of oral dryness. If a topical analgesic is needed, use:
1 benzydamine hydrochloride 0.15% solution 15 mL, rinsed in the mouth for 30 seconds then spat out, 1.5- to 3-hourly as necessary (use diluted with 15 mL of water if stinging occurs) mucositis benzydamine
OR
2 lidocaine 2% viscous solution, use the lowest dose necessary up to 15 mL, rinsed in the mouth for 30 seconds then spat out, 3-hourly as necessary; maximum 8 doses in 24 hours. mucositis lidocaine
If pain is not adequately managed with topical measures, systemic analgesics may be required—seek advice from the patient’s multidisciplinary team.
Establish preventive oral care regimens, and regularly assess the oral cavity. Patients with profound mucositis have difficulty performing oral hygiene measures effectively, though this should be encouraged nevertheless. Chlorhexidine limits exposure to water-borne pathogens, and can be used when pain and discomfort restrict oral hygiene practices; use:
chlorhexidine 0.2% mouthwash alcohol-free, 10 mL rinsed in the mouth for 1 minute then spat out, 8- to 12-hourly (use diluted with 10 mL of water if stinging occurs)1 . mucositis chlorhexidine
Chlorhexidine gel is an alternative oral hygiene adjunct to mouthwash, and may provide some lubrication and ease discomfort; use:
chlorhexidine 0.5% gel alcohol-free, apply 2 to 3 times daily to all mucosal surfaces and gingival margins1 . chlorhexidine
Nutritional support for patients with mucositis is important. Encourage patients to avoid irritant foods (eg acidic, spicy, salty, dry or abrasive foods). Refer patients for specialist nutritional advice if mucositis is severe.