INTRODUCTION
Oral mucositis presents as a sequelae of inflammatory changes in the
epithelial and subepithelial cells within the oral, oropharyngeal, and
esophageal mucosa and is very prevalent within the cancer population
[1]. Not only is it an uncomfortable complication for many patients
undergoing chemotherapy, it is also the most common symptom that
requires systemic analgesics among cancer patients [2]. Overall, it
is estimated that more than 70% of patients have some degree of
gastrointestinal mucositis because of its variable presentation and
underreporting [3, 4]. Oral mucositis can be painful, causing
impaired eating and drinking, which results in dehydration,
malnutrition, interruption in therapy, increased risk of infection,
longer hospital stays, and increased treatment costs, with an overall
reduction in quality of life [5].
More than 40,000 children in the United States undergo treatment for
cancer every year [6]. While cancer is considered a rare disease
among children and adolescents
[7],
oral mucositis is not rare; within this population, 40% of children who
receive standard-dose chemotherapy, 80% who receive radiation therapy
for head and neck cancers, and 75% who undergo bone marrow transplant
develop oral mucositis [6].
The current strategies to prevent oral mucositis in the pediatric
population include chewing gum, chlorhexidine gluconate, sucralfate, and
a preventive oral disease protocol [7]. Similarly, to alleviate the
symptoms of oral mucositis, a few pharmacologic agents have been
approved, such as oral rinses (e.g. saline solution and sodium
bicarbonate rinses), topical anesthetics (e.g. lidocaine and
benzocaine), compound mouthwashes (e.g. a “magic mouth rinse”
containing diphenhydramine, lidocaine, and combinations of aluminum
hydroxide, magnesium hydroxide, and simethicone), and mucosal surface
protectants (e.g., hydroxypropyl cellulose gels) [9]. When
a step-up approach fails to provide adequate relief, systemic opiate
analgesics are warranted.
Recently, methylene blue oral rinse, a non-anesthetic, non-opioid agent,
has been used to treat oral mucositis–associated pain in adult patients
with cancer [8]. However, the use of this alternative in the
pediatric population has not been reported.