Risk factors for chemotherapy-induced oral mucositis: Dental appliances, oral hygiene, previous oral lesions, and history of smoking

Oral mucositis is one of the dose-limiting toxicities of several chemothera py (CTX) agents. There are suggested risk factors that could influence the development of mucositis. The presence of dental appliances, history of ora l lesions, or smoking have the potential to irritate the oral mucosa and pr oduce breaks in the integrity of the mucosa. The purposes of this study wer e to determine if there were differences in the incidence, severity, and ti me to onset of CTX-induced mucositis in oncology outpatients who wore denta l appliances, had a history of oral lesions, had varying oral hygiene/care practices, and had a history of smoking and those who did not. Patients who were initiating a course of CTX that included stomatotoxic agents were fol lowed for three complete cycles of CTX. They were instructed on how to exam ine their mouths for mucositis, to contact and then to visit their outpatie nt settings if it occurred. Clinicians corroborated the presence of mucosit is, and the filer's Oral Assessment Guide was used by clinicians to determi ne the severity. Of 332 outpatients, almost half (46%) wore some type of de ntal appliance, 32% had a history of oral lesions, 10% were currently smoki ng, and 63% had a history of smoking. Oral hygiene/care practices varied: 8 1% brushed their teeth two or more rimes a day, 29% flossed at least daily 11% had visited their dentist within 2 months of beginning CTX, and 10% had their teeth professionally cleaned within 2 months of beginning CTX. There was a 31% (n = 104) incidence of CTX-induced mucositis. No significant dif ferences were found in the incidence between patients who wore dental appli ances, had a history of oral lesions had a history of smoking, and practice d different hygiene/care and patients who did not. Of 104 patients who deve loped mucositis, the average severity rating was 13.05 +/- 2.88 (+/- SD) (a normal mouth is rated at 8) and the average time to onset was 22.3 +/- 21. 46 days. There were no significant differences found in severity or time to onset of mucositis between patients who wore dental appliances had a histo ry of oral lesions, had a history of smoking, and practiced different denta l hygiene/care and patients who did not. Although not significant, there we re interesting differences in the time to onset across the suggested risk f actors (e.g., patients who had visited a dentist or had their teeth profess ionally cleaned within 2 months before beginning CTX developed mucositis 7. 4 and 10.6 days sooner, respectively, than patients who did not). These fin dings suggest that risk factors for the development of CTX-induced mucositi s are not as simple and direct as clinicians may believe.