Oral Mouthwash Research Articles

INGN 201

INGN 201

Management of oral mucositis at European transplantation centres

Oral mucositis (OM), which occurs in many patients with hematologic malignancies treated with high-dose therapy and stem cell transplantation, is associated with substantial clinical, economic, and quality-of-life (QOL) consequences. It has been associated with an increased need for total parenteral nutrition and opioid analgesics, prolonged hospital stays, and increased risk of infection. The research subgroup of the European Group for Blood and Marrow Transplantation Nurses Group surveyed nurses at transplantation centres for their thoughts about the clinical, QOL, and economic consequences of OM; tools for assessing OM; strategies for preventing and treating OM; and the need for the development and implementation of treatment guidelines. The responses from 46 centres, in 16 countries, indicated that most nurses (91%) believe OM has a large effect on patients' QOL. Nurses are not highly satisfied with current treatments for OM, but they believe the discomfort is reduced with oral care protocols and mouthwashes. Oral mucositis is routinely and frequently assessed, however there are inconsistencies in how it is managed. Most centres used unpublished, centre-specific guidelines, and the survey found that most nurses agreed that published national guidelines would be valuable for standardising the assessment and management of OM.

Pharmacokinetics of Triclosan Following Oral Ingestion in Humans

The number of personal hygiene products containing triclosan has increased rapidly during the last decade, and triclosan is one of the most common antibacterial compounds used in dentifrices today. However, the extent of triclosan exposure has not yet been well described. The potential risks of generating triclosan-resistant pathogenic microorganisms or of the selection of resistant strains are some areas of concern. The aim of the present study was to (1) obtain information on baseline levels of triclosan in plasma and urine, and (2) study the pharmacokinetic pattern of triclosan after a single-dose intake. Ten healthy volunteers were exposed to a single oral dose of 4 mg triclosan by swallowing an oral mouthwash solution. Triclosan in plasma and urine was followed before and up to 8 d after exposure. Triclosan levels in plasma increased rapidly, with a maximum concentration within 1 to 3 h, and the terminal plasma half-life was 21 h. The major fraction was excreted within the first 24 h. The accumulated urinary excretion varied between the subjects, with 24 to 83% of the oral dose being excreted during the first 4 d after exposure. In conclusion, triclosan appears to be readily absorbed from the gastrointestinal tract and has a rapid turnover in humans. The high lipid solubility of the substance gives rise to questions regarding distribution properties and accumulation. The findings of the present study form a basis for greater understanding of the toxicokinetic properties of triclosan in humans.

Palifermin Treatment in Patients Receiving High Dose Melphalan or BEAM Prior to Autologous Peripheral Blood Stem-Cell Transplantation.

Background. Oral mucositis (OM) is a common complication of high-dose (HD) chemotherapy conditioning regimens used with peripheral blood stem-cell transplantation (PBSCT). Severe grades of OM are associated with higher morbidity such as infections, need for total parenteral nutrition (TPN), opioid analgesics and prolonged hospitalization and has been historically underreported. Recent epidemiology reveals an incidence of severe OM of 50–60%. Moreover, OM is reported by patients as the worst and most debilitating complication of PBSCT. The keratinocyte growth factor, palifermin, stimulates the growth, differentiation, migration, and survival of epithelial cells. Palifermin is now approved in the US and the EU to decrease the incidence, duration, and severity of OM in patients (pts) with hematological malignancies requiring autologous PBSCT.Objective. This report describes the treatment of 60 pts who received palifermin through an early access program in Belgium. We evaluated the effect of palifermin on OM in pts with multiple myeloma or non-Hodgkin's lymphoma receiving HD melphalan (HD Mel) or BEAM conditioning regimen, respectively, prior to autologous PBSCT.Methods. The pts received palifermin (IV bolus: 60 μg/kg/day) for 3 days before and 3 days after HD Mel or BEAM. The common OM prevention strategy included basic oral hygiene, mouth washes and oral cryotherapy during HDM administration (n=9). For each patient, follow-up data were collected on mucositis grading, duration of hospitalization, neutropenic fever, treatment with G-CSF, IV antibiotics, opioids, and TPN. The grade of OM during treatment was assessed according to the WHO oral-toxicity scale (grade 0 to 4). Drug-related adverse events were also recorded.Results. Thirty pts received HD Mel and 30 pts received BEAM before PBSCT. All 60 pts received at least 3 palifermin bolus injections; the scheduled doses (6 bolus) were administered to 55 (91%) of 60 pts. Analysis of the follow-up data revealed that 10 (16%) pts experienced no OM. Furthermore, a low incidence (31%) of severe (grade 3 and 4) OM was observed with each conditioning regimen. The median duration of severe OM with the HD Mel regimen was 7 days (range 3–27) contrasting with a median OM duration of 3 days (range 2–12) with the BEAM regimen. Two pts in each regimen required prolonged hospitalization due to OM. With either regimen, neutropenic fever and use of IV antibiotics were common (70% of pts), while bacteremia was infrequent (20% of pts). Myeloid growth factors were administered post PBSCT to the majority of pts. Forty percent (40%) of HD Mel-treated pts and 26% of BEAM-treated pts required opioid analgesics. The percentages of pts receiving TPN were similar in the 2 conditioning regimens (66% of all pts). TPN was used in 16 (84%) pts with severe OM and in 24 (58%) pts with no or grade 1–2 OM. Adverse events clearly related to palifermin were reported in 25 (41%) of 60 pts. The most common adverse events included rash (18 events, 8 severe), disorders of tongue and oral mucosa (13 events, 2 severe), edema (10, no severe) and pruritus (7, no severe).Conclusions. These results indicate that palifermin use prior to HD Mel or BEAM and immediately following the transplantion may provide effective support in the prophylaxis of severe OM in pts undergoing autologous PBSCT, without major toxicity.

A preliminary study of the effect of probiotic Streptococcus salivarius K12 on oral malodour parameters

To determine whether dosing with bacteriocin-producing Streptococcus salivarius following an antimicrobial mouthwash effects a change in oral malodour parameters and in the composition of the oral microbiota of subjects with halitosis. Twenty-three subjects with halitosis undertook a 3-day regimen of chlorhexidine (CHX) mouth rinsing, followed at intervals by the use of lozenges containing either S. salivarius K12 or placebo. Assessment of the subjects' volatile sulphur compound (VSC) levels 1 week after treatment initiation showed that 85% of the K12-treated group and 30% of the placebo group had substantial (>100 ppb) reductions. The bacterial composition of the saliva was monitored by culture and PCR-denaturing gradient gel electrophoresis (PCR-DGGE). Changes in the PCR-DGGE profiles occurred in most subjects following K12 treatment. In vitro testing showed that S. salivarius K12 suppressed the growth of black-pigmented bacteria in saliva samples and also in various reference strains of bacteria implicated in halitosis. Administration of bacteriocin-producing S. salivarius after an oral antimicrobial mouthwash reduces oral VSC levels. The outcome of this preliminary study indicates that the replacement of bacteria implicated in halitosis by colonization with competitive bacteria such as S. salivarius K12 may provide an effective strategy to reduce the severity of halitosis.

Long-term Storage and Recovery of Buccal Cell DNA from Treated Cards

Economical methods for collecting and storing high-quality DNA are needed for large population-based molecular epidemiology studies. Buccal cell DNA collected via saliva and stored on treated filter paper cards could be an attractive method, but modest DNA yields and the potential for reduced recovery of DNA over time were unresolved impediments. Consequently, buccal cell DNA collection via oral mouthwash rinsing became the method of choice in epidemiologic studies. However, the amount of genomic DNA (gDNA) required for genotyping continues to decrease, and reliable whole genome amplification (WGA) methods further reduced the mass of gDNA needed for WGA to 10 ng, diminishing the obstacle of low DNA yields from cards. However, concerns about yield and DNA quality over time remained. We located and analyzed 42 buccal cell saliva samples collected and stored on treated cards for 7 years at room temperature, -20 degrees C, and -80 degrees C. We recovered DNA from the treated cards, estimated the concentration by a human-specific quantitative real-time PCR assay, and evaluated the quality by PCR amplification of 268-, 536-, and 989-bp fragments of the beta-globin gene and by AmpFlSTR Identifiler assay analysis. Most DNA yields per 3-mm punch were <10 ng, and most PCR amplicons failed to amplify, where size of the amplicon was negatively associated with successful amplification. Using these methods, treated cards did not consistently provide sufficient quantities of buccal cell gDNA after 7 years of storage for genotyping or WGA.

Knowledge of oral cancer risk factors among african americans: do nurses have a role?

To assess the knowledge of oral cancer risk factors among African Americans. Descriptive; guided by the Patient/Provider/System Theoretical Model for cancer screening. Community-based primary care center in a southern state. 141 African Americans. The majority was female, had a 12th grade education, and had an income less than 10,000 dollars; 25% were smokers. Participants were asked to identify whether each of 15 factors (i.e., seven risk factors and eight nonrisk factors) increased risk for oral cancer. One point was added for each correct response; therefore, scores could range from 0-15 points. Demographic data were collected. Knowledge of and misconceptions about oral cancer. Only six participants correctly identified all of the risk factors. The majority recognized tobacco but was not as aware of the effects of the sun, alcohol, and diet. Many erroneously identified factors such as hot beverages, poor oral hygiene, spicy foods, dentures, and mouthwash as risk factors. Those with higher incomes and those who visited their dentists in the prior year had more knowledge of risk factors. No differences were found in knowledge based on age, gender, education, or smoking status. Some patients are less likely to routinely visit a dentist and are less knowledgeable about the risk factors for oral cancer. Many of these risk factors are modifiable; therefore, patients need to be aware of the risks and have access to effective strategies to reduce risk. Assess risk factors, teach risk reduction, and correct misinformation. Refer patients to dental professionals. Develop community outreach to African American men at barbershops and fraternal organizations.

Management of oral malodour.

Halitosis is a common problem. Its aetiology is multifactorial, but oral malodour is usually caused by microbial metabolism from the tongue, saliva or dental plaque. Mouthwashes are only effective against halitosis caused by intraoral factors. The principal causative agents of oral malodour are volatile sulphide compounds (VSCs), including hydrogen sulphide, methyl mercaptan and dimethyl sulphide. Data suggest that oral VSC levels correlate with the depth of periodontal pockets. Trials have shown that both mechanical oral care and mouthwash use can reduce halitosis levels. The majority of studies involving mouthwashes have investigated chlorhexidine and essential oil mouthwashes, although comparative studies are sparse.

Screening of traditionally used South African plants for antifungal activity against Candida albicans

Twenty-four South African medicinal plants were screened against Candida albicans standard strain ATCC 10231 and two clinical isolates from a 5-month-old baby and an adult, in an attempt to find a traditional remedy to treat oral candidiasis, which is prevalent in HIV-patients. Allium sativum L. and Tulbaghia violacea L. aqueous bulb extracts had MIC values of 0.56 and 3.25 mg/ml respectively, whilst Polygala myrtifolia L. leaves and Glycyrrhiza glabra L. rhizome extracts had MIC values of 1.56 mg/ml when tested against the 5-month-old isolate. Fresh water extracts stored at 4, 23 and 33 °C over a period of a week, were used to determine the stability of these extracts. Allium sativum and Tulbaghia violacea maintained activity at 4 °C, but not at higher temperatures, whereas Polygala myrtifolia and Glycyrrhiza glabra lost activity within a day even at 4 °C. The unpleasant taste of the two species with a garlic smell, could however not be masked, and as the smell following the eating of the two species would lead to HIV-patients being recognised, these two plants where not considered for further investigation. Therefore, Polygala myrtifolia and Glycyrrhiza glabra are being further investigated for use as an oral mouthwash in clinics and homes.

Benzydamine hydrochloride oral rinses in management of burning mouth syndrome: A clinical trial

Objective. The purpose of this study was to evaluate the efficacy of the topical use of benzydamine hydrochloride 0.15% oral mouthwashes in the control of burning mouth syndrome symptoms. Study Design. In this double-blind, randomized, longitudinal investigation, each of 30 patients with burning mouth syndrome was assigned to one of 3 management modalities. Those in group A received an oral rinse solution of benzydamine hydrochloride 0.15% 3 times a day for 4 weeks, those in group B received a placebo 3 times a day for 4 weeks, and those in group C did not receive any kind of treatment. A visual analog scale was used for evaluation of the symptoms; a Kruskal-Wallis analysis of variance exact test was performed on the resulting data. Results. The findings of this investigation failed to reveal significant differences among the groups. Conclusions. The clinical application of benzydamine hydrochloride oral rinses in the treatment of patients with burning mouth syndrome did not demonstrate significative efficacy in comparison with use of a placebo solution. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:683-6)

Oral cancer and mouthwash use: Evaluation of the epidemiologic evidence

BACKGROUND:An association between mouthwash use and cancer of the oropharynx has been the focus of many epidemiologic studies. PURPOSE:To critically review the methodology of studies of this association. METHODS:Studies were identified through a computerized MEDLINE search of English-language publications from 1976 to 1994. Eligible studies were independently reviewed, and specific criteria were applied to assess issues in the design, analysis, and results of the studies. Methodologic criteria were used that define a case-control study of acceptable epidemiologic quality: (1) histologic confirmation of cancer; (2) use of incident cases; (3) population-based cases; (4) equal exclusions of controls; (5) population-based controls; (6) exposure to mouthwash use before the cancer diagnosis; and (7) adjustments or restrictions for tobacco, alcohol, or both. RESULTS:Seven case-control studies were identified. The odds ratios for these studies ranged from a protective effect (0.82 for any use of mouthwash) to an elevation in risk (2.5 at the highest exposure). Two studies had significant unadjusted odds ratios for the risk of oral cancer. Of the three studies with data on women adjusted for tobacco and alcohol use, one was statistically significant, and none of the three similar studies in men was significant (although one was close). The five studies with data on female nonsmokers, nondrinkers, or both had odds ratios ranging from 1.1 to 3.16 (only one study was significant at the p = 0.05 level), and the four studies with similar data on men were not significant. Two studies met only two of the methodologic criteria, three studies met three, one met four, and one met all seven. CONCLUSIONS:Few of the available studies on mouthwash use and risk of subsequent oropharynx cancer adhere to basic methodologic principles of case-control design. Neither the data for the overall association nor the analysis in patients without other clinical risk factors support a link between mouthwash use and oral cancer. (OTOLARYNGOL HEAD NECK SURG 1995;113:253-61.)

Oral Cancer and Mouthwash Use: Reply

Oral Cancer and Mouthwash Use: Reply E. L. Wynder, M.D., E. L. Wynder, M.D. Mahoney Institute for Health Maintenance American Health Foundation320 East 43d Street New York, New York 10017 Search for other works by this author on: Oxford Academic PubMed Google Scholar Geoffrey C. Kabat, Ph.D. Geoffrey C. Kabat, Ph.D. Mahoney Institute for Health Maintenance American Health Foundation320 East 43d Street New York, New York 10017 Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 71, Issue 6, December 1983, Page 1105, https://doi.org/10.1093/jnci/71.6.1105 Published: 01 December 1983

Oral Cancer and Mouthwash Use: Reply

Oral Cancer and Mouthwash Use: Reply

Oral Cancer and Mouthwash Use

Oral Cancer and Mouthwash Use

Oral Cancer and Mouthwash

As part of a case-control study in North Carolina involving 206 women with oral and pharyngeal cancers and 352 controls, questions were asked concerning the patterns of mouthwash use. No significant overall increase in risk was found among users; the relative risk, adjusted for snuff dipping and smoking habits, was 1.15 [lower, upper limits of the 95% confidence interval (95% Cl) = 0.8, 1.7]. The relative risk associated with mouthwash use was increased to 1.94 (95% Cl = 0.8, 4.7), however, among women abstaining from tobacco. Although consistent dose-response relationships were not observed for this subgroup, these findings and other reports of an increased risk among persons ordinarily at low risk of this disease raise the possibility that mouthwash may contribute to oral and pharyngeal cancers.

O-T-C Topical Oral Antiseptics and Mouthwashes

O-T-C Topical Oral Antiseptics and Mouthwashes