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.