Didem, A., Ayfer, E., & Ayse Ferda, O. (2014). The effect of chewing gum on oral mucositis in children receiving chemotherapy. Health Science Journal, 8, 373–382.

To determine if chewing gum is efficacious in the prevention and treatment of oral mucositis in children receiving chemotherapy regimens

• Permission from institution
• Written informed consent obtained from parents of each child
• Interview with parent and child to elicit demographic information
• The study group consisted of children chewing nonsugary gum for 10 days three times daily for 20 minutes (abstaining from drinking water one hour before chewing gum).
• Both study groups used Tantum^® mouthwash for standard oral care and continued usual tooth brushing.
• Children’s oral assessments were performed on day s1, 5, and 10 using the World Health Organization (WHO) Oral Mucositis Index (OMI). An Eilers’ Oral Assessment Guide with pH measurements was taken.
• All assessments were performed by the same researcher.

• N = 60  
• AGE RANGE = 6–18 years
• MALES: 48.33%, FEMALES: 51.7%
• KEY DISEASE CHARACTERISTICS: Acute myeloid leukemia, acute lymphoblastic leukemia, Hodgkin lymphoma, and Wilms tumor
• OTHER KEY SAMPLE CHARACTERISTICS: Duration of hospitalization by day, number receiving chemotherapy, and duration of disease by year

• SITE: Single site
• SETTING TYPE: Inpatient pediatric oncology clinic at a university hospital
• LOCATION: Istanbul

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics

Quasi-experimental study with a control group

• World Health Organization (WHO) Oral Mucositis Index (OMI)
• Eilers’ Oral Assessment Guide (EOAG)
• Intraoral pH assessment measured by researchers within one minute after chewing using pH colormatic strips placed under the tongue for two minutes (values ranged from 4–9)

• Acute lymphoblastic leukemia was the most common diagnosis.
• No statistical difference between demographic data in both control and study groups related to age, gender, or educational states was found.
• At end of the study, significant difference (p < 0.5) in mucositis severity between the two groups existed.
• At the start of study, the average pH value was 5.8 (SD = 0.6) for the study group and 5.9 (SD = 0.3) for the control group. At end of study (day 10), the average pH value was 6.4 (SD = 0.2) in the study group and 6 (SD = 0.3) in the control group. This was statistically significant (p < 0.5).

Chewing gum was an effective option for preventing and treating oral mucositis in pediatric patients with acute lymphoblastic leukemia, acute myeloid leukemia, Hodgkin lymphoma, and Wilms tumors.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Unintended interventions or applicable interventions not described that would influence results
• Findings not generalizable
• Other limitations/explanation: Unintended interventions such as avoiding certain foods or using ice chips at home were not described. Not all children had the same mucositis severity in this study. The type of gum was not described and its ingredients were not described.

• This study indicated a potential treatment and prevention intervention for pediatric patients with cancer.
• Its findings point to areas for additional nursing research.
• The intervention was low-cost, accessible, and easy to administer.