What strategies do you employ to mitigate mucositis related pain during the treatment of head and neck cancer?

The bottom line is there is no magic bullet that works well.

I start Glutamine a week before and throughout the duration of the treatment. It seems to delay the onset.

I use custom made mouth pieces to reduce dental scatter if possible--that will reduce mucositis

I start with over the counter analg...

In my practice, I usually start with NSAIDs and/or MMW with lidocaine (our formulation also has a low-to-intermediate potency corticosteroid in it), then short-acting opioids. Once taking short-acting opioids around-the-clock as Rx'ed, prescribe a long-acting opioid. In oropharynx or larynx primary,...

Best first step is to minimize mucositis with your radiation plan. At time of simulation, make sure any metal from dentures, bridges, appliances, etc are removed. In cases of BoT, have the patient extend his neck as much as possible to remove the oral cavity from entry/exit to the beam. Metal crowns...

Drs. Karam and Hadziahmetovic, thank you so much for your very thorough answers! These are extremely helpful. As a small addition, I want to mention a recent report on the potential benefit of methylene blue mouth rinse for patients with severe RT-related oral mucositis (Roldan et al, Pain Pract 201...

Best exploration of backscatter from dental amalgam I've recently seen. Amelioration technique is investigated too.

They have a non-exhaustive compendium of mucositis-related literature over on Wikibooks; I've seen a kajillion of these in the past so make this a kajillion and one. The methylene blue ...