{"id":7410,"date":"2026-09-01T06:00:00","date_gmt":"2026-09-01T06:00:00","guid":{"rendered":"https:\/\/www.belodonte.es\/?p=7410"},"modified":"2026-07-10T09:30:26","modified_gmt":"2026-07-10T09:30:26","slug":"mucositis-oral-en-pacients-oncologics-maneig-clinic-prevencio","status":"publish","type":"post","link":"https:\/\/www.belodonte.es\/ca\/mucositis-oral-en-pacients-oncologics-maneig-clinic-prevencio\/","title":{"rendered":"Mucositis oral en pacients oncol\u00f2gics: maneig cl\u00ednic i prevenci\u00f3"},"content":{"rendered":"\n

La mucositis oral<\/strong> \u00e9s la inflamaci\u00f3 i ulceraci\u00f3 de la mucosa de la cavitat oral provocada per l’efecte citot\u00f2xic de la quimioter\u00e0pia i la radioter\u00e0pia sobre les c\u00e8l\u00b7lules de revestiment de la boca. \u00c9s una de les complicacions m\u00e9s freq\u00fcents i debilitants del tractament oncol\u00f2gic: afecta a entre el 20% i el 40% dels pacients que reben quimioter\u00e0pia est\u00e0ndard, i a m\u00e9s del 80% dels quals reben radioter\u00e0pia al capdavant i coll o trasplantament de c\u00e8l\u00b7lules mare hematopo\u00e8tiques. El seu impacte va molt m\u00e9s enll\u00e0 del dolor local: pot obligar a reduir o interrompre el tractament oncol\u00f2gic, comprometre la nutrici\u00f3 i augmentar el risc d’infeccions sist\u00e8miques greus.<\/p>\n\n\n\n

Per qu\u00e8 es produeix la mucositis oral en pacients oncol\u00f2gics?<\/h2>\n\n\n\n

La mucosa oral \u00e9s un dels teixits m\u00e9s vulnerables a l’efecte de la quimioter\u00e0pia i la radioter\u00e0pia perqu\u00e8 est\u00e0 composta per c\u00e8l\u00b7lules de renovaci\u00f3 r\u00e0pida (el seu cicle de reposici\u00f3 complet dura entre 7 i 14 dies), exactament el tipus de c\u00e8l\u00b7lules sobre les quals actuen els tractaments oncol\u00f2gics. Els citost\u00e0tics i la radiaci\u00f3 interfereixen en la divisi\u00f3 cel\u00b7lular de les c\u00e8l\u00b7lules basals de l’epiteli oral, impedint la seva renovaci\u00f3 normal.<\/p>\n\n\n\n

El resultat \u00e9s una p\u00e8rdua progressiva de la barrera mucosa que exposa el teixit subjacent, genera \u00falceres doloroses i permet la colonitzaci\u00f3 per bacteris, fongs i virus oportunistes.<\/p>\n\n\n\n

El model fisiopatol\u00f2gic actualment acceptat, descrit per Sonis en 2004 i \u00e0mpliament validat des de llavors, divideix el proc\u00e9s en cinc fases seq\u00fcencials: iniciaci\u00f3, regulaci\u00f3 a l’al\u00e7a amb generaci\u00f3 de missatgers inflamatoris, amplificaci\u00f3 del senyal inflamatori, ulceraci\u00f3 i finalment curaci\u00f3 espont\u00e0nia quan cessa l’est\u00edmul t\u00f2xic.<\/p>\n\n\n\n

Quins s\u00edmptomes produeix i com es classifica?<\/h2>\n\n\n\n

La mucositis oral es manifesta inicialment com una sensaci\u00f3 d’ardor i eritema (enrogiment) de la mucosa, que evoluciona cap a la formaci\u00f3 d’\u00falceres doloroses cobertes per una pseudomembrana blanquinosa. El dolor pot ser d’intensitat extrema, interferint amb la capacitat de parlar, empassar i alimentar-se. L’escala m\u00e9s utilitzada per a la seva classificaci\u00f3 \u00e9s la de l’Organitzaci\u00f3 Mundial de la Salut (OMS), que estableix cinc graus:<\/p>\n\n\n\n

Grau Descripci\u00f3
0 Sense canvis
1 Eritema i dolor lleu, sense \u00falceres
2 Eritema, \u00falceres, pot menjar s\u00f2lids
3 \u00dalceres extenses, nom\u00e9s tolera l\u00edquids
4 Impossibilitat d’alimentar-se, requereix suport nutricional<\/p>\n\n\n\n

Els graus 3 i 4 es consideren mucositis severa i poden obligar a hospitalitzar al pacient, reduir la dosi de quimioter\u00e0pia o interrompre la radioter\u00e0pia, amb el conseg\u00fcent impacte negatiu sobre el resultat oncol\u00f2gic del tractament.<\/p>\n\n\n\n

Quins factors augmenten el risc de desenvolupar mucositis greu?<\/h2>\n\n\n\n

Existeixen factors de risc dependents del tractament i factors dependents del pacient. Entre els primers destaquen el tipus de citost\u00e0tic utilitzat (els agents alquilants, el metotrexat i el 5-fluorouraciltenen major potencial mucot\u00f2xic), la dosi acumulada de radioter\u00e0pia al capdavant i coll (especialment per sobre de 30 Gy), el fraccionament de la radioter\u00e0pia i la combinaci\u00f3 de qu\u00edmio i radioter\u00e0pia simult\u00e0nies.<\/p>\n\n\n\n

Entre els factors dependents del pacient es troben l’edat avan\u00e7ada, l’estat nutricional previ al tractament, la funci\u00f3 renal (que determina la velocitat d’eliminaci\u00f3 dels citost\u00e0tics), la pres\u00e8ncia de malaltia periodontal activa o focus infecciosos dentals no tractats abans de l’inici del tractament oncol\u00f2gic, i determinades variants gen\u00e8tiques relacionades amb el metabolisme dels citost\u00e0tics.<\/p>\n\n\n\n

Com es prev\u00e9 la mucositis oral?<\/h2>\n\n\n\n

La prevenci\u00f3 de la mucositis oral comen\u00e7a abans de l’inici del tractament oncol\u00f2gic. La valoraci\u00f3 i el sanejament oral previs (eliminaci\u00f3 de focus infecciosos, tractament periodontal, ajust de pr\u00f2tesis mal adaptades) redueixen de manera significativa el risc de complicacions infeccioses associades a la mucositis.<\/p>\n\n\n\n

Durant el tractament, les mesures amb m\u00e9s evid\u00e8ncia cient\u00edfica inclouen les esbandides amb crioter\u00e0pia oral (mantenir gel en la boca durant l’administraci\u00f3 intravenosa d’uns certs citost\u00e0tics, especialment el 5-fluorouracil en bitlla, redueix el flux sanguini muc\u00f3s i limita l’exposici\u00f3 al citost\u00e0tic), l’\u00fas de factor de creixement de queratin\u00f2cits (palifermina) en pacients sotmesos a trasplantament de c\u00e8l\u00b7lules mare, i la ter\u00e0pia amb l\u00e0ser de baixa intensitat (fotobiomodulaci\u00f3), que ha demostrat en m\u00faltiples assajos cl\u00ednics reduir tant la incid\u00e8ncia com la severitat de la mucositis en pacients que reben radioter\u00e0pia al capdavant i coll.<\/p>\n\n\n\n

En Cl\u00ednica Belodonte el protocol de valoraci\u00f3 preoncol\u00f2gica inclou la revisi\u00f3 oral sistem\u00e0tica i el sanejament complet abans de l’inici de qualsevol tractament amb potencial mucot\u00f2xic.<\/p>\n\n\n\n

Quin \u00e9s el tractament de la mucositis establerta?<\/h2>\n\n\n\n

El tractament de la mucositis oral establerta \u00e9s fonamentalment de suport, ja que no existeix fins a la data cap f\u00e0rmac que reverteixi el proc\u00e9s fisiopatol\u00f2gic una vegada iniciat.<\/p>\n\n\n\n

Els pilars del maneig inclouen el control del dolor (amb analg\u00e8sia escalonada que pot arribar a requerir opioides en els graus 3 i 4), el manteniment de la higiene oral amb productes suaus i no irritants (solucions salines, bicarbonat s\u00f2dic dilu\u00eft, evitant col\u00b7lutoris amb alcohol), el control de les infeccions oportunistes (antif\u00fangics t\u00f2pics o sist\u00e8mics per a la candidiasi, antivirals per a les reactivacions herp\u00e8tiques), el suport nutricional (nutrici\u00f3 enteral o parenteral quan la mucositis impedeix la ingesta oral adequada) i la hidrataci\u00f3.<\/p>\n\n\n\n

Els anest\u00e8sics t\u00f2pics com la lidoca\u00efna viscosa poden proporcionar alleujament temporal del dolor abans dels menjars, encara que el seu \u00fas ha de pautar-se amb cura pel risc d’interferir amb el reflex de degluci\u00f3.<\/p>\n\n\n\n

Preguntes freq\u00fcents sobre mucositis oral<\/h2>\n\n\n\n

Quant dura la mucositis oral?<\/h3>\n\n\n\n

En els pacients que reben quimioter\u00e0pia en cicles, la mucositis sol apar\u00e8ixer entre el cinqu\u00e8 i el des\u00e8 dia despr\u00e9s de cada cicle i es resol espont\u00e0niament en dos a tres setmanes, una vegada que les c\u00e8l\u00b7lules mucoses es regeneren. En els pacients que reben radioter\u00e0pia cont\u00ednua al capdavant i coll, la mucositis pot persistir durant tot el tractament i diverses setmanes despr\u00e9s de finalitzar-lo.<\/p>\n\n\n\n

Pot prevenir-se completament?<\/h3>\n\n\n\n

No existeix cap mesura que garanteixi la prevenci\u00f3 completa de la mucositis en pacients amb alt risc. No obstant aix\u00f2, la combinaci\u00f3 de sanejament oral previ, crioter\u00e0pia durant l’administraci\u00f3 de citost\u00e0tics i fotobiomodulaci\u00f3 amb l\u00e0ser ha demostrat reduir la seva incid\u00e8ncia i severitat de forma cl\u00ednicament rellevant.<\/p>\n\n\n\n

Quins productes d’higiene oral han d’evitar-se durant la mucositis?<\/h3>\n\n\n\n

Han d’evitar-se els col\u00b7lutoris amb alcohol, la clorhexidina en concentracions elevades (que resseca i irrita la mucosa ja lesionada), els raspalls de truges dures i qualsevol producte mentolat o amb sabors intensos que pugui agreujar la sensaci\u00f3 d’ardor.<\/p>\n\n\n\n

La mucositis oral pot provocar infeccions greus?<\/h3>\n\n\n\n

S\u00ed. La p\u00e8rdua de la barrera mucosa en un pacient amb problemes d’inmunitat pot facilitar l’entrada de bacteris al torrent sanguini (bacteri\u00e8mia) i generar s\u00e8psia, una complicaci\u00f3 potencialment greu que requereix hospitalitzaci\u00f3 i antibioter\u00e0pia intravenosa. Aquest risc \u00e9s especialment elevat en pacients amb neutrop\u00e8nia severa associada al tractament quimioter\u00e0pic.<\/p>\n\n\n\n

Si iniciar\u00e0s un tractament de quimioter\u00e0pia o radioter\u00e0pia al capdavant i coll, sol\u00b7licita una valoraci\u00f3 oral abans de comen\u00e7ar. Arribar al tractament amb la boca en les millors condicions possibles \u00e9s una de les mesures m\u00e9s eficaces per a reduir el risc de complicacions.<\/p>\n","protected":false},"excerpt":{"rendered":"

La mucositis oral \u00e9s la inflamaci\u00f3 i ulceraci\u00f3 de la mucosa de la cavitat oral provocada per l’efecte citot\u00f2xic de la quimioter\u00e0pia i la radioter\u00e0pia sobre les c\u00e8l\u00b7lules de revestiment de la boca. \u00c9s una de les complicacions m\u00e9s freq\u00fcents […]<\/p>\n","protected":false},"author":3,"featured_media":7409,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[32],"tags":[],"class_list":["post-7410","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cirugia-oral"],"yoast_head":"\nMucositis oral en pacients oncol\u00f2gics: maneig cl\u00ednic i prevenci\u00f3 - 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