PEP Topic 

Caphosol is a calcium phosphate solution resembling human saliva that is intended to replace the normal ionic and pH balance in the oral cavity. It has been used as a mouth rinse to moisten, lubricate, and clean the oral mucosa, tongue, and throat. Caphosol has been evaluated for mucositis.

Effectiveness Not Established

Research Evidence Summaries

Papas, A.S., Clark, R.E., Martuscelli, G., O’Loughlin, K.T., Johansen, E., & Miller, K.B. (2003). A prospective, randomized trial for the prevention of mucositis in patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplantation, 31, 705–712.

doi: 10.1038/sj.bmt.1703870

Intervention Characteristics/Basic Study Process:

Patients rinsed with 30 ml of calcium phosphate at least four times per day. Patients also received four topical treatments of 1% fluoride as neutral 2% sodium fluoride gel administered by tray at the screening visit and completed prior to hospitalization.

Patients in the control group received an aqueous 0.01% sodium fluoride rinse. Prior to transplantation, the control group received four topical treatments with a placebo gel administered with the same technique as the experimental group. During transplantation, patients used the sodium fluoride rinse at least four times daily, 30 ml each time.

Patients who developed severe mucositis were instructed to rinse up to 10 times per day with their solution.

All patients received acyclovir and antifungal prophylaxis per protocol.

Sample Characteristics:

  • The study reported on 95 patients undergoing hematopoietic stem cell transplantation (HSCT).
  • Patients receiving autologous HSCT had peripheral stem cells and granulocyte colony-stimulating factor (G-CSF).
  • Patients receiving allogenic HSCT had bone marrow cells and methotrexate (MTX).
  • The experimental group had 50 patients, and the control group had 47 patients.

Study Design:

This was a randomized, controlled trial.

Measurement Instruments/Methods:

The National Institute of Dental and Craniofacial Research scale was used.

The following were measured and recorded.

  • Days to absolute neutorphile count (ANC) greater than 200 mm3
  • Days to ANC greater than 500 mm3
  • Days of mucositis
  • Peak mucositis level
  • Peak pain level
  • Days of pain
  • Milligrams of self-administered morphine
  • Days of morphine
  • Average length of stay (ALOS)


  • Duration of mucositis was 7.2 days in the control group and 3.72 days in the caphosol group (p = 0.00096).
  • The control group had a smaller percentage of patients experiencing no mucositis (19% versus 40%).
  • Peak mucositis was significantly higher for the control group (p = 0.004).
  • The experimental group experienced fewer days of pain, milligrams of morphine, and days of morphine.


  • The study had an adequate sample size according to power analysis.
  • Frequency, duration, and severity of oral inflammatory processes were significantly lower in the experimental group.


  • Use of fluoride may have decreased infection.
  • No comparison was provided between allogeneic and autologous transplantations and the presence of mucositis.

Pettit, L., Sanghera, P., Glaholm, J., & Hartley, A. (2014). The use of MuGard™, Caphosol® and Episil® in patients undergoing chemoradiotherapy for squamous cell carcinoma of the head and neck. Journal of Radiotherapy in Practice, 13(2), 218–225.

doi: 10.1017/S1460396912000581

Study Purpose:

To record mucositis and dysphagia toxicity and level of anesthesia for patients receiving MuGard, Caphosol, or Episil in comparison to standard care

Intervention Characteristics/Basic Study Process:

Patients undergoing concurrent radiotherapy and chemotherapy for locally advanced head and neck cancer were audited for eight weeks during treatment. Patients were sequentially given either the standard oral care regimen of aspirin, glycerin, and sucralfate and Gelclair® or one of the other products. Patients were assessed weekly during four weeks of radiotherapy and for four weeks after completion. All patients received the same protocol approach for analgesia.

Sample Characteristics:

  • N = 104  
  • AGE: Not reported
  • MALES: Not reported, FEMALES: Not reported
  • KEY DISEASE CHARACTERISTICS: All had squamous cell head and neck cancer, most were of the oropharynx. All were receiving concurrent carboplatin or cetuximab. Radiotherapy was 55 Gy in 20 fractions over 25 days.


  • SITE: Single site 
  • SETTING TYPE: Outpatient 
  • LOCATION: United Kingdom

Phase of Care and Clinical Applications:

PHASE OF CARE: Active antitumor treatment

Study Design:


Measurement Instruments/Methods:

Common Terminology Criteria for Adverse Events v3


No differences were seen between groups in average grade of dysphagia or analgesia use. No differences were seen between those receiving radiotherapy with intensity-modulated radiation therapy or conformal radiotherapy.


  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Unintended interventions or applicable interventions not described that would influence results
  • A much larger group of patients was in the standard care group. No information is provided about general oral care, and frequency of use of any of the oral agents is not described. Adherence varied considerably across groups, with the largest adherence to the standard care regimen.

Nursing Implications:

This study had numerous design limitations and provides little supportive evidence for any of the approaches used for prevention and management of oral mucositis or associated pain.