Oral Complications

Published on 04/03/2015 by admin

Filed under Hematology, Oncology and Palliative Medicine

Last modified 04/03/2015

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Chapter 43

Oral Complications

Summary of Key Points

Prophylactic Measures

• The importance of instituting oral hygiene protocols in patients receiving chemotherapy is well established.

• Cryotherapy is the most conventional and easy to use preventative method, at least for 5-fluorouracil–based bolus therapy, and it appears to have implications for other chemotherapeutic regimens as well, such as edatrexate and high-dose melphalan therapy.

• Keratinocyte growth factor has been approved by the Food and Drug Administration for use with high-dose chemotherapeutic regimens associated with high rates of mucositis and has shown promise in other settings as well.

• Low-level laser therapy has shown promise, but its use is limited for now to centers that are able to support its use.

• Pretreatment dental care, good oral hygiene, and sophisticated treatment planning is recommended for patients receiving radiation therapy.

Treatment

• Overall, evidence is lacking regarding the efficacy of various agents in promoting healing of the oral mucosa after mucositis is established.

• Systemic analgesic therapy of mucositis pain with narcotic medications is well established and recommended.

• Antibiotics and/or antifungal medications should be given to patients with evidence of infection.

• In the palliative setting, various mouthwashes are widely used in clinical practice based on provider preference and experience. These mouthwashes most frequently contain combinations of diphenhydramine, viscous lidocaine, magnesium hydroxide/aluminum hydroxide, nystatin, and corticosteroids. The efficacy of these measures has not been adequately evaluated to date.

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