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BMC Oral Health

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Open Access 01-12-2023 | Cytostatic Therapy | Research

Antiseptic efficacy of two mouth rinses in the oral cavity to identify a suitable rinsing solution in radiation- or chemotherapy induced mucositis

Authors: Paula Zwicker, Marcus Freitag, Florian H. Heidel, Thomas Kocher, Axel Kramer

Published in: BMC Oral Health | Issue 1/2023

Abstract

Objectives

Oral mucositis caused by intensive cancer chemotherapy or radiotherapy frequently results in pronounced damage of the oral mucosa leading to painful oral hygiene. To support oral care, antimicrobial effective mouth rinses may be used. Thus, the efficacy of a hypochlorite-based mouth rinse (Granudacyn®), assumed to be highly biocompatible because of the compounds being part of the natural pathogen defense, as possible antiseptic agent in case of oral mucositis was compared to that of an octenidine based antiseptic mouth rinse (Octenidol® md).

Materials and methods

The study was conducted as monocentric, controlled, randomized, blind cross over comparative study on 20 volunteers. As a proof of principle, we performed the study on orally healthy subjects and not cancer patients. The efficacy was determined as reduction of colony forming units (cfu) on buccal mucosa as well as in saliva. After mouth rinsing for 30 s, samples were taken after 1 min, 15 min, 30 and 60 min. The lg-reduction was calculated as difference between lg-values of cfu pre- and post-treatment.

Results

Both antiseptic mouth rinses induced a significant reduction of cfu on buccal mucosa and in saliva 1 min after mouth rinsing. The effect persisted up to 60 min. The octenidine based rinse was significantly superior to the hypochlorite-based rinse up to the last sample 60 min after rinsing. However, the known cytotoxicity of octenidine argues against its application.

Conclusion

Within the limits of this study, due to its antiseptic efficacy, the hypochlorite-based rinse Granudacyn® can be regarded appropriate to support the oral hygiene in patients with a sensitive oral mucosa during an aggressive cancer chemotherapy and radiation treatment in case of oral mucositis.

Leitlinienprogramm Onkologie D, Krebsgesellschaft D, Krebshilfe AQMF. S3-Leitlinien Supportive Therapie bei onkologischen PatientInnen:Langversion1.1; 2017.

Kawajiri J, Nagata K, Nakamura A, Fujieda A, Ino K, Nomura J, et al. Clinical utility of oral management in allogeneic hematopoietic stem cell transplantation recipients: microbiological evidence based on molecular analysis of oral bacteria. Support Care Cancer. 2022;30:757–64. https://doi.org/10.1007/s00520-021-06462-9.CrossRefPubMed

Hong CHL, Gueiros LA, Fulton JS, Cheng KKF, Kandwal A, Galiti D, et al. Systematic review of basic oral care for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2019;27:3949–67. https://doi.org/10.1007/s00520-019-04848-4.CrossRefPubMed

Buglione M, Cavagnini R, Di Rosario F, Maddalo M, Vassalli L, Grisanti S, et al. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Xerostomia and trismus (part 2). Literature review and consensus statement. Crit Rev Oncol Hematol. 2016;102:47–54. https://doi.org/10.1016/j.critrevonc.2016.03.012.CrossRefPubMed

Schmoll H-J, Höffken K, Possinger K. Kompendium internistische Onkologie. 1st ed. Berlin: Springer; 1986.

Elad S, Cheng KKF, Lalla RV, Yarom N, Hong C, Logan RM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126:4423–31. https://doi.org/10.1002/cncr.33100.CrossRefPubMed

Chaveli-López B, Bagán-Sebastián JV. Treatment of oral mucositis due to chemotherapy. J Clin Exp Dent. 2016;8:e201–9. https://doi.org/10.4317/jced.52917.CrossRefPubMedPubMedCentral

Safarzadeh S, Shirban F, Bagherniya M, Sathyapalan T, Sahebkar A. The effects of herbal medicines on cancer therapy-induced oral mucositis: a literature review. Phytother Res. 2022;36:243–65. https://doi.org/10.1002/ptr.7308.CrossRefPubMed

Raza A, Karimyan N, Watters A, Emperumal CP, Al-Eryani K, Enciso R. 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. Support Care Cancer. 2022;30:8689–703. https://doi.org/10.1007/s00520-022-07190-4.CrossRefPubMed

10.

Xu J-L, Xia R, Sun Z-H, Sun L, Min X, Liu C, et al. Effects of honey use on the management of radio/chemotherapy-induced mucositis: a meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2016;45:1618–25. https://doi.org/10.1016/j.ijom.2016.04.023.CrossRefPubMed

11.

Yarom N, Hovan A, Bossi P, Ariyawardana A, Jensen SB, Gobbo M, et al. Systematic review of natural and miscellaneous agents, for the management of oral mucositis in cancer patients and clinical practice guidelines - part 2: honey, herbal compounds, saliva stimulants, probiotics, and miscellaneous agents. Support Care Cancer. 2020;28:2457–72. https://doi.org/10.1007/s00520-019-05256-4.CrossRefPubMed

12.

Delavarian Z, Pakfetrat A, Ghazi A, Jaafari MR, Homaei Shandiz F, Dalirsani Z, et al. Oral administration of nanomicelle curcumin in the prevention of radiotherapy-induced mucositis in head and neck cancers. Spec Care Dentist. 2019;39:166–72. https://doi.org/10.1111/scd.12358.CrossRefPubMed

13.

Puataweepong P, Dhanachai M, Dangprasert S, Sithatani C, Sawangsilp T, Narkwong L et al. The efficacy of oral Aloe vera juice for radiation induced mucositis in head and neck cancer patients: a double-blind placebo-controlled study.Asian Biomedicine. 2009:375–82.

14.

Javadzadeh Bolouri A, Pakfetrat A, Tonkaboni A, Aledavood SA, Fathi Najafi M, Delavarian Z, et al. Preventing and therapeutic effect of Propolis in Radiotherapy Induced Mucositis of Head and Neck Cancers: a Triple-Blind, randomized, placebo-controlled trial. Iran J Cancer Prev. 2015;8:e4019. https://doi.org/10.17795/ijcp-4019.CrossRefPubMedPubMedCentral

15.

Mohammad Hasan Akhavan-Karbassi. Randomized Double-Blind Placebo-Controlled Trial of Propolis for Oral Mucositis in Patients Receiving Chemotherapy for Head and Neck Cancer 2016. https://doi.org/10.14456/apjcp.2016.142.

16.

de Lima Dantas JB, Freire TFC, Sanches ACB, Julião ELD, Medrado ARAP, Martins GB. Action of Matricaria recutita (chamomile) in the management of radiochemotherapy oral mucositis: a systematic review. Phytother Res. 2022. https://doi.org/10.1002/ptr.7378.CrossRefPubMed

17.

Cardona A, Balouch A, Abdul MM, Sedghizadeh PP, Enciso R. Efficacy of chlorhexidine for the prevention and treatment of oral mucositis in cancer patients: a systematic review with meta-analyses. J Oral Pathol Med. 2017;46:680–8. https://doi.org/10.1111/jop.12549.CrossRefPubMed

18.

Pitten F-A, Kiefer T, Buth C, Doelken G, Kramer A. Do cancer patients with chemotherapy-induced leukopenia benefit from an antiseptic chlorhexidine-based oral rinse? A double-blind, block-randomized, controlled study. J Hosp Infect. 2003;53:283–91. https://doi.org/10.1053/jhin.2002.1391.CrossRefPubMed

19.

Müller G, Kramer A. Biocompatibility index of antiseptic agents by parallel assessment of antimicrobial activity and cellular cytotoxicity. J Antimicrob Chemother. 2008;61:1281–7. https://doi.org/10.1093/jac/dkn125.CrossRefPubMed

20.

Kramer A, Dissemond J, Kim S, Willy C, Mayer D, Papke R, et al. Consensus on Wound Antisepsis: Update 2018. Skin Pharmacol Physiol. 2018;31:28–58. https://doi.org/10.1159/000481545.CrossRefPubMed

21.

Göhring J, Müller G, Biffar R, Kramer A. Impact of the cosmetic mouthwash “Jack Pro Spülung plus” (“rheodol-Spülung plus”) on the oral cavity flora, tested in a monocentric, controlled, randomized, blind, cross-over comparative study. GMS Hyg Infect Control. 2014;9:Doc08. https://doi.org/10.3205/dgkh000228.CrossRefPubMedPubMedCentral

22.

Fukuyama T, Martel BC, Linder KE, Ehling S, Ganchingco JR, Bäumer W. Hypochlorous acid is antipruritic and anti-inflammatory in a mouse model of atopic dermatitis. Clin Exp Allergy. 2018;48:78–88. https://doi.org/10.1111/cea.13045.CrossRefPubMed

23.

Medina-Tamayo J, Sánchez-Miranda E, Balleza-Tapia H, Ambriz X, Cid ME, González-Espinosa D, et al. Super-oxidized solution inhibits IgE-antigen-induced degranulation and cytokine release in mast cells. Int Immunopharmacol. 2007;7:1013–24. https://doi.org/10.1016/j.intimp.2007.03.005.CrossRefPubMed

24.

Sam C-H, Lu H-K. The role of hypochlorous acid as one of the reactive oxygen species in periodontal disease. J Dent Sci. 2009;4:45–54. https://doi.org/10.1016/S1991-7902(09)60008-8.CrossRef

25.

Harnoss JC, Elrub QMA, Jung J-O, Koburger T, Assadian O, Dissemond J, et al. Irritative potency of selected wound antiseptics in the hen’s egg test on chorioallantoic membrane to predict their compatibility to wounds. Wound Repair Regen. 2019;27:183–9. https://doi.org/10.1111/wrr.12689.CrossRefPubMed

26.

D’Atanasio N, de Capezzone A, Mangano G, Meloni M, Giarratana N, Milanese C, Tongiani S. A New Acid-oxidizing solution: Assessment of its role on Methicillin-resistant Staphylococcus aureus (MRSA) Biofilm Morphological Changes. Wounds. 2015;27:265–73.PubMed

27.

Eryilmaz M, Im P. Hypochlorous Acid - Analytical Methods and Antimicrobial Activity. Trop J Pharm Res. 2013. https://doi.org/10.4314/tjpr.v12i1.20.CrossRef

28.

Miyaoka Y, Kabir MH, Hasan MA, Yamaguchi M, Shoham D, Murakami H, Takehara K. Virucidal activity of slightly acidic hypochlorous acid water toward influenza virus and coronavirus with tests simulating practical usage. Virus Res. 2021;297:198383. https://doi.org/10.1016/j.virusres.2021.198383.CrossRefPubMed

29.

Koburger T, Hübner N-O, Braun M, Siebert J, Kramer A. Standardized comparison of antiseptic efficacy of triclosan, PVP-iodine, octenidine dihydrochloride, polyhexanide and chlorhexidine digluconate. J Antimicrob Chemother. 2010;65:1712–9. https://doi.org/10.1093/jac/dkq212.CrossRefPubMed

30.

Sheth CC, Johnson E, Baker ME, Haynes K, Mühlschlegel FA. Phenotypic identification of Candida albicans by growth on chocolate agar. Med Mycol. 2005;43:735–8. https://doi.org/10.1080/13693780500265998.CrossRefPubMed

31.

Rohrer N, Widmer AF, Waltimo T, Kulik EM, Weiger R, Filipuzzi-Jenny E, Walter C. Antimicrobial efficacy of 3 oral antiseptics containing octenidine, polyhexamethylene biguanide, or Citroxx: can chlorhexidine be replaced? Infect Control Hosp Epidemiol. 2010;31:733–9. https://doi.org/10.1086/653822.CrossRefPubMed

32.

Wang L, Bassiri M, Najafi R, Najafi K, Yang J, Khosrovi B, et al. Hypochlorous acid as a potential wound care agent: part I. stabilized hypochlorous acid: a component of the inorganic armamentarium of innate immunity. J Burns Wounds. 2007;6:e5.PubMedPubMedCentral

33.

Severing A-L, Rembe J-D, Koester V, Stuermer EK. Safety and efficacy profiles of different commercial sodium hypochlorite/hypochlorous acid solutions (NaClO/HClO): antimicrobial efficacy, cytotoxic impact and physicochemical parameters in vitro. J Antimicrob Chemother. 2019;74:365–72. https://doi.org/10.1093/jac/dky432.CrossRefPubMed

34.

Gottardi W, Nagl M. Which conditions promote a remanent (persistent) bactericidal activity of chlorine covers? Zentralbl Hyg Umweltmed. 1998;201:325–35.PubMed

35.

Langer S, Sedigh Salakdeh M, Goertz O, Steinau HU, Steinstraesser l, Homann HH. The impact of topical antiseptics on skin microcirculation. Eur J Med Res. 2004;9 9:449–54.PubMed

36.

Rupe C, Gioco G, Almadori G, Galli J, Micciché F, Olivieri M, et al. Oral Candida spp. Colonisation is a risk factor for severe oral mucositis in patients undergoing Radiotherapy for Head & Neck Cancer: results from a multidisciplinary mono-institutional prospective observational study. Cancers (Basel). 2022. https://doi.org/10.3390/cancers14194746.CrossRefPubMed

Title: Antiseptic efficacy of two mouth rinses in the oral cavity to identify a suitable rinsing solution in radiation- or chemotherapy induced mucositis
Authors: Paula Zwicker
Marcus Freitag
Florian H. Heidel
Thomas Kocher
Axel Kramer
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Cytostatic Therapy
Published in: BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI: https://doi.org/10.1186/s12903-023-02884-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Antiseptic efficacy of two mouth rinses in the oral cavity to identify a suitable rinsing solution in radiation- or chemotherapy induced mucositis

Abstract

Objectives

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusion

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