Management Of Mucositis Research Articles

Peri-implantitis as the consequence of errors in implant therapy.

Peri-implantitis is a plaque-associated pathologic condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. It is a highly prevalent disease, as extensively estimated by large-population, cross-sectional studies. As peri-implant diseases represent opportunistic infections, it is reasonable to assume that nonideal conditions, local and/or general, may favor the progression of peri-implant inflammation. Some of these conditions could be a result of poor planning and/or inadequate execution of any step of the entire process treatment. This article describes the major possible factors in implant therapy that may lead to peri-implantitis. For some of these (ie, inappropriate patient selection, insufficient periodontal therapy, lack of diagnosis and management of peri-implant mucositis, erratic supportive peri-implant/periodontal therapy) there is a good level of evidence, whereas for others (ie, wrong implant placement, poor postoperative care, inadequate prosthetic reconstruction, lack of assessment and management of peri-implant soft-tissue deficiencies) there is little scientific evidence. More research is therefore needed to clearly identify the errors and/or complications possibly leading to peri-implantitis, particularly over the long term.

Efficacy of polyacrylate silver salt/polyvinylpyrrolidone-based liquid oral gel in management of concurrence chemoradiotherapy-induced oral mucositis

Acute oral mucositis (OM) is a painful complication of concurrent chemoradiotherapy (CCRT). This severe adverse symptom may impact on patient's quality of life, lead to malnutrition. Thus, finding more effective methods in OM management is very important. The purpose of this study is to evaluate the efficacy of polyacrylate silver salt/Polyvinylpyrrolidone-based liquid oral gel (named as polyacrylate silver salt oral gel) in improving the symptomatic relief of CCRT-induced oral mucositis and oral dysfunction in neck and head cancer patients. In this study, 24 oral cancer patients underwent CCRT and having OM grade 2 or higher were randomly assigned into the test group and the control group. Both groups followed Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) clinical practice guidelines for the management of mucositis, but adding rinsing with 15g oral gel right after oral hygiene treaded the test group. Clinical OM and oral function were assessed weekly for 4 consecutive weeks till 5-10 days after the completion of radiotherapy. For evaluation, Common Terminology Criteria for Adverse Events (CTCAE) v3.0 was used for collecting the data of OM grade. The results showed that polyacrylate silver salt oral gel had better effect for relieving the oral mucositis. There were statistically significant differences in OM grades (1.59 vs. 2.8, p<0.0001) between the test group and the control group. Our clinical studies demonstrated that polyacrylate silver salt oral gel is an effective interventional option in terms of rapid mucositis healing.

Comparison of chlorhexidine and benzydamine mouth rinses in the management of radiotherapy or chemotherapy-induced oral mucositis: A systematic review and meta-analysis

Comparison of chlorhexidine and benzydamine mouth rinses in the management of radiotherapy or chemotherapy-induced oral mucositis: A systematic review and meta-analysis

Management of hypopharyngeal mucositis in patients undergoing chemoradiotherapy in the head and neck region and its impact on swallowing: an integrative literature review

RESUMO Objetivo Investigar o impacto da mucosite hipofaríngea quimiorradioinduzida na deglutição e o seu manejo, a partir de uma revisão integrativa de literatura. Estratégia de pesquisa A busca e a seleção dos artigos foram realizadas nas seguintes bases de dados: PubMed, Embase, Scopus, ScienceDirect e LILACS. Critérios de seleção Os termos de busca utilizados foram ‘’Pharyngeal Mucositis”, ‘’Radiotherapy” e ‘’Esophagitis”, com auxílio do operador booleano (AND). A equação de busca utilizada foi: ‘’Pharyngeal Mucositis” AND “Radiotherapy” AND “Esophagitis”. A seguinte questão central orientou o estudo: “Qual a forma de avaliação e manejo da mucosite hipofaríngea induzida pela radiação na região de cabeça e pescoço e seu impacto na deglutição?”. Resultados Foram identificados 75 estudos, sendo que 6 foram excluídos devido à duplicidade e 60 foram excluídos por não se encaixarem nos critérios de inclusão; os artigos restantes foram lidos na íntegra e 4 foram selecionados para fazerem parte desta revisão integrativa da literatura. Conclusão Apesar da escassa literatura e das poucas informações sobre os métodos de avaliação da mucosite hipofaríngea, os artigos apontam que, independentemente da dose de radiação, a radioterapia na região cervical causa mucosite hipofaríngea. A mucosite hipofaríngea provoca grande impacto na deglutição, resultando na necessidade de uso de via alternativa de alimentação. Além da ausência de informações quanto à avaliação e graduação da mucosite hipofaríngea, os estudos não discutem o tratamento direto ou a prevenção desse tipo de doença.

ORAL MUCOSITIS MANAGEMENT IN A PEDIATRIC PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA: CASE REPORT

Introduction: Acute leukemia is a primary malignancy in the bone marrow, in children constituting 35% of childhood cancers. Eighty percent are Acute Lymphocytic Leukemia (ALL) and 20% are Acute Myeloid Leukemia (AML). In Indonesia, there are currently around 80,000 children under the age of 15 years. Mucositis, oral infections, taste dysfunction, xerostomia, and bleeding are recognized as common acute sequels with risks for severe pain, malnutrition, and potential source of systemic infections. The purpose of this article is to report the management of mucositis in a patient with Acute Lymphoblastic Leukemia. Case and Management: A 5 years old boy consulted from Pediatrician in Abdoel Wahab Sjahranie General Hospital to a Pediatric Dentist in the same hospital with the chief complaint of severe gingivitis, bleeding on gingival mucosa, ulcer, and mucositis on lips. Because the general conditions of the patient decreased, the supportive therapies were instructed to maintain oral hygiene by rinsing and cleaning intra-oral with sterile gauze with sterile or cold water and chlorhexidine gluconate 0,20% periodically, brushing teeth with soft bristles, applying oxygel, and soft diets with high in carbohydrate and protein. Conclusion: The risks of mucositis in children are higher compared with adults due to the uncooperative behavior of the patient and smaller oral cavities which limit the examination. Good oral hygiene protocols should be applied during and after chemo-radio therapy motivating the children and parents or caregivers to maintain an appropriate level of oral hygiene to minimize the risk of developing decay, local infections, hemorrhage, and oral mucositis.

Photobiomodulation in the management of oral mucositis for adult head and neck cancer patients receiving irradiation: the LiTEFORM RCT.

Oral mucositis is a debilitating and painful complication of head and neck cancer irradiation that is characterised by inflammation of the mucous membranes, erythema and ulceration. Oral mucositis affects 6000 head and neck cancer patients per year in England and Wales. Current treatments have not proven to be effective. International studies suggest that low-level laser therapy may be an effective treatment. To assess the clinical effectiveness and cost-effectiveness of low-level laser therapy in the management of oral mucositis in head and neck cancer irradiation. To identify barriers to and facilitators of implementing low-level laser therapy in routine care. Placebo-controlled, individually randomised, multicentre Phase III superiority trial, with an internal pilot and health economic and qualitative process evaluations. The participants, outcome assessors and therapists were blinded. Nine NHS head and neck cancer sites in England and Wales. A total of 87 out of 380 participants were recruited who were aged ≥ 18 years and were undergoing head and neck cancer irradiation with ≥ 60 Gy. Random allocation (1 : 1 ratio) to either low-level laser therapy or sham low-level laser therapy three times per week for the duration of irradiation. The diode laser had the following specifications: wavelength 660 nm, power output 75 mW, beam area 1.5 cm2, irradiance 50 mW/cm2, exposure time 60 seconds and fluence 3 J/cm2. There were 20-30 spots per session. Sham low-level laser therapy was delivered in an identical manner. The mean Oral Mucositis Weekly Questionnaire-Head and Neck Cancer score at 6 weeks following the start of irradiation. Higher scores indicate a worse outcome. A total of 231 patients were screened and, of these, 87 were randomised (low-level laser therapy arm, n = 44; sham arm, n = 43). The mean age was 59.4 years (standard deviation 8.8 years) and 69 participants (79%) were male. The mean Oral Mucositis Weekly Questionnaire-Head and Neck Cancer score at 6 weeks was 33.2 (standard deviation 10) in the low-level laser therapy arm and 27.4 (standard deviation 13.8) in the sham arm. The trial lacked statistical power because it did not meet the recruitment target. Staff and patients willingly participated in the trial and worked hard to make the LiTEFORM trial succeed. However, the task of introducing, embedding and sustaining new low-level laser therapy services into a complex care pathway proved challenging. Sites could deliver low-level laser therapy to only a small number of patients at a time. The administration of low-level laser therapy was viewed as straightforward, but also time-consuming and sometimes uncomfortable for both patients and staff, particularly those staff who were not used to working in a patient's mouth. This trial had a robust design but lacked power to be definitive. Low-level laser therapy is relatively inexpensive. In contrast with previous trials, some patients found low-level laser therapy sessions to be difficult. The duration of low-level laser therapy sessions is, therefore, an important consideration. Clinicians experienced in oral cavity work most readily adapt to delivering low-level laser therapy, although other allied health professionals can be trained. Blinding the clinicians delivering low-level laser therapy is feasible. There are important human resource, real estate and logistical considerations for those setting up low-level laser therapy services. Further well-designed randomised controlled trials investigating low-level laser therapy in head and neck cancer irradiation are needed, with similar powered recruitment targets but addressing the recruitment challenges and logistical findings from this research. This trial is registered as ISRCTN14224600. This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 46. See the NIHR Journals Library website for further project information.

Clinicians' experience with topical benzydamine and morphine for the management of oral mucositis: adverse effects and barriers.

Among the evidence-based agents outlined in the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) mucositis guidelines, benzydamine and morphine are advised for the management of oral mucositis (OM) in certain cancer patients. This study is aimed to collect information from a group of highly experienced healthcare professionals in the field of oral mucositis about their clinical experience with these agents. A survey questionnaire about the clinical experience with topical benzydamine and morphine to manage oral mucositis and their related adverse effects (AEs) was electronically distributed to the members of the Mucositis Study Group of MASCC/ISOO. Eighty-eight entries were recorded (response rate 25%), and 54 entries submitted complete questionnaires about the drug-related AE (completion rate 65%) and were used for the data analysis. Of the respondents, 44% and 27.7% prescribed benzydamine and morphine to manage their patients' oral mucositis, respectively. Lack of availability in the respondent's country was the common reason for not prescribing benzydamine and morphine (18.9% and 5.4%, respectively); however, a large portion of the respondents indicated that 'another reason' stopped them from prescribing these agents (51.3% and 73%, respectively). AEs to benzydamine or morphine were observed by 25.9% and 12.9% of respondents, respectively, with mild numbness and tingling as the most common drug-related AE for both agents. The use of topical benzydamine and morphine for the management of OM varies between countries. While relatively common, the AEs related to these agents are mild. Mitigating the barriers for prescribing them may increase their use.

An exploration of the use of photobiomodulation for management of oral mucositis in children and young people undergoing cancer treatment in the UK

PurposeOral mucositis affects up to 80% of children and young people (CYP) receiving chemotherapy. This can result in pain, reduced oral intake and, in severe cases, hospitalisation for parental nutrition and pain relief. Photobiomodulation is recommended by multiple bodies for mucositis management for those undergoing cancer treatments. The current use of photobiomodulation within the UK, and the barriers and facilitators to implementation is unknown.MethodAn online mixed-methods survey was administered to representatives from the Children’s Cancer and Leukaemia Group (CCLG) between October 2021 and March 2022. This explored: use of photobiomodulation, planned future use, barriers and facilitators to implementation and dental assessment. Quantitative data underwent descriptive statistics. Barriers and facilitators to the implementation of photobiomodulation were analysed using the Theoretical Domains Framework (TDF).ResultsAll UK CCLG centres responded (n = 20, a response rate of 100%). Two units in Scotland were delivering photobiomodulation. A further four units were planning to implement a service. Most units, 65% (n = 13) utilised specialist Paediatric Dentistry services for dental assessment. In the TDF analysis, five domains were most frequently populated: knowledge, skills, environmental context and resources, social influences, and social/professional role and identity.ConclusionPhotobiomodulation was only available in Scotland in two children’s cancer units. Lack of knowledge and skills, and insufficient environmental resources were identified as barriers. Collaboration with paediatric dental services was identified as a facilitator. The establishment of a national network of Paediatric Dentists and Oncologists would promote collaboration to standardise protocols and to address the identified barriers to wider implementation of photobiomodulation.

Synergistic antibacterial effects of 5-fluorouracil or thioridazine in combination with phytopolyphenols on cultured Porphyromonasgingivalis

Background/purpose5-Fluorouracil (5FU) is a commonly used anticancer drug. However, the severe oral mucositis induced by 5FU in about 60–70% of patients was a major cause of discontinuous therapy. Since oral dysbiosis induced by 5FU was well correlated with severity of oral mucositis and Porphyromonas gingivalis (P.g.) was a keystone pathogen of dysbiosis. Thus, in this study, we aimed to explore the novel regimens of 5FU combined with phytopolyphenols (curcumin, green tea polyphenols) as well as ZnSO4 on antibacterial effects of cultured P.g. growth. In addition, similar regimens containing thioridazine (TRZ) were also tested for their antibacterial efficacy. Materials and methodsThe synergistic (Combination Index (CI) < 1) antiproliferation and anti-protease efficacies (IC50) of novel regimens on cultured P.g. were evaluated by OD600 and colorimetric method respectively. ResultsThe results obtained indicated that both novel regimens of 5FU and TRZ exhibited potent synergistic antibacterial effects against growth and protease of P.g. ConclusionThese novel regimens of 5-FU and TRZ were potent antibacterial agents which merit for further preclinical and clinical trials in management of oral mucositis, cancers and infectious diseases.

Oncology nursing practices in the management of chemotherapy-related oral mucositis in accordance with evidence-based guidelines: a descriptive and cross-sectional study.

This study aimed to explore the practices of oncology nurses in the management of chemotherapy-related oral mucositis (OM) by MASCC/ISOO guidelines. This descriptive and cross-sectional study was conducted between December 25, 2021, and January 31, 2022, with 157 oncology nurses in Turkey. Data were collected through OM Practices Assessment Form. The mean age of the nurses was 29.05 ± 7.40, the majority (90.4%) of them were female and 76.4% of them have a Bachelor's degree. More of the nurses (59.9%) had a written protocol for managing OM in their institutions, 38.9% of them used the MASCC/ISOO guideline, and 63.0% of them used an OM assessment scale. Most of the nurses (99.4%) recommended mouthwash to patients and 65.6% of them recommended mouthwash four times and more a day. 54.1% of the nurses recommended saline (%10.8) or carbonate (%36.9) or a mixture of saline and carbonate (%6.4) solutions for mouthwash. Despite the lack of sufficient evidence in the MASCC/ISOO guidelines regarding black mulberry syrup, 45.2% of the nurses recommended it for the prevention of OM and 43.3% of them suggested the treatment of mucositis. It was found that 82.0% of nurses who followed MASCC/ISOO guidelines recommended to patients implement oral care four times and more a day, while 55.2% of them who did not follow MASCC/ISOO guidelines recommended four times and more a day. The difference was found to be statistically significant (χ2 = 11.836; p = 0.01). It was determined that there were deficiencies in the implementation of written protocols for OM and the use of guidelines, and there were differences between the frequency of oral care, oral care products, and the practices of nurses in the prevention and treatment of OM.

Randomized Control Study of the Effects of Turmeric Mouthwash on Oral Health Status, Treatment-Induced Mucositis, and Associated Oral Dysfunctions Among Patients With Head and Neck Cancer.

Oral mucositis is the most severe and debilitating adverse effect of cancer treatment, resulting in inadequate nutritional intake, treatment disruptions, and dose alteration, leading to increased hospital costs and decreased tumor control. The aim of this study was to determine the effectiveness of turmeric mouthwash on oral health status and onset and severity of treatment-induced oral mucositis and associated oral dysfunctions among head and neck cancer patients. A randomized controlled design was adopted (CTRI/2018/06/014367). Turmeric mouthwash was administered to the experimental group (n = 46) and benzydamine mouthwash was given to the control group (n = 46). Oral health status and mucositis were graded using the Oral Health Assessment Tool and the World Health Organization oral toxicity criteria, respectively. Oral dysfunctions were measured by a patient-reported oral mucositis symptom scale and xerostomia short-form inventory. All outcome variables were measured weekly during the entire course of radiation therapy. Both groups were comparable with regard to their demographic and outcome variables ( P > .05). The incidence of intolerable mucositis in the control group was 100% compared with 17.8% in the experimental group. Repeated-measures analysis of variance demonstrated significant differences in the onset and severity of oral mucositis ( P = .001), oral health status ( P = .001), and oral dysfunctions ( P = .001) between the experimental and control groups. Turmeric mouthwash was effective in reducing the severity of oral mucositis and associated oral dysfunctions as compared with benzydamine mouthwash. Use of turmeric, a nontoxic and cost-effective intervention, can be an alternative to the traditional management of oral mucositis.

Use of Honey in the Management of Chemotherapy-Associated Oral Mucositis in Paediatric Patients.

BackgroundOral mucositis (OM) is a critical condition during chemotherapy in both adult and child cancer patients. Paediatric cancer patients have a higher prevalence of OM than adult cancer patients. Honey is a natural product that has been reported to have the best tissue healing properties. The present mini-review focused on the evaluation of the effectiveness of oral care with honey products in the treatment and prophylaxis of chemotherapy-induced OM in child patients.MethodsA network of electronic English databases including CINAHL, CENTRAL, EMBASE, MEDLINE and PubMed, were used for primary search from April 2010 to April 2020. We have also considered data collected from ClinicalTrials.gov, Web of Science and Google Scholar. PRISMA software was used to build collective data. Controlled trials were included in this review and were critically appraised by Down and Black. The narrative synthesis was performed.ResultsA total number of 346 data of children and adolescents with cancer were considered in this short review. All patients were from three randomized controlled trial articles and two were non-randomised controlled trial articles. Based on the evidence so far revealed, honey may show an effect in the treatment and prophylaxis of OM. The analysis of collected data revealed that the probability value P<0.05. The honey enhanced recovery time and severity of OM were significantly compared with those without honey treatment receiving group of pediatric patients.ConclusionHoney not only has been shown to have the capability for healing injured tissues but it is also a more economical treatment, and it has fewer side effects compared to synthetic drugs. Honey or honey products can prevent chemotherapy-induced OM (CIOM) and be the best treatment to grade I, II and III CIOM. However, it is disappointing that studies involving children as patients were few, and limited data available so far.

CN77 Effect of chewing gum on the management of chemotherapy-induced oral mucositis in children: Systematic review of experimental studies

Chemotherapy-induced oral mucositis can be prevented or treated in a number of different ways among pediatric oncology patients. One of the methods is chewing gum. However, the evidence in the literature that chewing gum is effective in preventing or reducing chemotherapy-induced oral mucositis in pediatric oncology patients is weak. Objective: To systematically summarize research regarding chewing gum interventions and outcomes and to evaluate the effect of the chewing gum on reducing chemotherapy-induced oral mucositis in children.

Management of Oral Mucositis in Pediatric Oncology Patients Receiving Chemotherapy: Evaluation of Evidence-Based Practices

Oral mukozit, pediatrik popülasyonda kanser tedavileriyle ilişkili en yaygın görülen yan etkilerden biridir. Oral mukozanın eritamöz ve ağrılı ülseratif lezyonlarıyla seyretmektedir. Kanser tedavilerinde farmakolojik ve integratif tedavi yönetimlerine karşın mukozit görülme sıklığı fazladır. Oral mukozitin önlenmesinde/tedavisinde kullanılan farklı metodlar ve terapötik ajanlar bulunmaktadır. Bunlar; temel ağız bakım protokolü, antimikrobial ajanlar, kriyoterapi, antiseptik ajanlar, antibiyotikler, vitaminler, sitokinezler, immun regülatörler ve bitkisel yöntemlerdir. Temel ağız bakım protokollerinde medikal olmayan gargaralar önerilmektedir. Klorheksidin, normal salin, sodyum bikarbonat ve benzidamin içeren gargaraların oral mukozitin önlenmesine ilişkin kesin kanıtları yoktur. E vitamini, oral mukozit şiddetini azaltmada etkili bir tedavi yöntemi olabilmektedir. Kriyoterapi, kemoterapi alan ve koopere çocuklarda mukozit derecesine göre tercih edilebilir bir tedavi yöntemidir. Klorheksidinin, lazer terapinin ve glutaminin çocuklarda kullanımıyla ilgili literatürde farklı sonuçlar bulunmaktadır ve pediatrik onkoloji hastalarında kullanımına yönelik sistematik derleme ve meta-analiz çalışmalarında etkinliği gösterilene kadar kullanımından kaçınılması önerilmektedir. Bu derlemenin amacı, kemoterapi alan pediatrik onkoloji hastalarında oral mukozitin önlenmesi ve tedavisinde önerilen ve önerilmeyen metodların ve ajanların incelenmesidir.

PARAMETERS OF PHOTOBIOMODULATION IN ORAL MUCOSITIS: SYSTEMATIC REVIEW AND META-ANALYSIS

<h3>Objectives</h3> To identify the most used dosimetric parameters and their efficacy in photobiomodulation therapy (PBMT) for the management of oral mucositis (OM), due to conditioning before hematopoietic stem cell transplantation (HSCT). <h3>Study Design</h3> The research followed the PRISMA guidelines. We used the electronic databases PubMed/MEDLINE, Web of Science, Embase, BVS, and Cochrane Library for primary studies, whereas we used BDTD-Ibict and Open Gray for gray literature. The search did not have any language or year restrictions. <h3>Results</h3> A total of 903 studies were identified, and 9 met the eligibility criteria for qualitative assessment and 7 for meta-analysis. It involved 396 patients on conditioning before HSCT, 211 using PBMT for OM management, and 185 who did not use it. The most used parameters were as follows: 660 nm, 40 mW, 4 J/cm², 0.16 J, 1 W/cm², and a spot size of 0.04 cm². The meta-analysis showed that the management of OM with PBMT had a protection factor of 94%. It was more effective in decreasing the severity of OM compared with the group without PBMT <h3>Conclusions</h3> PBMT in the parameters used seems to be an effective therapeutic strategy for managing OM in this population.

ANTI-INFLAMMATORY POTENTIAL OF ALOE VERA IN ORAL MUCOSITIS THERAPY: SYSTEMATIC REVIEW

This review aims to analyse the potency of Aloe vera for Oral Mucositis (OM) therapy. Articles searched using the keywords “Oral Mucositis” AND “Aloe vera”, conducted through PubMed, ScienceDirect, and Cochrane Library databases, and adapted to the PICO (Population, Intervention, Comparison, Outcome) framework. The inclusion criteria for articles were: Randomized Controlled Trial (RCT) study design; in English; full paper available; published in the range between 2011-2021 and with low risk of bias. RoB-tools JADAD Oxford Quality Scoring System was used. This paper writing refers to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. A total of 5 (five) articles met the criteria for a qualitative review and all showed a high range of quality articles. It was found that both Aloe vera solution 70% and Aloe vera gel 10% showed a reduction of radiotherapy or chemotherapy-induced oral mucositis grade. Aloe vera mouthwash has an equal anti-inflammation effect compare to benzydamine on the patient with radiotherapy-induced oral mucositis, whereas the use of other formula containing Aloe vera with other herbal materials did not show an anti-inflammatory effect. Drug formulation containing Aloe vera can be used as an alternative therapy in the management of Oral Mucositis (OM) with anti-inflammatory potency that can reduce pain and the severity of oral mucositis.

Prevention and management of peri-implant mucositis and peri-implantitis: A systematic review of outcome measures used in clinical studies in the last 10 years.

To evaluate outcome measures, methods of assessment, and analysis in clinical studies on the prevention and management of peri-implant mucositis and peri-implantitis. Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with ≥10 patients on either the prevention or management of peri-implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment, and analytical methods. Risk of bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analysed in a descriptive manner. The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%), and composite outcomes (26%). Adverse events (8%) and patient-reported outcomes (6%) were only rarely mentioned. A primary outcome measure was clearly defined only in 36% of studies. Data on PPD, radiographic outcomes, and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions. For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled. PPD and BOP were routinely reported in studies on the prevention and management of peri-implant mucositis and peri-implantitis, while composite outcomes, adverse events, and patient-reported outcomes were only infrequently described.

Prevention and management of peri-implant mucositis and peri-implantitis: A systematic review of outcome measures used in clinical studies in the last 10 years.

To evaluate outcome measures, methods of assessment, and analysis in clinical studies on the prevention and management of peri-implant mucositis and peri-implantitis. Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with ≥10 patients on either the prevention or management of peri-implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment, and analytical methods. Risk of bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analysed in a descriptive manner. The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%), and composite outcomes (26%). Adverse events (8%) and patient-reported outcomes (6%) were only rarely mentioned. A primary outcome measure was clearly defined only in 36% of studies. Data on PPD, radiographic outcomes, and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions. For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled. PPD and BOP were routinely reported in studies on the prevention and management of peri-implant mucositis and peri-implantitis, while composite outcomes, adverse events, and patient-reported outcomes were only infrequently described.

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

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. 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. 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; (viii) minimally recommended intervention in oral mucositis research as a supplement. The final policy (Ver1.0) was completed on August 16, 2021. This policy may serve as a significant reference for planning and conducting clinical trials for the management of oral mucositis.

Efficacy of oral and topical antioxidants in the prevention and management of oral mucositis in head and neck cancer patients: a systematic review and meta-analyses.

To evaluate the effectiveness of antioxidants in the prevention and management of oral mucositis in adults undergoing radiotherapy and/or chemotherapy with diagnosed head and neck cancer (HNC) compared to placebo intervention. Cochrane, EMBASE, PubMed, and Web of Science databases were used to search for randomized controlled trials (RCTs) comparing oral or topical antioxidants with placebo in clinically diagnosed HNC adult patients receiving radiotherapy with/without chemotherapy. The primary outcome was to assess the efficacy of the antioxidant to prevent and decrease the incidence/prevalence and severity of oral/oropharyngeal mucositis. The risk of bias was assessed following Cochrane's guidelines. The database search resulted in 203 records up to February 19, 2021. Thirteen RCTs were included with 650 HNC-diagnosed patients. Included studies showed a statistically significant improvement in mucositis severity score for all antioxidants except melatonin. However, further studies are needed as only one study reported outcomes for zinc, propolis, curcumin, and silymarin. Patients receiving vitamin E were 60% less likely to develop severe mucositis grade 2 or higher than those receiving placebo in one study (P = 0.040). Patients receiving zinc were 95% less likely to develop severe mucositis (grades 3-4) in one study compared to placebo (P = 0.031). One meta-analysis showed no statistical difference in the risk of having severe mucositis (grades 3-4) with 199 patients compared to placebo for honey (n = 2 studies, P = 0.403). Meta-analyses could not be conducted for zinc, propolis, curcumin, melatonin, silymarin, and selenium due to the lack of studies reporting similar outcomes for the same intervention. Though oral and topical antioxidants significantly improved mucositis severity scores in HNC patients receiving radiotherapy with/without chemotherapy in individual studies, the quality of the evidence was low due to the small number of studies and unclear/high-risk bias. Additionally, large RCTs are needed to confirm these results.