Author: Nina Garlo-Melkas, MSc

Recent research suggests that antibacterial dual-light therapy may be an effective method to manage the symptoms of oral mucositis. Here’s what you need to know about this promising treatment.

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 mouth, potentially impacting the success of cancer therapy. To date, no existing medication has effectively prevented the development of mucositis. But 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, doctors may consider the use of antibiotics. 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.1,2

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.3

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 her bachelor’s thesis from the Faculty of Medicine at the University of Helsinki, “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) as local treatments on mucositis ulcers.3

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 it simultaneously provides red light therapy.

According to Dr. Tommi Pätilä, thesis advisor on 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.3

Improving quality of life for patients
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.4

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. He 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 that worsen 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.4

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. Dr. 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, he closely observed the development of cancer treatment pathways, particularly increasing understanding of the role of oral infections in treatment outcomes.

In the early 2000s, according to Dr. Waltimo, the importance of oral health in the context of general health care 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 cancer treatment side effects 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.4

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.

Dr. Waltimo emphasizes that good oral care can prevent infection complications, which cancer patients are more susceptible to given their increased risk for diseases. Maintaining oral health is essential 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. Mauramo, antibacterial treatment can influence the inflammatory process and induce an anti-inflammatory effect. Additionally, antibacterial dual-light therapy can complement traditional bactericidal treatments.

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

Preliminary observations suggest that antibacterial dual light therapy such as Lumoral (not yet available in the US) 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, and Dr. Waltimo says a new doctoral dissertation study will commence at the University of Helsinki in the spring of 2024.

Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.

1. Brown TJ, Gupta A. Management of cancer therapy-associated oral mucositis. JCO Oncol Pract. 2020;16(3):103-109. doi:10.1200/JOP.19.00652
2. 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;28(4):2852-2867. doi:10.3390/curroncol28040250
3. Hentilä J. Bachelor of Medicine thesis: Oral mucositis – antibacterial dual light in the treatment of oral mucositis. University of Helsinki, Faculty of Medicine. October 22, 2023.
4. Rapone B, Nardi GM, DDI Venere D, Pettini F, Grassi FR, Corsalini M. Oral hygiene in patients with oral cancer undergoing chemotherapy and/or radiotherapy after prosthesis rehabilitation: protocol proposal. Oral Implantol (Rome). 2017;9(Suppl 1/2016 to N 4/2016):90-97. doi:10.11138/orl/2016.9.1S.090

Other sources
– Cancer treatments and oral health. National Institute of Dental and Craniofacial Research. Reviewed March 2023.
– Gholami L, Shahabi S, Jazaeri M, Hadilou M, Fekrazad R. Clinical applications of antimicrobial photodynamic therapy in dentistry. Front Microbiol. 2023;13:1020995. doi:10.3389/fmicb.2022.1020995