Mucositis ? what is it and why does one get it?
 
The oral mucous membrane is the upper lining of our oral cavity. It is a  vulnerable organ with a high renewal rate of cells. The tissue turnover is just about 12 days. On its surface partially pathogenic bacteria like Actinobacillus live together with Actinomycetes, Porphyromonas gingivalis or the yeast fungus Candida albicans, as well as over 1000 kinds of micro-organisms. Viruses are hardly identified in the mouth when recovering. Some of these micro-organisms live in healthy individuals symbiotically (to the mutual benefit).
 
The first signs of the mucositis are redness of the gingiva and swelling of the mouth mucous membrane. Following that stage come pain, infections and ulcers in the mouth. Ulcers can begin within five to ten days after chemotherapy. Severity and frequency depends to a large extent on the kind of the chemotherapy. With radiotherapy mucositis begins after approximately 2 weeks, in the second irradiation cycle perhaps earlier. 
 
Chemo- and radiotherapy both intervene in the cell division procedure. Rapidly dividing cells like the mouth mucous membrane cells, which divide every three days, are affected directly. If these cells do not regenerate any longer, ulcers in the mouth will develop. Also, if the number of the white blood cells diminishes, the risk of the mouth infection increases.
 
Often patients receive high doses of chemotherapeutic agents or a combination of chemotherapy and radiotherapy, in particular after bone marrow transplantation. At first the intrinsic bone marrow is destroyed by the chemotherapy before the transplantation of the new marrow takes place. The likelihood for these patients to get a pronounced mucositis is high. The mouth mucous membrane of the weakened patients can be further damaged by the bacteria and fungi of the normal mouth flora. 
 
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