From the Guidelines
Mucositis relief using mouthwash is achievable with several treatment options.
Treatment Options
- Benzydamine mouthwash: is recommended to prevent oral mucositis in patients with head and neck cancer receiving moderate dose radiation therapy (up to 50 Gy), without concomitant chemotherapy 1, 2.
- Doxepin mouthwash: may be effective to treat pain due to oral mucositis, with a suggested concentration of 0.5% 3, 4.
- Morphine mouthwash: may be effective to treat pain due to oral mucositis in patients receiving chemoradiation therapy for head and neck cancer, with a suggested concentration of 0.2% 4.
- Oral care protocols: including good oral hygiene and prophylactic mouth rinses, such as sodium bicarbonate, may be used for prevention of mucositis 5.
- Local anesthetics: such as lidocaine, may be used to treat mucositis either as a component of a mouth rinse or separately, in a liquid or gel formulation 5. It is essential to note that the effectiveness of these ingredients for preventing or treating mucositis and the evidence supporting their use varies, and therefore, the choice of mouthwash should be individualized and based on the specific patient's needs and medical history.
From the Research
Treatment Options for Mucositis Relief Using Mouthwash
- Various mouthwashes have been studied for their effectiveness in treating mucositis, including: + Salt and soda mouthwash, which was found to be comparable in effectiveness to chlorhexidine and "magic" mouthwash (lidocaine, Benadryl, and Maalox) in a randomized clinical trial 6 + Sodium bicarbonate mouthwash, which was shown to be effective in reducing the severity of oral mucositis and improving quality of life in patients with cancer undergoing chemotherapy 7 + Zinc chloride mouthwash, which was also found to be effective in reducing the severity of oral mucositis and improving quality of life in patients with cancer undergoing chemotherapy 7 + Ectoine-containing mouthwash, which was found to be safe, well-tolerated, and effective for the active treatment of oral mucositis following chemotherapy, with comparable effectiveness to calcium phosphate mouthwash 8 + Benzydamine mouthwash, which is recommended for the prevention of radiotherapy-induced mucositis and suggested for the prevention of mucositis associated with chemoradiotherapy 9 + Chlorhexidine mouthwash, which was compared to benzydamine mouthwash in a study and found to have similar efficacy in controlling pain and mucositis, but better patient acceptance 10
Comparison of Mouthwashes
- A study comparing the effectiveness of salt and soda, chlorhexidine, and "magic" mouthwash found no significant differences in time to cessation of mucositis symptoms among the three groups 6
- A study comparing sodium bicarbonate and zinc chloride mouthwashes found both to be effective in reducing the severity of oral mucositis and improving quality of life in patients with cancer undergoing chemotherapy 7
- A study comparing ectoine-containing mouthwash to calcium phosphate mouthwash found both to be effective in treating oral mucositis, with ectoine mouthwash being more preferred by patients 8
- A systematic review of anti-inflammatory agents for the management of oral mucositis found evidence to support the use of benzydamine mouthwash in specific populations, but inadequate or conflicting evidence for other agents 9