Cheng, K.K., Molassiotis, A., Chang, A.M., Wai, W.C., & Cheung, S.S. (2001). Evaluation of an oral care protocol intervention in the prevention of chemotherapy-induced oral mucositis in pediatric cancer patients. European Journal of Cancer, 37, 2056–2063.

The study was conducted over an eight-month period. The first four months were with the control group, which received routine care, no oral protocol, and the center's standard use of 0.9% sodium chloride (NaCl) and benzydamine hydrochloride rinse to control oral mucositis (OM) when it developed.

The last four months involved the experimental group, which received an oral care protocol consisting of patient education, maintenance of patient diaries, and rinsing with normal saline chlorhexidine every two hours on days 1–21. The oral protocol prescribed toothbrushing; NaCl solution rinse for gums, tongue, and soft tissue; and chlorhexidine rinse every morning and evening, as well as NaCl rinse after each meal and every two hours for the second week only.

• The study reported on 42 children (21 in the control group and 21 in the experimental group) with hemotological or solid malignancies.
• Mean age was 10.3 years and a range of 6–18 years.

This was a prospective, comparative study.

• Oral assessment was performed initially and two times per week in each group.
• The Eilers Oral Assessment Guide was used.
• The Faces Pain Scale was used.
• Patients were observed for fevers and neutropenia.

• The oral protocol group experienced a 38% reduction of OM.
• Severity of OM (p = 0.000002) and related pain (p = 0.0001) were significantly reduced in the intervention group.
• The mean neutrophil count varied significantly between the seven time point evaluations (p = 0.008). A moderate negative correlation was found between the presence of OM and neutrophil count of the control group (p = 0.46) and protocol group (p = 0.15). Intensity of OM pain was significantly correlated with score of OM in two groups (p = 0.007).

• Assessment was performed twice per week.
• The results may not be generalizable to adult patients.
• The sample size was smal.
• A variety of chemotherapy protocols were used.
• The experimental group may have experienced a study effect.
• Use of chlorhexidine recommendation is in conflict with Multinational Association of Supportive Care in Cancer (MASCC) recommendations.

Although the sample is small, the evidence supports the use of normal saline found in other studies.