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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

Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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.

Keywords

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

Notes

Acknowledgements

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.

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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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