Patients may be asymptomatic, or they may experience pain ranging from mild to severe burning pain. Pain can be severe enough to impede the ability to eat, drink, and practice oral hygiene. Lesions may bleed. Oral mucositis can disrupt the patient's treatment, proper nutrition, hydration, and affect quality of life. Many patients treated for head and neck cancers develop severe mucositis that impairs their ability to eat to the point of requiring intravenous (IV) hydration, total parenteral nutrition (TPN), or gastrostomy tube feedings. Lesions can become infected, with risk of systemic infection, especially in the immunocompromised.
Chemotherapy and radiation are the most discussed causes of oral mucositis in the literature.
Chemotherapy-induced mucositis develops 5-10 days after the initiation of treatment and resolves slowly 2-3 weeks after cessation of treatment, usually when the absolute neutrophil count rises above 500/mL. This occurs in approximately 20%-40% of patients receiving conventional chemotherapy and 80% of patients receiving high-dose chemotherapy.
Radiation-induced oral mucositis may develop 2-3 weeks after beginning therapy. The lesions can last for 1-14 weeks. It can be expected to be seen in 80%-100% of patients receiving radiation for head and neck cancer. The lesions may be mild, but severe cases may be more common.
Less commonly reported causative drugs include:
- Gold therapy (auranofin) – May have prodromal metallic taste.
- Chelating agent (penicillamine)
- Antifungals
- Antidiabetics (dipeptidyl peptidase-4 [DPP-4] inhibitors)
- Granulocyte colony-stimulating factors (pegfilgrastim and filgrastim)
- NSAIDs (celecoxib)
- Retinoids
- Selegiline
- Azathioprine
- Eszopiclone
- Risperidone
- Drugs of abuse – Cocaine, ecstasy, khat chewing.
- Nicotine – Reported in smoking cessation aides.
Related topics: chemotherapy-induced mucositis, drug-induced oral ulcer, methotrexate-induced mucocutaneous toxicity