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Oropharyngeal mucositis complicating bone marrow transplantation: prognostic factors and the effect of chlorhexidine mouth rinse.

Abstract

Oral mucosal ulceration complicating bone marrow transplantation interferes with patients' comfort, nutrition and may lead to systemic infection derived from the mouth. The mucosal injury results from epithelial damage due to the cytotoxic effects of chemotherapy and radiation conditioning as well as from superficial oropharyngeal infection. Because chlorhexidine gluconate is a broad spectrum topical antimicrobial which has been demonstrably effective in preventing oral infection and gingivitis, we performed a randomized, placebo controlled, double-blind trial of chlorhexidine as a mouth rinse in BMT recipients to study the severity of oral mucositis and both oral and systemic infectious complications. One hundred patients were randomly assigned to receive either chlorhexidine gluconate 0.12% mouth rinse or placebo three times daily from the initiation (day -8) of chemoradiotherapy conditioning until day +35 post-BMT. Chlorhexidine use resulted in a trend toward improved oral hygiene index (reduced dental plaque) (p = 0.06) but did not modify the oral mucositis. Patients using chlorhexidine developed a maximum ulceration of 18 +/- 22% of their oral mucosa, while placebo patients ulcerated 25 +/- 31% of the mouth. Ulcerative mucositis was significantly worse in adults compared with children, in individuals who received methotrexate for graft-versus-host disease prophylaxis, and was most prominent on non-keratinized epithelium. Overall, there was no clinically demonstrable additional therapeutic advantage to the use of chlorhexidine in either reducing the mucositis, controlling oral pain, facilitating oral nutrition, shortening hospital stay, or reducing oral infection with herpes simplex virus. There was a trend toward diminished oral candidiasis in chlorhexidine users (p = 0.06).(

ABSTRACT

TRUNCATED AT 250 WORDS)

Authors+Show Affiliations

,

Department of Medicine, University of Minnesota, Minneapolis 55455.

, , , , , , , ,

Source

Bone marrow transplantation 4:1 1989 Jan pg 89-95

MeSH

Adult
Antineoplastic Agents
Bone Marrow Transplantation
Candidiasis
Child
Chlorhexidine
Clinical Trials as Topic
Double-Blind Method
Humans
Mouth Mucosa
Mouthwashes
Nutrition Disorders
Pain
Pharyngitis
Postoperative Complications
Prognosis
Radiation Injuries
Random Allocation
Stomatitis
Stomatitis, Aphthous

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

2647192

Citation

Weisdorf, D J., et al. "Oropharyngeal Mucositis Complicating Bone Marrow Transplantation: Prognostic Factors and the Effect of Chlorhexidine Mouth Rinse." Bone Marrow Transplantation, vol. 4, no. 1, 1989, pp. 89-95.
Weisdorf DJ, Bostrom B, Raether D, et al. Oropharyngeal mucositis complicating bone marrow transplantation: prognostic factors and the effect of chlorhexidine mouth rinse. Bone Marrow Transplant. 1989;4(1):89-95.
Weisdorf, D. J., Bostrom, B., Raether, D., Mattingly, M., Walker, P., Pihlstrom, B., ... Woods, W. (1989). Oropharyngeal mucositis complicating bone marrow transplantation: prognostic factors and the effect of chlorhexidine mouth rinse. Bone Marrow Transplantation, 4(1), pp. 89-95.
Weisdorf DJ, et al. Oropharyngeal Mucositis Complicating Bone Marrow Transplantation: Prognostic Factors and the Effect of Chlorhexidine Mouth Rinse. Bone Marrow Transplant. 1989;4(1):89-95. PubMed PMID: 2647192.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oropharyngeal mucositis complicating bone marrow transplantation: prognostic factors and the effect of chlorhexidine mouth rinse. A1 - Weisdorf,D J, AU - Bostrom,B, AU - Raether,D, AU - Mattingly,M, AU - Walker,P, AU - Pihlstrom,B, AU - Ferrieri,P, AU - Haake,R, AU - Goldman,A, AU - Woods,W, PY - 1989/1/1/pubmed PY - 1989/1/1/medline PY - 1989/1/1/entrez SP - 89 EP - 95 JF - Bone marrow transplantation JO - Bone Marrow Transplant. VL - 4 IS - 1 N2 - Oral mucosal ulceration complicating bone marrow transplantation interferes with patients' comfort, nutrition and may lead to systemic infection derived from the mouth. The mucosal injury results from epithelial damage due to the cytotoxic effects of chemotherapy and radiation conditioning as well as from superficial oropharyngeal infection. Because chlorhexidine gluconate is a broad spectrum topical antimicrobial which has been demonstrably effective in preventing oral infection and gingivitis, we performed a randomized, placebo controlled, double-blind trial of chlorhexidine as a mouth rinse in BMT recipients to study the severity of oral mucositis and both oral and systemic infectious complications. One hundred patients were randomly assigned to receive either chlorhexidine gluconate 0.12% mouth rinse or placebo three times daily from the initiation (day -8) of chemoradiotherapy conditioning until day +35 post-BMT. Chlorhexidine use resulted in a trend toward improved oral hygiene index (reduced dental plaque) (p = 0.06) but did not modify the oral mucositis. Patients using chlorhexidine developed a maximum ulceration of 18 +/- 22% of their oral mucosa, while placebo patients ulcerated 25 +/- 31% of the mouth. Ulcerative mucositis was significantly worse in adults compared with children, in individuals who received methotrexate for graft-versus-host disease prophylaxis, and was most prominent on non-keratinized epithelium. Overall, there was no clinically demonstrable additional therapeutic advantage to the use of chlorhexidine in either reducing the mucositis, controlling oral pain, facilitating oral nutrition, shortening hospital stay, or reducing oral infection with herpes simplex virus. There was a trend toward diminished oral candidiasis in chlorhexidine users (p = 0.06).(ABSTRACT TRUNCATED AT 250 WORDS) SN - 0268-3369 UR - https://www.unboundmedicine.com/medline/citation/2647192/Oropharyngeal_mucositis_complicating_bone_marrow_transplantation:_prognostic_factors_and_the_effect_of_chlorhexidine_mouth_rinse_ L2 - http://www.diseaseinfosearch.org/result/7171 DB - PRIME DP - Unbound Medicine ER -