Systematic review of basic oral care for the management of oral mucositis in cancer patients and clinical practice guidelines

  • Catherine H. L. HongEmail author
  • Luiz Alcino Gueiros
  • Janet S. Fulton
  • Karis Kin Fong Cheng
  • Abhishek Kandwal
  • Dimitra Galiti
  • Jane M. Fall-Dickson
  • Jorgen Johansen
  • Suzanne Ameringer
  • Tomoko Kataoka
  • Dianna Weikel
  • June Eilers
  • Vinasha Ranna
  • Anusha Vaddi
  • Rajesh V. Lalla
  • Paolo Bossi
  • Sharon Elad
  • On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO)
Special Article



The aim of this study was to update the clinical practice guidelines for the use of basic oral care (BOC) interventions for the prevention and/or treatment of oral mucositis (OM).


A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention in each cancer treatment setting was assigned an evidence level. The findings were added to the database used to develop the 2013 MASCC/ISOO clinical practice guidelines. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, No guideline possible.


A total of 17 new papers across six interventions were examined and merged with a previous database. Based on the literature, the following guidelines were possible. The panel suggests that the implementation of multi-agent combination oral care protocols is beneficial for the prevention of OM during chemotherapy, head and neck (H&N) radiation therapy (RT), and hematopoietic stem cell transplantation (Level of Evidence III). The panel suggests that chlorhexidine not be used to prevent OM in patients undergoing H&N RT (Level of Evidence III). No guideline was possible for professional oral care, patient education, saline, and sodium bicarbonate, and expert opinion complemented these guidelines.


The evidence supports the use of multi-agent combination oral care protocols in the specific populations listed above. Additional well-designed research is needed on the other BOC interventions prior to guideline formulation.


Basic oral care Chlorhexidine Oral mucositis Sodium bicarbonate Saline Patient education Dental care Guidelines Cancer 



The authors would like to gratefully acknowledge Mr. Eyal Zur, BSc Pharm, RPh, MBA, for the calculations of the hydrogen peroxide and sodium bicarbonate concentrations under the bland mouth rinses in the results section.The authors are also thankful for the medical librarians for their valuable contribution to this project: Lorraine Porcello, MSLIS, MSIM – Bibby Dental Library, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA; Daniel A. Castillo, MLIS – Edward G. Miner Library, University of Rochester Medical Center, Rochester, NY, USA.

Compliance with ethical standards

Conflict of interest

Per the MASCC Guidelines Policy, employees of commercial entities were not eligible to serve on this MASCC Guidelines Panel. The following authors disclose no conflict of interest (CHLH, LAG, JF, KKFC, AK, DG, JMFD, JJ, SA, TK, DW, JE, VR, AV, SE). PB has served an advisory role for AstraZeneca, Helsinn, and Kyowa Kyrin and received grants from Merck, Kyowa Kyrin, and Roche. RVL has served as a consultant for Colgate Oral Pharmaceuticals, Galera Therapeutics, Ingalfarma SA, Monopar Therapeutics, Mundipharma, and Sucampo Pharma; has received research support to his institution from Galera Therapeutics, Novartis, Oragenics, and Sucampo Pharma; and has received stock in Logic Biosciences.


  1. 1.
    Bellm LA, Epstein JB, Rose-Ped A, Martin P, Fuchs HJ (2000) Patient reports of complications of bone marrow transplantation. Support Care Cancer 8(1):33–39Google Scholar
  2. 2.
    Elting LS, Cooksley CD, Chambers MS, Garden AS (2007) Risk, outcomes, and costs of radiation-induced oral mucositis among patients with head-and-neck malignancies. Int J Radiat Oncol Biol Phys 68(4):1110–1120CrossRefGoogle Scholar
  3. 3.
    Sonis ST, Elting LS, Keefe D, Peterson DE, Schubert M, Hauer-Jensen M, Bekele BN, Raber-Durlacher J, Donnelly JP, Rubenstein EB, for the Mucositis Study Section of the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology (2004) Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer 100(9 Suppl):1995–2025CrossRefGoogle Scholar
  4. 4.
    Robien K, Schubert MM, Bruemmer B, Lloid ME, Potter JD, Ulrich CM (2004) Predictors of oral mucositis in patients receiving hematopoietic cell transplants for chronic myelogenous leukemia. J Clin Oncol 22(7):1268–1275CrossRefGoogle Scholar
  5. 5.
    Lalla RV, Saunders DP, Peterson DE (2014) Chemotherapy or radiation-induced oral mucositis. Dent Clin N Am 58(2):341–349CrossRefGoogle Scholar
  6. 6.
    Al-Dasooqi N, Sonis ST, Bowen JM, Bateman E, Blijlevens N, Gibson RJ, Logan RM, Nair RG, Stringer AM, Yazbeck R, Elad S, Lalla RV (2013) Emerging evidence on the pathobiology of mucositis. Support Care Cancer 21(7):2075–2083Google Scholar
  7. 7.
    Sonis ST (2004) Pathobiology of mucositis. Semin Oncol Nurs 20(1):11–15CrossRefGoogle Scholar
  8. 8.
    Rubenstein EB, Peterson DE, Schubert M, Keefe D, McGuire D, Epstein J, Elting LS, Fox PC, Cooksley C, Sonis ST (2004) Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 100(9 Suppl):2026–2046Google Scholar
  9. 9.
    Worthington HV, Clarkson JE, Bryan G, Furness S, Glenny AM, Littlewood A, McCabe MG, Meyer S, Khalid T (2010) Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev (12):CD000978Google Scholar
  10. 10.
    Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, Migliorati CA, McGuire DB, Hutchins RD, Peterson DE, (2007) for the mucositis study section of the multinational association of supportive care in cancer, and the international society for oral oncology, updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 109(5):820–831Google Scholar
  11. 11.
    Stringer AM, Logan RM (2015) The role of oral flora in the development of chemotherapy-induced oral mucositis. J Oral Pathol Med 44(2):81–87CrossRefGoogle Scholar
  12. 12.
    Vasconcelos RM, N Sanfilippo, Paster BJ, Kerr AR, Li Y, Ramalho L, Queiroz EL, Smith B, Sonis ST, & Corby PM (2016) Host-microbiome cross-talk in Oral mucositis. J Dent Res 95(7):725–733Google Scholar
  13. 13.
    Vanhoecke B, de Ryck T, Stringer A, van de Wiele T, Keefe D (2015) Microbiota and their role in the pathogenesis of oral mucositis. Oral Dis 21(1):17–30CrossRefGoogle Scholar
  14. 14.
    Lalla RV, Sonis ST, Peterson DE (2008) Management of oral mucositis in patients who have cancer. Dent Clin N Am 52(1):61–77 viiiCrossRefGoogle Scholar
  15. 15.
    McGuire DB, Fulton JS, Park J, Brown CG, Correa ME, Eilers J, Elad S, Gibson F, Oberle-Edwards LK, Bowen J, Lalla RV (2013) Systematic review of basic oral care for the management of oral mucositis in cancer patients. Support Care Cancer 21(11):3165–3177Google Scholar
  16. 16.
    Ranna V, Cheng K, Castillo D, Porcello L, Vaddi A, Lalla R, Bossi P, Elad S (2019) Development of the MASCC/ISOO clinical practice guidelines for mucositis: an overview of the methods support care. Support Care Cancer
  17. 17.
    Somerfield M, Padberg J, Pfister D, Bennett C, Recht A, Smith T, Weeks J, Winn R, Duraant J (2000) ASCO clinical practice guidelines: process, progress, pitfalls, and prospects. Classic Papers and Current Comments 4:881–886Google Scholar
  18. 18.
    Hadorn DC, Baker D, Hodges JS, Hicks N (1996) Rating the quality of evidence for clinical practice guidelines. J Clin Epidemiol 49(7):749–754CrossRefGoogle Scholar
  19. 19.
    Coke L, Otten K, Staffileno B, Minarich L, Nowiszewski C (2015) The impact of an oral hygiene education module on patient practices and nursing documentation. Clin J Oncol Nurs 19(1):75–80CrossRefGoogle Scholar
  20. 20.
    Lanzos I, Herrera D, Lanzós E, Sanz M (2015) A critical assessment of oral care protocols for patients under radiation therapy in the regional University Hospital Network of Madrid (Spain). J Clin Exp Dent 7(5):e613–e621Google Scholar
  21. 21.
    Tringali CA, Kanaskie ML (2012) Measuring the impact of an educational program on nurses: teaching an evidence-based approach to oral mucositis. J Nurses Staff Dev 28(6):E1–E4CrossRefGoogle Scholar
  22. 22.
    Morais MO, Elias MRA, Leles CR, Dourado Pinezi JC, Mendonça EF (2016) The effect of preventive oral care on treatment outcomes of a cohort of oral cancer patients. Support Care Cancer 24(4):1663–1670CrossRefGoogle Scholar
  23. 23.
    Qutob AF, Allen G, Gue S, Revesz T, Logan RM, Keefe D (2013) Implementation of a hospital oral care protocol and recording of oral mucositis in children receiving cancer treatment : a retrospective and a prospective study. Support Care Cancer 21(4):1113–1120CrossRefGoogle Scholar
  24. 24.
    Martinez JM, Pereira D, Chacim S, Mesquita E, Sousa I, Martins Â, Azevedo T, Mariz JM (2014) Mucositis care in acute leukemia and non-Hodgkin lymphoma patients undergoing high-dose chemotherapy. Support Care Cancer 22(9):2563–2569Google Scholar
  25. 25.
    Soares AF, Aquino ARL, Carvalho CHP, Nonaka CFW, Almeida D, Pinto LP (2011) Frequency of oral mucositis and microbiological analysis in children with acute lymphoblastic leukemia treated with 0.12% chlorhexidine gluconate. Braz Dent J 22(4):312–316CrossRefGoogle Scholar
  26. 26.
    Mason H, DeRubeis MB, Foster JC, Taylor JMG, Worden FP (2013) Outcomes evaluation of a weekly nurse practitioner-managed symptom management clinic for patients with head and neck cancer treated with chemoradiotherapy. Oncol Nurs Forum 40(6):581–586Google Scholar
  27. 27.
    Salvador P, Azusano C, Wang L, Howell D (2012) A pilot randomized controlled trial of an oral care intervention to reduce mucositis severity in stem cell transplant patients. J Pain Symptom Manag 44(1):64–73CrossRefGoogle Scholar
  28. 28.
    Soga Y, Sugiura Y, Takahashi K, Nishimoto H, Maeda Y, Tanimoto M, Takashiba S (2010) Progress of oral care and reduction of oral mucositis--a pilot study in a hematopoietic stem cell transplantation ward. Support Care Cancer 19(2):303–307Google Scholar
  29. 29.
    Saito H, Watanabe Y, Sato K, Ikawa H, Yoshida Y, Katakura A, Takayama S, Sato M (2014) Effects of professional oral health care on reducing the risk of chemotherapy-induced oral mucositis. Support Care Cancer 22(11):2935–2940CrossRefGoogle Scholar
  30. 30.
    Kartin PT, Tasci S, Soyuer S, Elmali F (2014) Effect of an oral mucositis protocol on quality of life of patients with head and neck cancer treated with radiation therapy. Clin J Oncol Nurs 18(6):E118–E125CrossRefGoogle Scholar
  31. 31.
    Leppla L, de Geest S, Fierz K, Deschler-Baier B, Koller A (2016) An oral care self-management support protocol (OrCaSS) to reduce oral mucositis in hospitalized patients with acute myeloid leukemia and allogeneic hematopoietic stem cell transplantation: a randomized controlled pilot study. Support Care Cancer 24(2):773–782CrossRefGoogle Scholar
  32. 32.
    Diaz-Sanchez RM, Pachón-Ibáñez J, Marín-Conde F, Rodríguez-Caballero Á, Gutierrez-Perez JL, Torres-Lagares D (2015) Double-blind, randomized pilot study of bioadhesive chlorhexidine gel in the prevention and treatment of mucositis induced by chemoradiotherapy of head and neck cancer. Med Oral Patol Oral Cir Bucal 20(3):e378–e385Google Scholar
  33. 33.
    Choi SE, Kim HS (2012) Sodium bicarbonate solution versus chlorhexidine mouthwash in oral care of acute leukemia patients undergoing induction chemotherapy: a randomized controlled trial. Asian Nurs Res (Korean Soc Nurs Sci) 6(2):60–66CrossRefGoogle Scholar
  34. 34.
    Mehdipour M, Taghavi Zenoz A, Asvadi Kermani I, Hosseinpour A (2011) A comparison between zinc sulfate and chlorhexidine gluconate mouthwashes in the prevention of chemotherapy-induced oral mucositis. Daru 19(1):71–73Google Scholar
  35. 35.
    Mutters NT, Neubert TR, Nieth R, Mutters R (2015) The role of Octenidol((R)), Glandomed((R)) and chlorhexidine mouthwash in the prevention of mucositis and in the reduction of the oropharyngeal flora: a double-blind randomized controlled trial. GMS Hyg Infect Control 10:Doc05Google Scholar
  36. 36.
    Roopashri G, Jayanthi K, Guruprasad R (2011) Efficacy of benzydamine hydrochloride, chlorhexidine, and povidone iodine in the treatment of oral mucositis among patients undergoing radiotherapy in head and neck malignancies: a drug trail. Contemp Clin Dent 2(1):8–12CrossRefGoogle Scholar
  37. 37.
    Djuric M, Hillier-Kolarov V, Belic A, Jankovic L (2006) Mucositis prevention by improved dental care in acute leukemia patients. Support Care Cancer 14(2):137–146CrossRefGoogle Scholar
  38. 38.
    Yoneda S, Imai S, Hanada N, Yamazaki T, Senpuku H, Ota Y, Uematsu H (2007) Effects of oral care on development of oral mucositis and microorganisms in patients with esophageal cancer. Jpn J Infect Dis 60(1):23–28Google Scholar
  39. 39.
    Kubota K, Kobayashi W, Sakaki H, Nakagawa H, Kon T, Mimura M, Ito R, Furudate K, Kimura H (2015) Professional oral health care reduces oral mucositis pain in patients treated by superselective intra-arterial chemotherapy concurrent with radiotherapy for oral cancer. Support Care Cancer 23(11):3323–3329CrossRefGoogle Scholar
  40. 40.
    Yokota T, Tachibana H, Konishi T, Yurikusa T, Hamauchi S, Sakai K, Nishikawa M, Suzuki M, Naganawa Y, Hagihara T, Tsumaki H, Kubo T, Sato M, Taguri M, Morita S, Eguchi T, Kubota K, Zenda S (2016) Multicenter phase II study of an oral care program for patients with head and neck cancer receiving chemoradiotherapy. Support Care Cancer 24(7):3029–3036Google Scholar
  41. 41.
    Melkos AB, Massenkeil G, Arnold R, Reichart PA (2003) Dental treatment prior to stem cell transplantation and its influence on the posttransplantation outcome. Clin Oral Investig 7(2):113–115CrossRefGoogle Scholar
  42. 42.
    Santos PS, Coracin FL, Barros JC, Dulley FL, Nunes FD, Magalhães MG (2011) Impact of oral care prior to HSCT on the severity and clinical outcomes of oral mucositis. Clin Transpl 25(2):325–328Google Scholar
  43. 43.
    Kashiwazaki H, Matsushita T, Sugita J, Shigematsu A, Kasashi K, Yamazaki Y, Kanehira T, Yamamoto S, Kondo T, Endo T, Tanaka J, Hashino S, Nishio M, Imamura M, Kitagawa Y, Inoue N (2012) Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation. Support Care Cancer 20(2):367–373CrossRefGoogle Scholar
  44. 44.
    Gurgan CA, Özcan M, Karakus Ö, Zincircioglu G, Arat M, Soydan E, Topcuoglu P, Gürman G, Bostanci HS (2013) Periodontal status and post-transplantation complications following intensive periodontal treatment in patients underwent allogenic hematopoietic stem cell transplantation conditioned with myeloablative regimen. Int J Dent Hyg 11(2):84–90Google Scholar
  45. 45.
    Rojas de Morales T, Zambrano O, Rivera L, Navas R, Chaparro N, Bernardonni C, Rivera F, Fonseca N, Tirado DM (2001) Oral-disease prevention in children with cancer: testing preventive protocol effectiveness. Med Oral 6(5):326–334Google Scholar
  46. 46.
    Levy-Polack MP, Sebelli P, Polack NL (1998) Incidence of oral complications and application of a preventive protocol in children with acute leukemia. Spec Care Dentist 18(5):189–193CrossRefGoogle Scholar
  47. 47.
    Cheng KK, Molassiotis A, Chang AM, Wai WC, Cheung SS (2001) Evaluation of an oral care protocol intervention in the prevention of chemotherapy-induced oral mucositis in paediatric cancer patients. Eur J Cancer 37(16):2056–2063Google Scholar
  48. 48.
    Cheng KK, Molassiotis A, Chang AM (2002) An oral care protocol intervention to prevent chemotherapy-induced oral mucositis in paediatric cancer patients: a pilot study. Eur J Oncol Nurs 6(2):66–73CrossRefGoogle Scholar
  49. 49.
    Chen CF, Wang RH, Cheng SN, Chang YC (2004) Assessment of chemotherapy-induced oral complications in children with cancer. J Pediatr Oncol Nurs 21(1):33–39CrossRefGoogle Scholar
  50. 50.
    Kenny SA (1990) Effect of two oral care protocols on the incidence of stomatitis in hematology patients. Cancer Nurs 13(6):345-53CrossRefGoogle Scholar
  51. 51.
    Shieh SH, Wang ST, Tsai ST, Tseng CC (1997) Mouth care for nasopharyngeal cancer patients undergoing radiotherapy. Oral Oncol 33(1):36–41Google Scholar
  52. 52.
    Janjan NA, Weissman DE, and Pahule A (1992) Improved pain management with daily nursing intervention during radiation therapy for head and neck carcinoma. Int J Radiat Oncol Biol Phys 23(3):647–652Google Scholar
  53. 53.
    Yuce UO, Yurtsever S (2017) Effect of education about oral mucositis given to the cancer patients having chemotherapy on life quality. J Cancer EducGoogle Scholar
  54. 54.
    Borowski B, Benhamou E, Pico JL, Laplanche A, Margainaud JP, Hayat M (1994) Prevention of oral mucositis in patients treated with high-dose chemotherapy and bone marrow transplantation: a randomised controlled trial comparing two protocols of dental care. Eur J Cancer B Oral Oncol 30B(2):93–97Google Scholar
  55. 55.
    Bhatt V, Vendrell N, Nau K, Crumb D, Roy V (2010) Implementation of a standardized protocol for prevention and management of oral mucositis in patients undergoing hematopoietic cell transplantation. J Oncol Pharm Pract 16(3):195–204CrossRefGoogle Scholar
  56. 56.
    Yamagata K, Arai C, Sasaki H, Takeuchi Y, Onizawa K, Yanagawa T, Ishibashi N, Karube R, Shinozuka K, Hasegawa Y, Chiba S, Bukawa H (2012) The effect of oral management on the severity of oral mucositis during hematopoietic SCT. Bone Marrow Transplant 47(5):725–730CrossRefGoogle Scholar
  57. 57.
    Legert KG, Remberger M, Ringdén O, Heimdahl A, Dahllöf G (2014) Reduced intensity conditioning and oral care measures prevent oral mucositis and reduces days of hospitalization in allogeneic stem cell transplantation recipients. Support Care Cancer 22(8):2133–2140CrossRefGoogle Scholar
  58. 58.
    Schmidt H, Boese S, Bauer A, Landenberger M, Lau A, Stoll O, Schmoll HJ, Mauz-Koerholz C, Kuss O, Jahn P (2017) Interdisciplinary care programme to improve self-management for cancer patients undergoing stem cell transplantation: a prospective non-randomised intervention study. Eur J Cancer Care (Engl) 26(4)Google Scholar
  59. 59.
    Yavuz B, Bal Yilmaz H (2015) Investigation of the effects of planned mouth care education on the degree of oral mucositis in pediatric oncology patients. J Pediatr Oncol Nurs 32(1):47–56CrossRefGoogle Scholar
  60. 60.
    Feber T (1996) Management of mucositis in oral irradiation. Clin Oncol (R Coll Radiol) 8(2):106–111CrossRefGoogle Scholar
  61. 61.
    Vokurka S, Bystřická E, Koza V, Sčudlová J, Pavlicová V, Valentová D, Bocková J, Mišaniová L (2005) The comparative effects of povidone-iodine and normal saline mouthwashes on oral mucositis in patients after high-dose chemotherapy and APBSCT--results of a randomized multicentre study. Support Care Cancer 13(7):554–558CrossRefGoogle Scholar
  62. 62.
    Dudjak LA (1987) Mouth care for mucositis due to radiation therapy. Cancer Nurs 10(3):131–140CrossRefGoogle Scholar
  63. 63.
    McGaw WT, Belch A (1985) Oral complications of acute leukemia: prophylactic impact of a chlorhexidine mouth rinse regimen. Oral Surg Oral Med Oral Pathol 60(3):275–280CrossRefGoogle Scholar
  64. 64.
    Ferretti GA, Raybould TP, Brown AT, Macdonald JS, Greenwood M, Maruyama Y, Geil J, Lillich TT, Ash RC (1990) Chlorhexidine prophylaxis for chemotherapy- and radiotherapy-induced stomatitis: a randomized double-blind trial. Oral Surg Oral Med Oral Pathol 69(3):331–338CrossRefGoogle Scholar
  65. 65.
    Rutkauskas JS, Davis JW (1993) Effects of chlorhexidine during immunosuppressive chemotherapy. A preliminary report. Oral Surg Oral Med Oral Pathol 76(4):441–448CrossRefGoogle Scholar
  66. 66.
    Dodd MJ, Larson PJ, Dibble SL, Miaskowski C, Greenspan D, MacPhail L, Hauck WW, Paul SM, Ignoffo R, Shiba G (1996) Randomized clinical trial of chlorhexidine versus placebo for prevention of oral mucositis in patients receiving chemotherapy. Oncol Nurs Forum 23(6):921–927Google Scholar
  67. 67.
    Sorensen JB, Skovsgaard T, Bork E, Damstrup L, Ingeberg S (2008) Double-blind, placebo-controlled, randomized study of chlorhexidine prophylaxis for 5-fluorouracil-based chemotherapy-induced oral mucositis with nonblinded randomized comparison to oral cooling (cryotherapy) in gastrointestinal malignancies. Cancer 112(7):1600–1606CrossRefGoogle Scholar
  68. 68.
    Spijkervet FK, van Saene HK, Panders AK, Vermey A, van Saene JJ, Mehta DM, Fidler V (1989) Effect of chlorhexidine rinsing on the oropharyngeal ecology in patients with head and neck cancer who have irradiation mucositis. Oral Surg Oral Med Oral Pathol 67(2):154–161Google Scholar
  69. 69.
    Foote RL, Loprinzi CL, Frank AR, O'Fallon JR, Gulavita S, Tewfik HH, Ryan MA, Earle JM, Novotny P (1994) Randomized trial of a chlorhexidine mouthwash for alleviation of radiation-induced mucositis. J Clin Oncol 12(12):2630–2633CrossRefGoogle Scholar
  70. 70.
    Ferretti GA, Ash RC, Brown AT, Parr MD, Romond EH, Lillich TT (1988) Control of oral mucositis and candidiasis in marrow transplantation: a prospective, double-blind trial of chlorhexidine digluconate oral rinse. Bone Marrow Transplant 3(5):483–493Google Scholar
  71. 71.
    Raether D, Walker PO, Bostrum B, Weisdorf D (1989) Effectiveness of oral chlorhexidine for reducing stomatitis in a pediatric bone marrow transplant population. Pediatr Dent 11(1):37–42Google Scholar
  72. 72.
    Weisdorf DJ, Bostrom B, Raether D, Mattingly M, Walker P, Pihlstrom B, Ferrieri P, Haake R, Goldman A, Woods W, et al. (1989) Oropharyngeal mucositis complicating bone marrow transplantation: prognostic factors and the effect of chlorhexidine mouth rinse. Bone Marrow Transplant 4(1):89–95Google Scholar
  73. 73.
    Pitten FA, Kiefer T, Buth C, Doelken G, Kramer A (2003) Do cancer patients with chemotherapy-induced leukopenia benefit from an antiseptic chlorhexidine-based oral rinse? A double-blind, block-randomized, controlled study. J Hosp Infect 53(4):283–291CrossRefGoogle Scholar
  74. 74.
    Cheng KK, Chang AM, Yuen MP (2004) Prevention of oral mucositis in paediatric patients treated with chemotherapy; a randomised crossover trial comparing two protocols of oral care. Eur J Cancer 40(8):1208–1216CrossRefGoogle Scholar
  75. 75.
    Dodd MJ, Dibble SL, Miaskowski C, MacPhail L, Greenspan D, Paul SM, Shiba G, Larson P (2000) Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90(1):39–47CrossRefGoogle Scholar
  76. 76.
    Samaranayake LP, Robertson AG, MacFarlane TW, Hunter IP, MacFarlane G, Soutar DS, Ferguson MM (1988) The effect of chlorhexidine and benzydamine mouthwashes on mucositis induced by therapeutic irradiation. Clin Radiol 39(3):291–294CrossRefGoogle Scholar
  77. 77.
    Kin-Fong Cheng K, Ka Tsui Yuen J (2006) A pilot study of chlorhexidine and benzydamine oral rinses for the prevention and treatment of irradiation mucositis in patients with head and neck cancer. Cancer Nurs 29(5):423–430CrossRefGoogle Scholar
  78. 78.
    Madan PD, Sequeira PS, Shenoy K, Shetty J (2008) The effect of three mouthwashes on radiation-induced oral mucositis in patients with head and neck malignancies: a randomized control trial. J Cancer Res Ther 4(1):3–8Google Scholar
  79. 79.
    Epstein JB, Vickars L, Spinelli J, Reece D (1992) Efficacy of chlorhexidine and nystatin rinses in prevention of oral complications in leukemia and bone marrow transplantation. Oral Surg Oral Med Oral Pathol 73(6):682–689CrossRefGoogle Scholar
  80. 80.
    Dodd MJ, Miaskowski C, Greenspan D, MacPhail L, Shih AS, Shiba G, Facione N, Paul SM (2003) Radiation-induced mucositis: a randomized clinical trial of micronized sucralfate versus salt & soda mouthwashes. Cancer Investig 21(1):21–33Google Scholar
  81. 81.
    Seto BG, Kim M, Wolinsky L, Mito RS, Champlin R (1985) Oral mucositis in patients undergoing bone marrow transplantation. Oral Surg Oral Med Oral Pathol 60(5):493–497CrossRefGoogle Scholar
  82. 82.
    Lindquist SF, Hickey AJ, Drane JB (1978) Effect of oral hygiene on stomatitis in patients receiving cancer chemotherapy. J Prosthet Dent 40(3):312–314CrossRefGoogle Scholar
  83. 83.
    Antunes HS, Ferreira EM, de Faria LM, Schirmer M, Rodrigues PC, Small IA, Colares M, Bouzas LF, Ferreira CG (2010) Streptococcal bacteraemia in patients submitted to hematopoietic stem cell transplantation: the role of tooth brushing and use of chlorhexidine. Med Oral Patol Oral Cir Bucal 15(2):e303–e309Google Scholar
  84. 84.
    Elad S, Raber-Durlacher JE, Brennan MT, Saunders DP, Mank AP, Zadik Y, Quinn B, Epstein JB, Blijlevens NM, Waltimo T, Passweg JR, Correa ME, Dahllöf G, Garming-Legert KU, Logan RM, Potting CM, Shapira MY, Soga Y, Stringer J, Stokman MA, Vokurka S, Wallhult E, Yarom N, Jensen SB (2015) Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer 23(1):223–236Google Scholar
  85. 85.
    Costa EM, et al. (2003) Evaluation of an oral preventive protocol in children with acute lymphoblastic leukemia. Pesqui Odontol Bras 17(2):147–50Google Scholar
  86. 86.
    Cabrera-Jaime S, Martínez C, Ferro-García T, Giner-Boya P, Icart-Isern T, Estrada-Masllorens JM, Fernández-Ortega P (2018) Efficacy of Plantago major, chlorhexidine 0.12% and sodium bicarbonate 5% solution in the treatment of oral mucositis in cancer patients with solid tumour: a feasibility randomised triple-blind phase III clinical trial. Eur J Oncol Nurs 32:40–47CrossRefGoogle Scholar
  87. 87.
    Huang BS, Wu SC, Lin CY, Fan KH, Chang JTC, Chen SC (2018) The effectiveness of a saline mouth rinse regimen and education programme on radiation-induced oral mucositis and quality of life in oral cavity cancer patients: a randomised controlled trial. Eur J Cancer Care (Engl) 27(2):e12819CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Catherine H. L. Hong
    • 1
    Email author
  • Luiz Alcino Gueiros
    • 2
  • Janet S. Fulton
    • 3
  • Karis Kin Fong Cheng
    • 4
  • Abhishek Kandwal
    • 5
  • Dimitra Galiti
    • 6
  • Jane M. Fall-Dickson
    • 7
  • Jorgen Johansen
    • 8
  • Suzanne Ameringer
    • 9
  • Tomoko Kataoka
    • 10
  • Dianna Weikel
    • 11
  • June Eilers
    • 12
  • Vinasha Ranna
    • 13
  • Anusha Vaddi
    • 14
  • Rajesh V. Lalla
    • 15
  • Paolo Bossi
    • 16
  • Sharon Elad
    • 17
  • On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO)
  1. 1.Discipline of Orthodontics and Paediatric Dentistry, Faculty of DentistryNational University of SingaporeSingaporeSingapore
  2. 2.Oral Medicine UnitUniversidade Federal de PernambucoRecifeBrazil
  3. 3.Indiana University School of NursingIndianapolisUSA
  4. 4.Alice Lee Center for Nursing StudiesNational University of SingaporeSingaporeSingapore
  5. 5.Cancer Research Institute, Himalayan Institute of Medical SciencesSwami Rama Himalayan UniversityDehradunIndia
  6. 6.Dental School, University of AthensAthensGreece
  7. 7.Department of Professional Nursing PracticeGeorgetown University School of Nursing & Health StudiesWashington, DCUSA
  8. 8.Department of OncologyOdense University HospitalOdenseDenmark
  9. 9.School of NursingVirginia Commonwealth UniversityRichmondUSA
  10. 10.Multi-institutional Clinical Trials Section, Research Management Division, Clinical Research Support OfficeNational Cancer Center HospitalTokyoJapan
  11. 11.Marlene and Stewart Greenebaum Comprehensive Cancer CenterUniversity of MarylandBaltimoreUSA
  12. 12.College of Nursing—Omaha DivisionUniversity of Nebraska Medical CenterOmahaUSA
  13. 13.Department of Oral and Maxillofacial SurgeryThe Mount Sinai HospitalNew YorkUSA
  14. 14.Oral Medicine, Eastman Institute for Oral HealthUniversity of RochesterRochesterUSA
  15. 15.Section of Oral MedicineUniversity of Connecticut HealthFarmingtonUSA
  16. 16.Department of Medical and Surgical Specialties, Radiological Sciences and Public Health—Medical OncologyUniversity of BresciaBresciaItaly
  17. 17.Oral Medicine, Eastman Institute for Oral HealthUniversity of Rochester Medical CenterRochesterUSA

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