Management Of Mucositis Research Articles

Pharmaceutical Interventions in the Management of Oral Mucositis in Cancer Patients Undergoing Dental Treatments: A Randomized Controlled Trial

Benzydamine hydrochloride, chlorhexidine as mouthwash, amifostine, palifermin, and a placebo were the five treatments that were investigated in this study. Oral mucositis is a common adverse effect of cancer treatment, and this study aimed to analyse and compare the effectiveness of these treatments. For the purpose of evaluating the treatments, we used descriptive statistics, analysis of variance (ANOVA), and rigorous tests to determine whether or not the means were equal. We took into account standard scores, deviations from the mean, and statistically significant differences. The data showed significant differences in the mean scores of each treatment group (p 0.001), indicating that different treatments had different levels of effectiveness in treating oral mucositis. Benzydamine hydrochloride consistently had superior mean scores and lower standard deviations compared to chlorine dioxide mouthwash, amifostine, palifermin, and the placebo. Oral mucositis may be treated with a variety of different medications, however the research suggests that benzydamine hydrochloride in is the most successful option. These results have significant ramifications for the decisions that should be made for therapy based on evidence, and they highlight the need to compare the relative efficacy of the many drugs used to treat oral mucositis. Additional research is required to examine the underlying mechanisms and unique treatment responses, which will pave the way for more individualised and effective treatment approaches.

Nursing care approaches to oral mucositis in pediatric oncology clinics: a cross-sectional study from Türkiye.

It is important to determine the approaches for oral mucositis (OM) care in pediatric oncology clinics to reflect the profile of practices. The aim of this study was to report on current nursing care approaches for OM in Türkiye. The descriptive, cross-sectional study was conducted with nurse managers in pediatric oncology centers in Türkiye between April and December 2022. The data were obtained online by reaching pediatric oncology nurse managers. The data was collected with the "Oral Mucositis Care Application Form" developed by the researchers based on current literature. The study reached approximately 60% (n = 41) of pediatric oncology clinics across Türkiye. Oral assessment of children was mainly conducted by nurses (95.1%), and 53.7% of clinics used the WHO Oral Mucositis Assessment Scale. To prevent OM, oral care routines were performed twice a day (36.6%) using sodium bicarbonate (61%) and 0.9% sodium chloride (26.8%) agents. For oral mucositis management, pharmacological agents included glutamine (oral) (51.2%), chlorhexidine (43.9%), and benzydamine hydrochloride (36.6%), while non-pharmacological agents included black mulberry syrup (41.5%), honey (19.8%), and chewing gum (9.8%). Chlorhexidine and benzydamine hydrochloride were used for all mucositis grades, while glutamine was frequently used for grades 2 and above. The study revealed that the practices related to preventing and managing oral mucositis in pediatric oncology clinics in Türkiye are heterogeneous. These findings will contribute to the existing literature on the multidisciplinary, systematic, and evidence-based approaches used in oral mucositis care in Türkiye.

Glycyrrhizin loaded hyaluronic acid nanofiber-based artificial saliva for the management of oral mucositis: Preparation, optimization and in-vitro evaluation

Glycyrrhizin loaded hyaluronic acid nanofiber-based artificial saliva for the management of oral mucositis: Preparation, optimization and in-vitro evaluation

Nurses' knowledge on assessment and management of cancer therapy-associated oral mucositis.

This study aimed to explore baseline nursing knowledge on assessment and management of patients at risk for developing cancer therapy-associated oral mucositis (OM) at a tertiary hospital in Ghana. A descriptive generic qualitative study design was conducted. The study population were nurses who cared for patients diagnosed with cancer. Participants were recruited using a purposive non-probability sampling technique. Data were obtained through face-to-face interviews using semi-structured interview guide. Data collection and analysis were done concurrently. The study found that nurses had knowledge on the pre-treatment assessment of clients undergoing cancer treatment; however, they had insufficient knowledge on the standardized tool for the assessment of OM. They also lack a definitive approach to prevent and treat OM. Nurses provided general education on cancer treatment but paid little attention to the education on the possible side effect that includes OM. Additionally, insufficient knowledge level of nurses on cancer treatment-associated mucositis and lack of structured protocol for OM coupled with unavailable tools for assessing the oral mucosa were also identified as militating against the management of OM. Findings from this study will guide policy that will improve the care that clients who are at risk of oral mucositis receive.

Efficacy of bioadhesives in the management of oral mucositis in patients undergoing radio-chemotherapy for treatment of head and neck cancer-a systematic review and meta-analysis.

Management of head and neck cancers requires a multidisciplinary approach where surgery followed by radio and chemotherapy is the mainstay of treatment. The above-mentioned treatment can cause mucositis, a severely debilitating side effect. This can have a significant impact on quality of life. A recent advancing mode of drug delivery is the bioadhesive system. This interacts with mucosa by adhering to it and thereby improving the efficacy of the therapeutic agent delivered. The purpose of this systematic review is to evaluate the effectiveness of bioadhesives in reducing oral mucositis and relieving pain associated with mucositis in head and neck cancer patients receiving radio-chemotherapy. Studies assessing the effectiveness of bioadhesives for the treatment of radiation-induced oral mucositis were retrieved from specialized databases (PubMed/MEDLINE, Scopus, ProQuest, Google Scholar, LILACS, OpenGrey) as well as institutional repositories. Data on incidence, pain reduction, resolution, and improvement of oral mucositis using bioadhesive were compiled. A Cochrane tool was used for randomized controlled trials and a JBI tool for non-randomized controlled trials and observational studies to assess the quality of included studies. Based on the eligible study data, a meta-analysis was conducted with STATA version 16, 2019 software, and 95% confidence intervals and p values greater than 0.05. A total of 15 studies were included which assessed the effectiveness of bioadhesives in managing mucositis and its associated pain. Studies included in the review described either reduction,resolution,or incidenceof oral mucositis respectively. A total of three meta-analyses were conducted to assess the incidence of oral mucositis and the pain associated with it, as well as the reduction in incidence. Bioadhesives showed statistically significant differences in the incidence of severe mucositis (p = 0.04). A meta-analysis comparing bioadhesives efficacy in reducing mucositis and pain associated with it found no statistically significant differences (p = 0.36). Bioadhesives are emerging as a novel drug delivery method for treating radio-chemotherapy-induced oral mucositis because of their rapid absorption and easy application. Regardless of its benefits, clinical trials comparing it with conventional treatment methods are necessary to assess its efficacy in treating oral mucositis.

The Effect of Coffee in the Prevention of Oral Mucositis Associated with Head and Neck Radiotherapy.

This study investigates the effect of coffee on the management of oral mucositis associated with head and neck radiotherapy. Twenty-nine patients who underwent radiotherapy for the first time due to head and neck cancer between March 2019 and February 2020 were included in the experimental study. One cup/day of Turkish coffee (6 mg) was given to the patients in the intervention group every day for 3 weeks from the first day of radiotherapy. Data monitoring of both groups was performed once a week for 3 weeks. Most of the patients participating in the study were at local stage (65.2%), and 72.4% underwent head and neck radiotherapy with the diagnosis of nasopharynx and larynx cancer. Although the development rate of oral mucositis was lower in the intervention group, no statistically significant difference was determined (p > 0.05). In the repeated follow-up, the quality of life scores was found to be similar in both groups. We concluded that coffee application is not an effective approach in the prevention of oral mucositis associated with head and neck radiotherapy. Further studies with larger sample sizes are needed to determine the prophylactic effect of coffee in the management of oral mucositis.

A SYSTEMATIC REVIEW OF THE DIRECT COSTS ASSOCIATED WITH THE MANAGEMENT OF MUCOSITIS

Objective To evaluate and report the direct economic outcomes associated with the management of mucositis across several cancer treatments through a systematic review. Study Design A systematic search using the databases Scopus, MEDLINE/PubMed, and Embase to identify articles that provided data on costs associated with mucositis in cancer patients following antineoplastic therapies. Results 37 studies were included. The costs attributable to mucositis ranged from 1,124.47 to 29,9214.14 US dollars (USD) per patient in the hematopoietic stem cell transplantation setting; from 51.23 to 33,560.58 USD per patient in the radiotherapy/ chemoradiotherapy/radiotherapy plus molecular targeted therapy setting; from 4.18 to 31,963.64 USD per patient in the chemotherapy setting; from 565.85 to 20,279.12 USD per patient when cancer treatment was not specified; from 12.42 to 5,670.46 USD per patient for the multimodal therapy setting; and from 45.78 to 3,484.91 USD per patient in the molecular targeted therapy setting. Conclusion Mucositis is associated with increased resource use, consultations, hospitalizations and extended hospitalizations, leading to a substantial incremental cost that exacerbates the economic burden on the patient, health plan, and health system across several cancer treatments and diagnosis. More studies with a prospective evaluation of the economic costs associated with mucositis management are needed. To evaluate and report the direct economic outcomes associated with the management of mucositis across several cancer treatments through a systematic review. A systematic search using the databases Scopus, MEDLINE/PubMed, and Embase to identify articles that provided data on costs associated with mucositis in cancer patients following antineoplastic therapies. 37 studies were included. The costs attributable to mucositis ranged from 1,124.47 to 29,9214.14 US dollars (USD) per patient in the hematopoietic stem cell transplantation setting; from 51.23 to 33,560.58 USD per patient in the radiotherapy/ chemoradiotherapy/radiotherapy plus molecular targeted therapy setting; from 4.18 to 31,963.64 USD per patient in the chemotherapy setting; from 565.85 to 20,279.12 USD per patient when cancer treatment was not specified; from 12.42 to 5,670.46 USD per patient for the multimodal therapy setting; and from 45.78 to 3,484.91 USD per patient in the molecular targeted therapy setting. Mucositis is associated with increased resource use, consultations, hospitalizations and extended hospitalizations, leading to a substantial incremental cost that exacerbates the economic burden on the patient, health plan, and health system across several cancer treatments and diagnosis. More studies with a prospective evaluation of the economic costs associated with mucositis management are needed.

EFFICACY OF MATRICARIA RECUTITA (CHAMOMILE) IN THE PREVENTION AND/OR TREATMENT OF ORAL MUCOSITIS: UMBRELLA REVIEW

Oral mucositis is a common complication resulting from antineoplastic treatment. It is well-know that the use of natural products is a therapeutic alternative that should be investigated due to its anti-inflammatory action with less possibility of side and adverse effects and affordable costs. The aim of this umbrella review was to perform an overview of available systematic reviews on the efficacy of Matricaria Recutita (Chamomile) in the prevention and/or treatment of oral mucositis. The guiding PICOT question was: Is the pharmacological herbal management with chamomile (Matricaria recutita) effective in the prevention and/or treatment of oral mucositis in patients undergoing oncological radiotherapy treatment of the head and neck region and/or chemotherapy? The articles were selected by two independent reviewers. This study screened 3416 papers, of which 12 papers were deemed to be eligible and were read in full. Any disagreements were resolved by a third author. Glenny's and AMSTAR 2 scales were used to assess the quality of the systematic reviews included in this review. Matricaria recutita in the prophylactic and therapeutic management of oral mucositis was used and showed promising results, apparently presenting beneficial effects to patients, mainly in reducing the symptomatology and severity of this condition, however, the evidence presented limitations. Oral mucositis is a common complication resulting from antineoplastic treatment. It is well-know that the use of natural products is a therapeutic alternative that should be investigated due to its anti-inflammatory action with less possibility of side and adverse effects and affordable costs. The aim of this umbrella review was to perform an overview of available systematic reviews on the efficacy of Matricaria Recutita (Chamomile) in the prevention and/or treatment of oral mucositis. The guiding PICOT question was: Is the pharmacological herbal management with chamomile (Matricaria recutita) effective in the prevention and/or treatment of oral mucositis in patients undergoing oncological radiotherapy treatment of the head and neck region and/or chemotherapy? The articles were selected by two independent reviewers. This study screened 3416 papers, of which 12 papers were deemed to be eligible and were read in full. Any disagreements were resolved by a third author. Glenny's and AMSTAR 2 scales were used to assess the quality of the systematic reviews included in this review. Matricaria recutita in the prophylactic and therapeutic management of oral mucositis was used and showed promising results, apparently presenting beneficial effects to patients, mainly in reducing the symptomatology and severity of this condition, however, the evidence presented limitations.

EFFECT OF LOW-LEVEL LASER ON CYTOKINE PRODUCTION BY MONOCYTES EXPOSED TO CISPLATIN AND STIMULATED WITH P. GINGIVALIS

Objective This study aimed to evaluate the effect of photobiomodulation (PBM) on monocytes exposed to cisplatin and P. gingivalis (Pg). Study Design Peripheral blood mononuclear cells from 10 healthy donors were exposed to cisplatin, irradiated with red laser (AlGaInP, 660nm, 0.028cm², 20mW, 0.71W/cm², 0.14J, 7s, 5J/cm²) and stimulated with Pg. Cell viability and cytokine expression by total monocytes and monocyte subpopulations were evaluated by flow cytometry. Results The treatments did not affect the viability of monocytes and TGF-β1 expression. In Pg-stimulated cells, cisplatin reduced the expression of IL-6, IL-8, and IL-10 in total and classical monocytes and increased IL-6 and TNF expression in the intermediate monocytes. In cisplatin exposed cells, PBM reduced the expression of IL-6 and IL-8 in total, classical, and intermediate monocytes, and IL-10 and TNF in total monocytes. In cisplatin and Pg-stimulated cells, PBM increased the expression of IL-6 and IL-8 in total and intermediate monocytes. Conclusion The red laser modulates the expression of cytokines by human monocytes treated with cisplatin, which may represent PBM mechanisms of action in the management of oral mucositis. Apoio: FAPEMIG APQ03601-16, FIP/PUC Minas 2020/24894-1S, and CAPES Code 001. This study aimed to evaluate the effect of photobiomodulation (PBM) on monocytes exposed to cisplatin and P. gingivalis (Pg). Peripheral blood mononuclear cells from 10 healthy donors were exposed to cisplatin, irradiated with red laser (AlGaInP, 660nm, 0.028cm², 20mW, 0.71W/cm², 0.14J, 7s, 5J/cm²) and stimulated with Pg. Cell viability and cytokine expression by total monocytes and monocyte subpopulations were evaluated by flow cytometry. The treatments did not affect the viability of monocytes and TGF-β1 expression. In Pg-stimulated cells, cisplatin reduced the expression of IL-6, IL-8, and IL-10 in total and classical monocytes and increased IL-6 and TNF expression in the intermediate monocytes. In cisplatin exposed cells, PBM reduced the expression of IL-6 and IL-8 in total, classical, and intermediate monocytes, and IL-10 and TNF in total monocytes. In cisplatin and Pg-stimulated cells, PBM increased the expression of IL-6 and IL-8 in total and intermediate monocytes. The red laser modulates the expression of cytokines by human monocytes treated with cisplatin, which may represent PBM mechanisms of action in the management of oral mucositis.

Clinical guidance for maintaining oral hygiene in patients under-going chemotherapy or radiation therapy: a scoping review

The aim of this scoping review was to identify clinical guidance for maintaining oral hygiene in patients undergoing chemotherapy, radiation therapy, or both. Electronic searches were conducted in PubMed, Embase, Cochrane Library, and Google Scholar for articles published between January 2000 and May 2020. Systematic reviews, meta-analyses, clinical trials, case series, and expert consensus reports were considered eligible for inclusion. The SIGN Guideline system was used to evaluate the level evidence and the grade of recommendations. A total of 53 studies met the eligibility criteria. The results showed the presence of recommendation for oral care in three domains: management of oral mucositis, prevention and control of radiation caries, and management of xerostomia. However, most of the included studies had low levels of evidence. The review provides recommendations for healthcare professionals caring for patients undergoing chemotherapy, radiation therapy, or both, but a standard oral care protocol could not be established owing to a paucity of evidence-based data.
 Accepted for publication: February 20, 2023
 Published online: February, 2022

Treatment of Oral Mucositis Using Platelet-Rich-Fibrin: A Retrospective Study on Oncological Patients.

Oral mucositis is an inflammatory mucosal demolition frequently observed during treatments for neoplastic diseases such as chemotherapy or radiation therapy. The side effects of these treatments often drastically reduce patients' quality of life. Oral mucositis is the result of the systemic consequences of chemotherapy and radiotherapy, which due to their cytotoxic and local effects, lead to pain and severe ulceration with a consequent decrease in the quality of life of affected subjects. Plasma rich in fibrin is often used to enhance soft tissue wound healing and fight bacterial sepsis through the presence of leukocytes within it. The retrospective study aimed to evaluate the efficacy and safety of the topic use of platelet gel in the clinical management of oral mucositis to improve the life quality of patients. The results of the study were promising even though the topical application of platelet-rich-fibrin is like a skin-care treatment. Future studies with a larger sample of patients will be needed to understand the real benefits of platelet-rich-fibrin.

Clinical research policy for oral mucositis associated with cancer treatment (J-SUPPORT).

e24110 Background: Oral mucositis is one of the main areas of research in supportive and palliative care of cancer patients. However, the methodology of prospective clinical trials on oral mucositis has not been established, despite its uniqueness. Here, we propose a novel research policy on oral mucositis, including an implementable set of recommendations for researchers conducting clinical trials. Methods: The first draft was developed by an expert panel of six specialists from the Japanese Supportive, Palliative, and Psychosocial Care Study Group. A provisional draft was developed after review by the following medical societies: the Japanese Association of Supportive Care in Cancer, the Japanese Association of Oral Supportive Care in Cancer, the Japanese Cancer Association, and the receipt of public comments. Results: The research policy on oral mucositis mainly consists of the following components: (i) definition of oral mucositis; (ii) characteristics of oral mucositis; (iii) characteristics of oral mucositis research; (iv) target population for oral mucositis research; (v) endpoints and assessment measures in oral mucositis; (vi) eligibility criteria; (vii) research design; and (viii) minimally recommended intervention in oral mucositis research as a supplement. The final policy (Ver1.0) was completed on August 16, 2021. Conclusions: This policy may serve as a significant reference for planning and conducting clinical trials for the management of oral mucositis.

The Effect of Honey Therapy on the Management of Oral Mucosites in Head and Neck Cancer Patients with Chemoradiotherapy: A Randomized Controlled Study

Purpose: Mucositis management has an important place in the treatment of these cancer patients. Therefore, the aim of our study is to examine the effect of honey treatment on oral mucositis management in patients with head and neck cancer receiving radiotherapy. 
 Methods: The study was planned as a randomized controlled, single-blind, parallel group study. The study was conducted on 32 patients with 16 patients in each parallel group. Five data collection tools were used to collect the research data. Patient Identification Form , Researcher Mucositis Index, VAS- Pain, Honey Management Monitoring Chart (given to the patients in the treatment group). Oral Care Management Follow-up Form (given to the patients in the control group). 
 Results: The number of days with mucositis was similar in both parallel groups (Honey Group / Mean ± SD: 14.88 ± 7.36, Bicarbonate Group / Mean ± SD: 14.38 ± 6.33).
 Conclusion: Honey application has not been found to be superior to bicarbonate mouthwash on the development and staging of oral mucositis.

A Prospective Study of Nurse-Led Oral Mucositis Management: Impact on Health Outcomes of Patients Receiving Radiotherapy for Head and Neck Cancer and Lung Cancer

ObjectivesThe study aimed to evaluate the impact of nurse-led mucositis management on the health outcomes of patients receiving radiotherapy for head and neck cancer and lung cancer. The study adopted a holistic approach that involved the patient in the care process by screening, providing education and counseling about mucositis management and integrating it into daily life by the radiotherapy nurse. Data SourcesIn this prospective, longitudinal cohort study, 27 patients were assessed and monitored through use of the WHO Oral Toxicity Scale and Oral Mucositis Follow-up Form and educated on mucositis during their radiotherapy through use of the Mucositis Prevention and Care Guide. At the end of radiotherapy, an evaluation of the radiotherapy process was performed. In this study, each patient was followed for 6 weeks from the start of radiotherapy. ConclusionThe worst clinical data for oral mucositis and its variables emerged at week 6 of treatment. While the Nutrition Risk Screening score increased over time, weight decreased was observed to decrease. The mean stress level was 4.74 ± 0.33 in the first week and 5.77 ± 0.35 in the last week. It was observed that 88.9% of the patients showed good compliance with the treatment. Implications for Nursing PracticeNurse-led mucositis management contributes to better patient outcomes during the radiotherapy process. Such an approach improves oral care management in patients receiving radiotherapy for head and neck and lung cancer, demonstrating its positive impact on additional patient-focused outcomes.

Intramuscular injections of human placental extract versus conventional symptomatic approaches in radiation-induced oral mucositis, in patients with head and neck cancers, on definitive chemoradiotherapy - A ray of hope?

Despite the availability of a wide range of agents, no single treatment exists for the management of radiation-induced oral mucositis, in patients, with head and neck malignancies, on radical chemoradiation; a debilitating and limiting sequela. Human placental extract is one option that has been proposed. This study aimed at evaluating the therapeutic benefits of human placental extract (Placentrex) in the management of radiation-induced oral mucositis in patients on curative intent treatment for head and neck cancers with concurrent chemoradiation, and to compare the observations with other conventional approaches. Patients presenting to the Department of Radiation Oncology, of a tertiary cancer care center, with biopsy-proven carcinoma of the oral cavity, oropharynx, and hypopharynx, planned for definitive, curative intent chemoradiation, between January 2020 and June 2021, were recruited for this study. The interventional group received a deep intramuscular injection of 2 ml of Placentrex to the deltoid muscle, once-a-day from the 11th fraction of radiation till completion, on treatment and non-treatment days. The control group received supportive, symptomatic, conventional treatments for mucositis. The response was assessed every week during treatment and at the third and sixth months of follow-up and was compared. The study comprised 26 patients, 15 in the interventional group and 11 in the control group. On completion of treatment, 40% in the interventional arm and 81.82% in the control arm had progressed to grade 2 and 3 mucositis (P < 0.05). Treatment interruption was seen in 13% in the interventional arm and 55% in the control arm (P < 0.001). Results from this study show that human placental extract, injection Placentrex, had a significant effect in decreasing the severity of radiation-induced mucositis and thereby reducing any interruption or delay in treatment when compared to other conventional methods.

Prophylactic High-Dose Gabapentin Reduces Opiate Use during Radiation Therapy for Head and Neck Squamous Cell Carcinoma.

The role of prophylactic high-dose gabapentin for the management of oral mucositis during radiation therapy for head and neck squamous cell carcinoma (HNSCC) remains controversial. A retrospective cohort analysis was performed on primary HNSCC patients treated at our institution. Kruskal-Wallis and Fisher's exact tests were used to compare the patients' baseline characteristics. Multivariate competing risk and logistic regressions were performed to evaluate time to first opioid use and feeding tube placement. In total, 480 consecutive HNSCC patients were included. Within this cohort, 186 patients received 3600 mg gabapentin, 182 received 300 to 3200 mg gabapentin, and 112 received no gabapentin. The time to first opioid use was greater in the 3600 mg group compared with the no gabapentin group (34.3 vs. 23.9 days, p < 0.001) and to the 300 to 3200 mg group (28.0 days, p < 0.001). The proportion of patients requiring opioids at any point during RT was lower in the 3600 mg gabapentin group compared with the no gabapentin group (31.8% vs. 60.1%, p < 0.001) and with the 300 to 3200 mg group (63.8%, p < 0.001). Prophylactic use of 3600 mg gabapentin was well tolerated, halved overall opioid use, and delayed the time to first opioid use during radiation therapy.

Management of Oral Hygiene in Head-Neck Cancer Patients Undergoing Oncological Surgery and Radiotherapy: A Systematic Review.

In the literature, among oral health prevention programs dedicated to cancer patients, a wide heterogeneity is evident. The purpose of this work is to analyze the available scientific evidence for the treatment of head and neck cancer (HNC) patients undergoing resective surgery and radiotherapy and to draw up a diversified oral hygiene protocol during oncological therapy. PubMed was used as database. Studies published from 2017 to September 2022 were analyzed. Studies investigating the effectiveness of the preventive procedures carried out by the dental professionals in HNC patients undergoing postoperative adjuvant therapy have been taken into account. The application of the search string on PubMed allowed the selection of 7184 articles. The systematic selection of articles led to the inclusion of 26 articles in this review, including 22 RCTs, 3 observational studies, and 1 controlled clinical study. Articles were divided according to the debated topic: the management of radiation-induced mucositis, xerostomia, the efficacy of an oral infection prevention protocol, and the prevention of radiation-induced caries. Dental hygienists are fundamental figures in the management of patients undergoing oncological surgery of the maxillofacial district. They help the patient prevent and manage the sequelae of oncological therapy, obtaining a clear improvement in the quality of life.

Effect of a Novel Handheld Photobiomodulation Therapy Device in the Management of Chemoradiation Therapy-Induced Oral Mucositis in Head and Neck Cancer Patients: A Case Series Study

Oral mucositis (OM) is a debilitating adverse event in patients undergoing treatment for cancer. This study aimed to evaluate the therapeutic effect of a novel handheld photobiomodulation therapy (PBMT) device on chemoradiation therapy (CRT)-induced OM in patients with head and neck cancer. Head and neck cancer patients undergoing CRT who developed moderate-to-severe OM during treatment were enrolled. After PBMT and at 2 and 4 weeks after PBMT, the mean value of OM grade decreased significantly from 2.63 to 2.13, 1.31, and 0.75, respectively (p &lt; 0.05, p &lt; 0.001, and p &lt; 0.001). Moreover, we observed significant improvement in health-related quality of life (HRQoL) after PBMT compared to baseline through a validated questionnaire; EORTC QLQ-C30. In the present study, the use of this PBMT device in the management of CRT-induced OM in patients with head and neck cancer was generally well tolerated and resulted in the improvement of OM. However, evidence supporting its use remains lacking owing to limitations such as the small number of participants and lack of a control group. Therefore, further mechanistic studies and large-scale randomized controlled trials are needed to confirm the effectiveness of PBMT in the treatment of CRT-induced OM, as shown in our results.

Ozonized Hydrogels vs. 1% Chlorhexidine Gel for the Clinical and Domiciliary Management of Peri-Implant Mucositis: A Randomized Clinical Trial

Peri-implant mucositis consists of a reversible inflammation of peri-implant tissues characterized by bleeding on gentle probing in the absence of bone loss. Ozone therapy is being extensively studied for its efficacy in treating different dental conditions. To date, few studies have evaluated ozone as an adjunct to the oral hygiene measures of peri-implant mucositis patients. The aim of the present study is to assess the efficacy of an ozonized gel (Trial group) compared to chlorhexidine (Control group) after a domiciliary protocol of oral hygiene in a 6-month study. According to a split-mouth study design, patients were divided into Group 1 for the application of chlorhexidine gel in peri-implant mucositis sites of quadrants Q1 and Q3, whereas in quadrants Q2 and Q4, the ozonized gel was in-office administered. For Group 2, the quadrants were inverted. At baseline (T0), and after 1 (T1), 2 (T2), and 3 (T3) months, Probing Depth (PD), Plaque Index (PI), SI Suppuration Index (SI), Bleeding Score (BS) and Marginal Mucosa Condition (MMC) were measured. A statistically significant decrease was found for all the variables assessed in each group (p < 0.05), whereas significant intergroup differences were found only for PI, BoP, and BS. Accordingly, both agents tested in this study showed an efficacy in treating peri-implant mucositis. The ozonized gel deserves particular attention, considering the better outcome than chlorhexidine on specific clinical periodontal parameters, as well as its lesser shortcomings.

Developing Ice Cream for Mucositis Management and Improving the Nutritional Support for Pediatric Cancer Patients

Introduction: Mucositis is one of the main complications of cancer treatment, associated with several nutritional limitations and the ability to cause secondary infections. Cryotherapy is a low-cost treatment consistent with clinical practice guidelines for treating patients with mucositis. Objective: To develop and evaluate the acceptance of ice cream for the prevention and treatment of mucositis and nutritional support of pediatric cancer patients. Method: Based on knowledge about the side effects of chemotherapy (especially in oral and gastrointestinal mucositis) and the nutritional needs of pediatric cancer patients, a literature search for ingredients that could meet the study’s objectives was undertaken. Food Technology Laboratory of the São Paulo State University (Unesp), Botucatu campus, and in partnership with Sorvetes Naturais ice cream shop in the municipality of Botucatu-SP, produced the ice cream. An acceptance test was applied in ten patients undergoing cancer treatment and 30 individuals in the control group using the 5-point mixed facial hedonic scale. Results: The final formula consisted of semi-skimmed lactose-free milk, extra virgin coconut oil, oat flour, honey, chamomile, Fortini® food supplement, demerara sugar, and stabilizer/emulsifier. 90% of patients undergoing cancer treatment rated the final product as “liked” or “loved it,” compared to 63% of the control group. Conclusion: Development of an ice cream that met the objectives of the study was possible through the choice of its composition. Honey and chamomile can favor the prevention of mucositis, and other ingredients offer the caloric density and protein supply.