ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Use of Chlorhexidine Prophylaxis in Preventing Oral Mucositis for Pediatric Cancer Patients
Clinical Question Are pediatric cancer patients who received 0.12% chlorhexidine prophylaxis less likely to have oral mucositis?
Clinical Bottom Line The effectiveness of chlorhexidine prophylaxis in preventing oral mucositis for pediatric cancer patients has not been clearly supported by the literature.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22959949Qutob/21327 articlesSystematic review of non-randomized studies
Key resultsThis paper systematically reviewed evidence on different agents used to prevent oral mucositis in children. Out of the 27 articles only seven reported efficacy rates in reduction of oral mucositis using chlorhexidine. Only three articles were done exclusively in children, the others combined children and adults. Five articles with a mixed patient pool reported significant reduction in mucositis; the ones with fair strength of evidence (three articles all with mixed population) reported a reduction of 41-46%. The other two (just children) with less strength of evidence reported rates of 8% and 54% reduction. Six articles reported a statistical significance with a P value of <0.05 in the reduction of onset and the severity of oral mucositis in children.
#2) 21821553Nashwan/20115 articles were reviewed to evaluate the effectiveness of using chlorhexidine in childrenLiterature review
Key resultsSignificant effect for chlorhexidine in preventing oral mucositis or decreasing its severity in children was seen in 4 studies when compared to benzydamine and a placebo group. The fifth study showed no benefit from the use of chlorhexidene mouthwash. The paper suggested but did not conclude that using chlorhexidine as prophylactic agent for oral mucositis in children who will receive chemotherapy may have a positive effect because of the reduction of the microbes in the oral flora.
#3) 26131350Hashemi A/201530 papers were evaluated Systematic review of non-randomized studies
Key resultsInitially, 151 articles covering clinical data and research work were included. After that, case reports, literature reviews and review articles were excluded leaving 30 papers for this study. Those articles included seven mouthwashes. Chlorhexidine results did not confirm its effectiveness as a prophylactic agent for oral mucositis in children. This could be attributed to the differences in populations, diseases, chemotherapy regimen, chlorhexidine concentration and the frequency of its use.
Evidence Search PubMed – clinical queries – mucositis, chlorhexidine
Comments on
The Evidence
Validity: Qutob’s paper was a systematic review with no meta-analysis. Seven articles reported that chlorhexidine is an effective agent in reducing oral mucositis. However, only three of them were done exclusively in pediatric population. Nashwan’s paper compared chlorhexidine to benzydamine and a placebo group. Four out of five articles showed positive results. Hashemi’s paper studied the effect of seven mouthwashes including chlorhexidine that did not have confirmatory results proving its effectiveness as a prophylactic agent in pediatric cancer patients. Perspective: Chlorhexidine is considered to be a safe agent if used based on manufacturer’s instructions. Thus, including it in the preventive oral hygiene protocol for cancer patients may be beneficial. However the results were indecisive and further studies are needed to confirm its effectiveness.
Applicability In cancer patients, it is common to develop oral mucositis after receiving chemotherapy and/or radiotherapy. Developing a protocol that could prevent such event from occurring would be extremely beneficial. The current evidence did not support the use of chlorhexidine prophylaxis due to insufficient studies and inconclusive results. Further investigation in this area is needed.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Pediatric Dentistry)
Keywords Oral mucositis, chlorhexidine, pediatric patients, cancer.
ID# 2960
Date of submission: 10/27/2015spacer
E-mail Alkhodier@livemail.uthscsa.edu
Author Haifa Alkhodier, BDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Maria Mendez Cervantes, DDS
Faculty mentor/Co-author e-mail CervantesMen@uthscsa.edu
Basic Science Rationale
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post a rationale
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