Oral mucositis is one of the most common complications of cancer therapy. It is an inflammatory mucosal lesion that has developed as a result of chemotherapy or radiation therapy. It is estimated that 40% of the cases on standard chemotherapy may develop oral mucositis. Patients receiving radiation, especially in the cases of head and neck cancer, have a 30%–60% chance of developing mucositis. Chemotherapy and radiotherapy interfere with the normal turnover of epithelial cells, leading to mucosal injuries. These injuries can also occur due to indirect invasion of gram-negative bacteria and fungi, as most of the chemo-therapeutic agents will cause neutropenia and will give a favorable environment for the development of mucositis. The patient-related factors are also responsible for developing mucositis in chemo-induced and radiation-induced mucositis. Poor oral hygiene may also be responsible for bacterial superinfection followed by chemotherapy.
Mucositis can be categorized into two types: direct and indirect mucositis. In case of direct mucositis, the epithelial cells of the oral mucosa undergo rapid turnover in usually 7–14 days, due to which these cells are more susceptible to the effect of cytotoxic therapy, which results in oral mucositis. On the other hand, indirect mucositis can develop due to the infection caused by Gram-negative bacteria and fungal infection. There will be a greater risk of oral infection due to neutropenia. The onset of mucositis secondary to mylo-suppression varies based on the timing of neutrophil counts associated with chemotherapy agents, but typically, these lesions develop around 10-21 days following the administration of chemotherapy.
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