Disclaimer. This article is for information and knowledge purposes only. It is imperative that you get clearance and are monitored if you plan to undertake any form of diet therapy especially if you have Cancer or and Chronic Illness.

What Is Oral Mucositis?

One of the most distressing symptoms that I encounter in practice is oral mucositis. This condition is the development of painful ulcers or sores on the lining of the mouth. It is one of the most common and distressing side effects of cancer therapy, occurring in approximately 20% – 40% of patients receiving standard chemotherapy, up to 80% of those undergoing high-dose chemotherapy for stem cell transplantation, and in nearly all patients receiving head and neck radiation therapy (1).
While the severity of mucositis can vary, more advanced cases can make it difficult to eat, drink, or speak, resulting in a profound reduction in quality of life. These painful ulcers may also lead to infection, weight loss, malnutrition, and aspiration, all of which represent serious complications in vulnerable patients. When severe, mucositis can even force clinicians to delay or discontinue cancer treatment.

Why Does Mucositis Occur?

Although the precise biological mechanisms underlying mucositis are not yet fully understood, it is well established that chemotherapy targets rapidly dividing cells by interfering with DNA replication and inducing cell death (2,3). Because the cells lining the gastrointestinal (GI) tract, including those of the oral mucosa, have a high turnover rate, they are especially susceptible to this cytotoxic damage, leading to impaired tissue regeneration and mucosal breakdown
Certain chemotherapy drugs are more strongly associated with mucositis than others. Research indicates that cytarabine, high-dose 5-fluorouracil (5-FU), alkylating agents, and platinum-based compounds such as oxaliplatin and cisplatin carry a higher risk. Although data on the effects of individual agents are limited, it is well established that when two or more cytotoxic drugs are used in combination, the risk of mucositis increases by approximately 2.5 times (4).

Oral Cryotherapy: A Simple, Evidence-Based Prevention

The Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) strongly recommends oral cryotherapy as a safe and effective strategy to prevent mucositis during specific cancer treatments, particularly in patients receiving conditioning regimens for autologous stem cell transplantation or bolus doses of 5-fluorouracil (5-FU).
Oral cryotherapy involves cooling the oral cavity using ice chips or specialised cooling devices during chemotherapy infusion. The concept is similar to that of scalp cooling caps used to prevent chemotherapy-induced hair loss, but in this case, the cooling is applied inside the mouth to protect the oral mucosa. The cold temperature induces vasoconstriction (narrowing of blood vessels), which reduces blood flow to the oral mucosa and thereby limits the amount of chemotherapy drug reaching the tissues. This results in less mucosal injury and inflammation.

Enhancing Cryotherapy with Chamomile

But what if the effects of cryotherapy could be enhanced even further? Researchers have explored ways to further harness the protective effects of oral cryotherapy by combining it with herbal agents known for their soothing and anti-inflammatory properties (5). One such agent is chamomile, a traditional herbal remedy that has been used for centuries to treat inflammatory conditions of the mouth, throat, and gastrointestinal tract.

Chamomile is rich in more than 120 active constituents, including flavonoids and terpenoids, which contribute to its anti-inflammatory, antioxidant, antibacterial, antifungal, and anticancer effects. Chamomile’s anti-inflammatory properties, in particular, make it a promising candidate for supporting mucosal healing in patients undergoing cancer treatment (5).

With these beneficial properties in mind, researchers in 2016 investigated whether adding chamomile extract to the ice used in oral cryotherapy could improve its protective effects. In this study, participants receiving 5-fluorouracil chemotherapy were instructed to swish ice made with 2.5% chamomile extract around their mouths for 30 minutes during infusion over five consecutive days (6).

The results of the 2016 study were remarkable:

• None of the patients in the chamomile group developed grade 2 or higher mucositis.
• By day 22, no patients in the chamomile group had mucositis, compared with 11% in the plain ice control group.

These findings suggest that combining chamomile extract with cryotherapy may enhance its mucosal protective effects.

Performing Cryotherapy with Ice

When preparing ice for cryotherapy, special care should be taken to prevent contamination, particularly for immunocompromised patients. Using filtered or reverse osmosis water is recommended to reduce microbial risk.
Patients should begin holding ice chips in their mouths for approximately 5–15 minutes before the start of chemotherapy infusion, allowing adequate time for vasoconstriction to occur. This constriction helps limit the delivery of cytotoxic agents to the oral mucosa.

Although oral cryotherapy is generally safe and well tolerated, some patients experience mild, transient side effects, including:

• Altered or reduced oral sensation
• Dental sensitivity
• Nausea
• Ice-induced headaches or chills
• Uneven cooling of the oral mucosa

A minor risk of microbial contamination exists if the ice or cooling water is not handled hygienically.
Because cryotherapy relies on vasoconstriction, it may temporarily reduce taste and smell perception. These sensory changes are reversible once normal oral temperature is restored.

It is also important to recognize that some patients may develop a psychological aversion to stimuli associated with chemotherapy. For instance, individuals who use ice during treatment may later find the sight, taste, or feel of ice unpleasant, as it becomes linked with the memory of chemotherapy. This is relatively common and may affect comfort or adherence in future treatment cycles.

Oral cryotherapy is an effective, low-cost, and evidence-supported strategy for preventing oral mucositis in selected chemotherapy regimens. When prepared hygienically and used appropriately, it can significantly reduce the severity and duration of mucosal injury. Emerging evidence suggests that herbal adjuncts such as chamomile may further enhance these protective effects, offering a promising area for future clinical research.