From the Guidelines
BMT mouthwash is not recommended to contain GM-CSF, pentoxifylline, or other suggested interventions that have been shown to be ineffective in preventing oral mucositis in patients undergoing bone marrow transplantation, as stated in the guidelines 1. The standard formula for BMT mouthwash typically contains equal parts of Benadryl (diphenhydramine), Maalox (or Mylanta), and viscous lidocaine, mixed together to create a soothing rinse.
- Patients usually swish 1-2 teaspoons (5-10 ml) in their mouth for 1-2 minutes before spitting it out, repeating every 4-6 hours as needed.
- This mixture works by combining the antihistamine effects of diphenhydramine to reduce inflammation, the coating properties of Maalox to protect irritated tissues, and the numbing effect of lidocaine to relieve pain. Some variations may include antibiotics like nystatin to prevent fungal infections.
- Patients should avoid eating or drinking for 30 minutes after use and should not swallow large amounts of the mixture due to potential systemic effects of lidocaine.
- The mouthwash should be stored in the refrigerator and discarded after 7-14 days. If pain persists or worsens despite using BMT mouthwash, patients should contact their healthcare provider, as low-level laser therapy (LLLT) or other interventions may be suggested to reduce the incidence of oral mucositis and its associated pain 1.
From the Research
BMT Mouthwash Studies
- The use of chlorhexidine mouthwash in BMT patients has been studied for its effectiveness in reducing oral mucositis and infection [(2,3)].
- A study published in 1989 found that chlorhexidine use resulted in a trend toward improved oral hygiene index, but did not modify the oral mucositis 2.
- However, another study published in 1988 found that chlorhexidine mouthrinse produced significant reductions in the incidence and severity of oral mucositis 3.
- The same study also found concomitant reductions in total oral streptococci and oral candida in patients using chlorhexidine 3.
Oral Mucositis and Infection
- Oral mucositis is a common complication of BMT, and can lead to systemic infection and other complications [(2,4)].
- A study published in 2012 found that professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic BMT 5.
- Another study published in 1985 found that oral mucositis was more severe and of longer duration when associated with herpes simplex infections and when optimal oral hygiene was not maintained 4.
Chlorhexidine Resistance
- A study published in 1989 found that the use of chlorhexidine mouthrinse did not lead to changes in sensitivity or resistance to chlorhexidine in oral gram-negative bacilli 6.
- The study suggested that the mouths of BMT patients should be routinely monitored for gram-negative bacilli, as are other clinically important sites 6.