Stomatitis

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Stomatitis

Description

Stomatitis describes an inflammation of the mucous membranes of the mouth. This condition, frequently referred to as mucositis , can result from cancer treatments such as chemotherapy and radiation therapy . It is characterized by mouth ulcers or sores, and pain in the mouth. The first symptoms may be sensitivity to spicy foods and reddened mucous membranes. The patient with stomatitis may also experience a dry or swollen tongue, difficulty swallowing, and an inability to eat or drink. It is usually a short-term condition, lasting from just a few days to a few weeks. Reddened areas in the mouth may appear as early as three days after receiving chemotherapy, but normally it is within five to seven days. As time goes on, ulceration occurs. The inflammation can range from mild to severe. If complications such as infection do not occur, stomatitis usually heals completely within two to four weeks.

Causes

Stomatitis is most often caused by cancer treatments such as chemotherapy and radiation therapy. Chemotherapy medications work because they are attracted to rapidly growing cells like cancer cells. However, many of the body's normal cells also grow rapidly, and chemo-therapy kills them as well. The mouth includes several structures that together are referred to as the oral cavity: the lips, teeth, gums, tongue, pharynx, and the salivary glands. Most of these structures are covered by mucous membranes, the shiny, pink moist lining of the mouth. The outer layer of mucous membranes grows very rapidly, and because of this they can easily be damaged by chemotherapy and radiation therapy. When these cells are damaged, they slough off, and the lining of the mouth is left vulnerable and without protection. This exposed lining may become inflamed, swollen, and dry, and will often develop ulcers or sores.

Stomatitis caused by radiation therapy normally develops in the area where the radiation is given. It generally begins seven to fourteen days after starting radiation. It will usually exhibit improvement about two to three weeks after the treatment stops.

Stomatitis may also develop as an indirect result of cancer treatment or the cancer itself. Chemotherapy can frequently cause the patient's infection-fighting white blood cells to drop down below normal levels. When this happens, the body may be unable to keep the normal organisms in the oral cavity in balance and stomatitis, as well as infections, may result. The severity of the stomatitis is dependent on various factors, including the diagnosis, the patient's age, the patient's oral condition before cancer treatment, and the level of oral care during therapy. The duration and severity of the low white blood count is another factor.

Treatments

Various measures can be taken by the cancer patient to help prevent the occurrence or severity of stomatitis. A carefully followed program of good oral care started before cancer treatment can reduce the severity of stomatitis. The primary preventative measures include good nutritional intake, good oral hygiene practices, and early detection of any oral lesions by either the patient or a health care professional.

Once cancer treatment has started, the patient should carefully observe the mouth daily. The patient should inform their health care professional if any symptoms such as reddened areas, swelling, blisters, sores, white patches, or bleeding are noted. Meticulous oral hygiene and comfort measures are the focus of care. Sometimes, no matter what the patient does, stomatitis occurs. However, if good oral care is performed, the severity of symptoms is usually lessened. The following measures may be recommended to treat stomatitis:

Rinsing the oral cavity after meals and before bedtime with a mild salt-water or baking soda and water solution will help keep the mouth clean and free of debris.
A soft-bristled toothbrush or soft foam tooth-cleaning device should be used to keep the mouth and teeth very clean.
Maintaining a good nutritional intake and drinking adequate amounts of fluids helps the body heal the stomatitis.
The use of any tobacco products and alcohol should be avoided, as they can irritate the lining of the mouth.
Avoid spicy or acidic foods, or very hot foods.

Sometimes stomatitis develops, no matter what the patient does. If the mouth sores are painful enough to prohibit eating and drinking, pain medications, including numbing medicines and both non-narcotic and narcotic pain medicines, may be prescribed.

Alternative and complementary therapies

Some preliminary studies have shown glutamine, an amino acid, to be effective in shortening the duration of stomatitis. Topical Vitamin E has also been studied and it shows some suggestions of being an effective therapy in patients with stomatitis. Other small studies suggest that using ice chips or a chamomile mouthwash will decrease the severity of symptoms. However, most of these studies have been small in scope, and cannot definitively claim the effectiveness of the varying treatments. As with anyone undergoing cancer treatment, the patient with stomatitis should consult with their physician or other health care professional regarding the usage of these alternative approaches.

Resources

BOOKS

Sonis, Stephen T. "Oral Complications of Cancer Chemotherapy." In Cancer Medicine, 5th ed. Hamilton: B.C. Decker, 2000.

PERIODICALS

Madeya, Mary L. "Oral Complications From Cancer Therapy: Part 1. Pathophysiology and Secondary Complications." Oncology Nursing Forum 23 (June 1996).

Meloni, G., et al. "Ice Pops to Prevent Melphalan-induced Stomatitis." The Lancet 347 (15 June 1996): 1691-2.

Napoli, Marya. "Chemo Effect Alleviated." Health Facts (1 October 1998).

Wojtaszek, Cynthia. "Management of Chemotherapy-induced Stomatitis." Clinical Journal of Oncology Nursing 4 (November/December 2000).