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Mouthcare prophylaxis protocol

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Patients should start off with different levels of mouthcare depending on the mucositis potential of their therapy. As mucositis occurs then additional therapies should be added in. (See Treatment of Established Mucositis in Mouth care and Mucositis guideline.)

Group A: Protocols with very high Mucositis-inducing potential

  • AML
  • Autologous stem cell rescue
  • Allogenic stem cell transplantation


  • Cryotherapy (sucking cold ice blocks for 30 minutes is recommended prior to melpahlan)
  • Basic mouthcare BD in Mouth care and Mucositis guideline
  • Antifungal prophylaxis as recommended
  • Commence Oral Assessment Guide if neutrophils < 1.0
  • Increase frequency of toothbrushing to TDS.

Group B: Protocols with high Mucositis-inducing potential

  • ALL - Induction and reinduction/reconsolidation blocks
  • Relapsed ALL
  • Multi-agent therapy for poor prognosis solid tumours
  • Infant ALL - all phases except maintenance
  • High risk Neuroblastoma
  • Ewings sarcoma protocols
  • Osteosarcoma protocols
  • High risk B-cell NHL protocols
  • Anaplastic Large Cell Lymphoma protocol
  • Brain Tumour patients receiving chemotherapy or radiation therapy and Dexamethasone.


Group C: Standard risk (low Mucositis-inducing potential)

All other patients receive basic mouthcares only.


  • Peterson et al on behalf of the ESMO guidelines working group. Management of oral and gastrointestinal mucositis:ESMO clinical recommendations. Annals of oncology 2009; 20 (supp 4):174 - 177.
  • Lalla R V, Bowen J, Barasch A, et al. MASCC = ISOO Clinical Practice Guidelines for the Management of Mucositis Secondary to Cancer Therapy. 2014:1453-1461. doi:10.1002/cncr.28592

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Document Control

  • Date last published: 22 February 2017
  • Document type: Clinical Guideline
  • Services responsible: National Child Cancer Network
  • Owner: Karen Tsui
  • Review frequency: 2 years