Caphosol® Supersaturated Calcium Phosphate Rinse

Start Cancer Therapy... Start Caphosol

Patients & Caregivers

Oral Mucositis

Caphosol^®

Support Programs

Healthcare Professionals

Patient Programs

Product News

About Oral Mucositis

Learn more about Oral Mucositis (OM) by browsing the content below. Or click on the links that interest you most to go directly to that information.

What is Oral Mucositis?
What causes Oral Mucositis?
Who is affected by Oral Mucositis?
When does Oral Mucositis start and how does the condition progress?

What are the grades of OM?
What does OM look like?
Why should I manage Oral Mucositis before it starts?
How can I manage Oral Mucositis?

What is Oral Mucositis?

Oral mucositis is a side effect of some cancer therapies. It is an irritation inside the mouth affecting the lining of the mouth and tongue.
The condition appears first as a thinning of the lining of the mouth, leading to redness or inflammation.
The hallmark of oral mucositis is pain, as the surfaces that line the mouth and the tongue become red, swollen and covered in ulcers. The pain can be so severe that it is very hard to eat, drink and speak. In extreme cases, a feeding tube may be required so that a patient can maintain enough strength to continue with cancer therapy.
Oral mucositis is an underestimated and under-treated condition that can severely affect quality of life and the success of cancer treatment.

What causes Oral Mucositis?

Radiation and chemotherapy not only kill cancer cells, but unfortunately can also damage healthy tissues of the body - like the soft lining of the mouth and tongue - resulting in oral mucositis. The combination of chemotherapy and radiation increases the risk of developing severe oral mucositis. The symptoms of OM also tend to get worse the longer radiation treatment lasts.
Cancer therapy can weaken the immune system allowing bacteria in the mouth to more easily spread - making patients susceptible to oral mucositis.
All radiation that passes through and near the mouth is very likely to cause oral mucositis.

During radiation for head and neck cancer or conditioning regimen for Bone Marrow Transplant [BMT] or Hematopietic Stem Cell Transplantation (HSCT), the beam of radiation passes near and through the mouth. Normally healthy cells in the mouth quickly divide and replace surface cells with new cells. However, radiotherapy kills these dividing cells meaning the surface cells cannot be replaced, causing ulcers to form.

Radiation to the head and neck and chemotherapy damage the glands in the mouth that produce saliva, causing the mouth to be drier than normal. A dry mouth makes it difficult to chew and swallow and is also more likely to be damaged by hard food that is normally washed away by saliva.

Certain types of chemotherapy will affect the likelihood of developing oral mucositis. Chemotherapy drugs that are known to cause oral mucositis include:¹⁰

5-fluorouracil

Methotrexate

Doxorubicin (Adriamycin®)

Etoposide (Vepesid®)

Melphalan

Cyclophosphamide

Capecitabine (Xeloda®)

Docetaxel (Taxotere®)

Cisplatin

Who is affected by Oral Mucositis?

Oral mucositis is estimated to affect more than 400,000 cancer patients each year¹. It affects:

Nearly all patients undergoing radiation therapy for head and neck cancer.⁴

75% to 85% of bone marrow transplant recipients².

Approximately 40% of patients receiving chemotherapy³.

The likelihood of developing oral mucositis varies depending upon the situation, lifestyle and medical history of the person. Those at particular risk are:

Children and the elderly

People with previous oral health problems or oral mucositis

People who have poor oral hygiene during treatment

Smokers

People who drink alcohol

Diabetic patients

The incidence of oral mucositis was greater in the patients who received radiation or a combination of radiation with chemotherapy.⁴

When does Oral Mucositis start and how does the condition progress?

With both chemotherapy and radiation, damage to lining of the mouth begins on the first day of cancer treatment. Therefore, it is imperative to manage oral mucositis before it starts.
The first stages of oral mucositis happen below the mouth's surface and are not always noticeable. Symptoms of oral mucositis may not appear until the second week after the start of cancer treatment.¹

Chemotherapy: Typically people undergoing chemotherapy don't start noticing symptoms until 5 to 8 days after starting treatment. The symptoms of oral mucositis can last between 7 to 14 days before healing begins. With each cycle of chemotherapy the risk of developing oral mucositis increases and the severity of the condition often worsens.⁴
Radiation: Oral mucositis manifests later with radiation (at 2 weeks) and the symptoms may gradually intensify thereafter. Healing doesn't begin until the end of therapy and the symptoms may last for two to three weeks after the completion of treatment.⁴ Therefore with radiation for head and neck cancer, the symptoms of oral mucositis can continue for up to 10 weeks.

What are the grades of Oral Mucositis?

There are 4 grades of oral mucositis. Grades 1 and 2 are mild and characterized by soreness and the beginning of ulceration. During grades 3 and 4, oral mucositis is more severe. At grade 3, sufferers cannot tolerate solid food and so switch to a liquid-only diet. Eating is not possible at grade 4 and patients may need further help getting enough nutrients.⁹
The World Health Organization (WHO) and the National Cancer Institute's Common Toxicity Criteria (NCI-CTC) measure the pain associated with oral mucositis through the following pain grading system:³

0 = no pain

Click on the thumbnail images above to see a larger image of the oral mucositis stages

Why should I manage Oral Mucositis before it starts?

Cancer Cure Rates: The most important reason to stop oral mucositis before it starts is that many people develop OM so severely that it interferes with cancer therapy. This could ultimately influence the success of the cancer treatment.
Infection & Possible Hospitalization: Oral mucositis sores and ulcers are at serious risk for infection. Because people receiving chemotherapy are less able to fight off infection, viruses, bacteria or fungi can more easily infect the ulcers and infection can travel more easily into the blood. In some cases, infections can lead to hospitalization and even cause death.
Weakness & Dehydration: Pain is a major symptom of oral mucositis. The pain can make it very difficult to eat and drink, at a time when people with cancer need the physical strength to cope with aggressive cancer therapies. Without enough food and fluids, people may feel weak, become dehydrated and lose weight - affecting cancer treatment outcomes. In some cases, the use of a feeding tube may be recommended.
Depression: Unsightly ulcers, pain, difficulty speaking and eating can lead to isolation and feelings of depression.
Taste: If the tongue is exposed during radiation the taste buds on the surface of the tongue may become damaged. Some patents lose their sense of taste completely during treatment, but it will normally return within 4 months of finishing treatment. In some cases however, the taste buds may never fully recover.

How can I manage Oral Mucositis?

Minor oral mucositis symptoms can often be managed using simple home remedies like careful oral hygiene, drinking plenty of fluids, changes in diet and using over-the-counter products to reduce pain. Click here to download a booklet with more information.
But many of these remedies merely soothe the symptoms of oral mucositis. Caphosol is the only prescription mouth rinse that is clinically proven to decrease the incidence, duration and severity of oral mucositis.⁷ In the clinical trial, more than twice as many patients avoided oral mucositis by using Caphosol.

Don't Wait for the Onset of Symptoms,
Ask Your Doctor about Caphosol Today

To learn more about Oral Mucositis and get tips on diet and nutrition, visit:
www.mouthsmadegood.com

Caphosol Safety Information:

If Caphosol is swallowed accidently, no adverse effects are expected
There are no known interactions with other medications
Reported side effects have been rare and generally mild

Keep out of reach of children. For full prescribing information, please click here.

C-0157-08