Effective Strategies for Managing Oral Mucositis in Pediatric Cancer Patients

Importance of Addressing Oral Mucositis in Pediatric Cancer

Oral mucositis (OM) is a significant and painful complication commonly associated with cancer treatments such as chemotherapy and radiation therapy. This condition not only leads to discomfort but can severely affect a child’s ability to eat, communicate, and maintain overall quality of life. The incidence of OM in pediatric cancer patients can reach as high as 80%, particularly in those receiving intensive chemotherapeutic regimens (Kaur et al., 2025). Effective management of OM is essential for improving treatment outcomes and ensuring that patients can continue their cancer therapies without interruption.

Mechanisms and Causes of Chemotherapy-Induced Oral Mucositis

Chemotherapy agents, especially those that target rapidly dividing cells, can damage the epithelial layers of the oral mucosa. The most commonly implicated drugs include methotrexate, doxorubicin, and cyclophosphamide, which are integral to treating various pediatric malignancies such as acute lymphoblastic leukemia (ALL) and osteosarcoma (Kaur et al., 2025).

The pathophysiology of chemotherapy-induced OM involves a complex interplay of direct mucosal toxicity and an inflammatory response. Following chemotherapy administration, the injury to the mucosal cells leads to the release of pro-inflammatory cytokines, resulting in a cascade of events that can exacerbate the condition. This includes increased oxidative stress and alterations in cellular signaling pathways, leading to cell death and ulceration (Kaur et al., 2025).

Table 1: Common Chemotherapeutic Agents Associated with Oral Mucositis

Benefits of Photobiomodulation Therapy for Oral Mucositis

Photobiomodulation (PBM) therapy, also known as low-level laser therapy (LLLT), has emerged as a promising modality for the prevention and treatment of OM in pediatric patients. This technique involves the application of light at specific wavelengths to stimulate cellular processes that promote healing, reduce inflammation, and alleviate pain. Recent studies have demonstrated that PBM can significantly decrease the severity of OM and accelerate mucosal healing in children undergoing chemotherapy (Kaur et al., 2025).

The mechanisms by which PBM exerts its effects include the modulation of reactive oxygen species, enhancement of mitochondrial activity, and promotion of angiogenesis. The activation of these pathways can lead to improved healing responses in damaged tissues, making PBM a valuable adjunctive treatment in the management of OM (Kaur et al., 2025).

Table 2: Parameters of PBM Therapy

Role of Boric Acid in Treating Oral Mucositis in Children

Boric acid has been studied for its potential role in managing OM due to its anti-inflammatory and antiseptic properties. In pediatric oncology, boric acid has shown promise in reducing the severity of OM by promoting mucosal healing and reducing the incidence of infections that can complicate the condition. Its application as a topical treatment in the oral cavity can help manage symptoms effectively (Kaur et al., 2025).

Mechanisms of Action

Boric acid acts through several biological mechanisms, including the modulation of pH levels in the oral cavity, which can help to create an unfavorable environment for bacterial growth. Moreover, it has been shown to induce apoptosis in cancer cells, thus potentially limiting the growth of tumor-derived lesions in the oral mucosa (Kaur et al., 2025).

Table 3: Effects of Boric Acid on Oral Mucositis

Future Directions in the Prevention and Treatment of Oral Mucositis

The management of oral mucositis in pediatric cancer patients requires a multifaceted approach that includes prevention, timely diagnosis, and effective treatment strategies. Future research should focus on the following areas:

1. Standardization of PBM Protocols: Establishing universal guidelines for PBM therapy, including optimal parameters for wavelength, power density, and treatment frequency, will enhance its utility in clinical settings.

2. Clinical Trials for Boric Acid: While preliminary findings are promising, larger clinical trials are necessary to confirm the efficacy and safety of boric acid in treating OM in pediatric patients.

3. Integrated Care Approaches: Developing multidisciplinary care models that involve oncologists, dentists, and nutritionists can improve the management of OM by addressing the comprehensive needs of pediatric patients.

4. Exploration of Novel Therapeutics: Investigating new agents that can mitigate the effects of chemotherapy on the oral mucosa, such as anti-inflammatory drugs or growth factors, may provide additional benefits in preventing and treating OM.

FAQ

What is oral mucositis?
Oral mucositis is an inflammation of the mucous membranes in the mouth, which can occur as a side effect of cancer treatments, particularly chemotherapy and radiation therapy.

How common is oral mucositis in pediatric cancer patients?
Oral mucositis affects approximately 50-80% of pediatric cancer patients undergoing chemotherapy.

What are the main treatments for oral mucositis?
Treatment options include pain management, maintaining oral hygiene, photobiomodulation therapy, and topical agents such as boric acid.

Can photobiomodulation therapy prevent oral mucositis?
Yes, studies indicate that PBM therapy can significantly reduce the incidence and severity of oral mucositis in pediatric patients undergoing chemotherapy.

Is boric acid safe for children with oral mucositis?
Boric acid has shown potential in treating oral mucositis, but further research is needed to establish its safety and efficacy in pediatric populations.

References

1. Kaur, A., Babaliari, E., Bolanos-Garcia, V. M., Kefalogianni, M., Psilodimitrakopoulos, S., Kavatzikidou, P., … & Eskin, D. G. (2025). Efficacy of photobiomodulation for the prevention and treatment of chemotherapy-induced oral mucositis in pediatric patients with hematologic cancers: a randomized clinical trial. BMC Surgery, 25(1). https://doi.org/10.1186/s12885-025-14213-w

2. Kaur, A., et al. (2025). Assessment of aqueous graphene as a cancer therapeutics delivery system. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-025-98406-0

3. Kaur, A., et al. (2025). Boric Acid Induces Oxidative Damage and Apoptosis Through SEMA3A/PLXNA1/NRP1 Signalling Pathway in U251 Glioblastoma Cell. Journal of Cellular and Molecular Medicine, 29(9)

4. Kaur, A., et al. (2025). Preoperative Predictive Factors for Seminal Vesicle Invasion (pT3b) in Robotic-assisted Radical Prostatectomy. Cancer Diagnosis & Prognosis, 5(3)

5. Kaur, A., et al. (2025). Laparoscopic versus open distal gastrectomy with D2 lymphadenectomy in treatment of locally T4A gastric cancer: the protocol of a randomized controlled trial. BMC Surgery, 25(1). https://doi.org/10.1186/s12893-025-02933-6