Oral mucositis, an inflammation of the oral mucosa, often occurs in association with cancer treatments, particularly radiation and chemotherapy. It manifests as severe pain, redness, and swelling in the patient's mouth, potentially impacting the success of cancer therapy. To date, no existing medication has effectively prevented the development of mucositis. Recent research suggests that antibacterial dual light therapy may be an effective method to manage the symptoms of this condition.

Traditional approaches to treating oral mucositis include preventive measures such as maintaining good oral hygiene and using ice therapy during chemotherapy. If bacterial infection is present, the use of antibiotics may be considered by the physician. Corticosteroids are also a treatment option to alleviate pain and the inflammatory response associated with mucositis. However, corticosteroid use poses risks, as it can suppress the immune system, making cancer patients more susceptible to infections.

Ongoing research explores novel methods for preventing and treating oral mucositis. Mitochondria-stimulating red light therapy has proven to be very effective in treating oral mucositis, particularly as a preventive measure. Although light therapy is estimated to be the most effective treatment modality, its widespread implementation faces challenges such as availability and practical issues.

The latest studies investigate antibacterial treatments to preventively address oral mucosal ulcers originating from mucositis, aiming to mitigate the adverse effects of aggressive cancer treatments.

In the bachelor's thesis from the Faculty of Medicine at the University of Helsinki titled "Oral Mucositis – Antibacterial Dual Light in the Treatment of Oral Mucositis," medical student Jessica Hentilä explores the effects of antibacterial photodynamic therapy (aPDT) and antibacterial blue light (aBL) on mucositis ulcers as local treatments.

Hentilä's research evaluates the efficacy of dual light therapy against Streptococcus Oralis – a common bacterium in the oral microbiome. The study indicates that antibacterial dual light, a combination of aPDT and aBL, not only effectively targets streptococcal infections found in mucositis-induced ulcers but provides red light therapy simultaneously.

According to Dr. Tommi Pätilä, the thesis advisor of Hentilä’s project and specialist in pediatric heart and organ transplantation surgery, the reduction of oral bacterial load in the mouth promotes mucosal wound healing, concurrently reducing the risk of local and systemic infection complications common in cancer patients. This is an important addition to the conventionally applied red light therapy.

Oral Health Improves Quality of Life

Oral mucositis is a prevalent side effect in cancer patients undergoing chemotherapy, radiation therapy, or combined chemo-radiation therapy. Its pathophysiology stems from the ability of cancer treatments to inhibit rapidly dividing cells, present not only in cancer tissues but also in the oral mucosa.

Clinically, oral mucositis induces an inflammatory reaction in the oral mucosa, leading to swelling, redness, and painful ulcers. These mucosal variations create an entry point for oral bacteria, exacerbating mucositis-related inflammation or potentially spreading to other parts of the body, explains Dr. Matti Mauramo, a dentist and specialist in pathology.

Mauramo emphasizes that maintaining good oral hygiene is crucial for overall well-being. For cancer patients, oral health preservation is especially vital, as a clean mouth reduces the inflammatory burden caused by bacteria, worsening mucositis. Cancer patients must maintain good chewing ability and a diverse, high-calorie diet during intensive cancer treatments to avoid malnutrition and the development of a general weakness known as cachexia.

Professor Tuomas Waltimo from the University of Basel notes that while mucositis can occur in any part of the digestive tract, its manifestation on the oral mucosa poses specific challenges for cancer patients. Severe cases may hinder oral nutrition intake, leading to premature discontinuation of cancer treatments and compromising overall prognosis.

Waltimo, currently practicing as a private dentist at a Finnish clinic providing specialized dental care for patients undergoing cancer treatments, acknowledges the improvement in managing the side effects of cancer treatments compared to the early 2000s. Throughout his two-decade-long career as a researcher, Waltimo closely observed the development of cancer treatment pathways, particularly the increasing understanding of the role of oral infections in treatment outcomes.

In the early 2000s, according to Waltimo, the importance of oral health in the context of general healthcare was not systematically recognized as it is today in many European countries. However, the situation has improved, with dental care becoming a standard practice before initiating stem cell transplantation treatments in countries like Switzerland.

Simultaneously, patients’ prognoses have improved, and, most importantly, the quality of life for many patients has improved as the management and prevention of side effects of cancer treatments have become more efficient.

A Healthy Mouth Guards Against Serious Infections

Professor Waltimo highlights that alongside mucosal inflammation, cancer treatments often induce dry mouth, exposing cancer patients to various other oral diseases as well, such as tooth decay, gingivitis, and challenging periodontal and peri-implant diseases.

Oral infections are detrimental to overall health, causing a low-grade inflammatory state and potentially affecting the entire body. Oral infections are particularly harmful to cancer patients due to an increased risk of bacteremia – a bacterial infection that occurs when bacteria entering the bloodstream trigger the body's defense reaction. In severe cases, bacteremia can lead to life-threatening sepsis.

Waltimo emphasizes that good oral care can prevent infection complications, which cancer patients are more susceptible to, given their increased risk of diseases. Maintaining oral health is crucial for cancer patients, as the mouth is the primary source of routine bacterial seeding in the body. Mucous membranes, teeth, and gums must be kept in impeccable condition through daily effective oral hygiene.

According to Dr. Matti Mauramo, Lumoral's antibacterial treatment can influence the inflammatory process and induce an anti-inflammatory effect. Additionally, antibacterial dual light therapy can complement traditional bactericidal treatments.

Professor Tuomas Waltimo suggests that Lumoral's antibacterial dual light therapy could potentially serve as a preventive measure to support the oral health of cancer patients before the initiation of cancer treatments.

Preliminary observations suggest that Lumoral's antibacterial dual light therapy might be an important tool in the armory for oral mucositis treatment. Confirmation studies shall be set up to further investigate the effectiveness of the novel approach. A new doctoral dissertation study will commence at the University of Helsinki in spring to delve into this topic, adds Tuomas Waltimo.

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World Cancer Day is observed on February 4th every year. It is a day dedicated to raising awareness about cancer, promoting its prevention, detection, and treatment, as well as advocating for improved access to cancer care for all people globally. The day also serves as a reminder of the importance of early detection and education about cancer risk factors.

Sources:

Brown TJ, Gupta A. Management of Cancer Therapy-Associated Oral Mucositis. JCO Oncol Pract. 2020 Mar;16(3):103-109. doi: 10.1200/JOP.19.00652. Epub 2020 Feb 3. PMID: 32048926.

Al-Rudayni AHM, Gopinath D, Maharajan MK, Veettil SK, Menon RK. Efficacy of Oral Cryotherapy in the Prevention of Oral Mucositis Associated with Cancer Chemotherapy: Systematic Review with Meta-Analysis and Trial Sequential Analysis. Curr Oncol. 2021 Jul 29;28(4):2852-2867. doi: 10.3390/curroncol28040250. PMID: 34436016; PMCID: PMC8395421.

Hentilä, Jessica. "Oral Mucositis – Antibacterial Dual Light in the Treatment of Oral Mucositis." Bachelor of Medicine, University of Helsinki, Faculty of Medicine, October 22, 2023.

Gholami L, Shahabi S, Jazaeri M, Hadilou M, Fekrazad R. Clinical applications of antimicrobial photodynamic therapy in dentistry. Front Microbiol. 2023 Jan 5;13:1020995. doi: 10.3389/fmicb.2022.1020995. PMID: 36687594; PMCID: PMC9850114.