Oral Mucositis

Aka: Oral Mucositis, Stomatitis

1. See Also
   1. Oral Ulcers
   2. Pharyngitis
2. Definitions
   1. Stomatitis
      1. Inflammation of the mouth and lips
      2. Broader term that includes Oral Mucositis
   2. Mucositis
      1. Painful inflammation and ulceration of the gastrointestinal tract
      2. Typically caused by Chemotherapy or Radiation Therapy
3. Causes: Stomatitis
   1. Vitamin Deficiency (typically associated with recurrent Aphthous Ulcers)
      1. Iron Deficiency Anemia
      2. Vitamin B1 Deficiency (Thiamine deficiency)
      3. Vitamin B2 Deficiency (Riboflavin deficiency)
      4. Vitamin B6 Deficiency (Pyridoxine deficiency)
      5. Vitamin B9 Deficiency (Folic Acid Deficiency)
      6. Vitamin B12 Deficiency (Cobalamin Deficiency)
   2. Specific lesions
      1. Angular Stomatitis
      2. Aphthous Stomatitis
      3. Herpes Gingivostomatitis
      4. Nicotinic Stomatitis
      5. Acute Necrotizing Ulcerative Gingivitis (Vincent's Stomatitis)
      6. Local Trauma or reaction (e.g. ill-fitting dentures, Contact Dermatitis)
      7. Oral Mucositis associated with Chemotherapy or Radiation Therapy
         1. May be complicated by Oral Candidiasis (Thrush) or Herpes Gingivostomatitis
4. Management
   1. See Oral Ulcer
   2. See Pharyngitis Symptomatic Treatment
   3. Treat specific causes
      1. Angular Stomatitis
      2. Aphthous Stomatitis
      3. Herpes Gingivostomatitis
   4. Symptomatic management
      1. Saline rinses
         1. Prepare one teaspoon salt in 32 ounces water
         2. Some recipes recommend adding bicarbonate
      2. Topical over-the-counter agents
         1. Amphojel (coats lesions)
         2. Zilactin (forms film over the lesion)
      3. Topical prescription agents (expensive)
         1. Episil (viscous gel)
         2. Mugard (oral rinse)
         3. Gelclair (viscous gel)
      4. Consider topical combination agents
         1. Magic Mouthwash
            1. Typically compounded (e.g. Lidocaine, Benadryl, maalox, with or without a Corticosteroid and/or antibiotic)
         2. First Mouthwash BLM (commercially prepared)
            1. Diphenhydramine, Lidocaine, Maalox, and Simethicone
      5. Avoid unhelpful or harmful agents
         1. Avoid sucralfate (ineffective)
         2. Avoid chlorhexidine (ineffective)
         3. Avoid Alcohol-based rinses (may exacerbate pain)
         4. Avoid hydrogen peroxide (may delay healing)
5. References
   1. Negrin in Drews (2014) Oral Toxicity Associated with Chemotherapy, UpToDate, accessed online 11/05/2014
   2. (2014) Presc Lett 21(11): 64
   3. Nolan (1991) J Oral Pathol Med 20(8):389-91 [PubMed]
   4. Sun (2014) J Oral Pathol Med [PubMed]
   5. Thongprasom (2001) Southeast Asian J Trop Med Public Health 32(3):643-7 [PubMed]