Legert, K.G., Remberger, M., Ringden, O., Heimdahl, A., & Dahllof, G. (2014). Reduced intensity conditioning and oral care measures prevent oral mucositis and reduces days of hospitalization in allogeneic stem cell transplantation recipients. Supportive Care in Cancer, 22, 2133–2140.

To compare the incidence of oral mucositis (OM) in patients conditioned with myloablative conditioning (MAC) versus reduced-intensity conditioning (RIC) and to determine the effect of a new oral care protocol

A radiographic full-mouth exam and an oral exam by an investigating dentist were performed one week prior to hematopoietic stem cell transplantation (HSCT). Prior to the start of conditioning, daily oral exams began three days prior to HSCT for 25 days or until discharge. A dentist or dental hygienist assessed oral cavities three times per week. From 2007 to 2010, 142 patients used a protocol (soft tooth brushing twice daily only; no interdental brushes, toothpicks, or flossing were allowed). From 2010 to 2011, 29 patients received the intensive protocol (intensive protocol brushing, interdental brushes or flossing, sucking on ice chips every two to three hours while awake, rinsing normal saline solution every two hours while awake from transplantation until neutrophil count was > 0.5). Dental infections foci were treated conservatively.

• N = 171
• MEDIAN AGE = 50 years
• MALES: 53.2%, FEMALES: 46.7%
• KEY DISEASE CHARACTERISTICS: Allogeneic HSCT; 94% malignant disease; 5% nonmalignant; 12% previous HSCT; 44% early-stage; 56% late-stage
• OTHER KEY SAMPLE CHARACTERISTICS: 57 human leukocyte antigen identical sibling or related donors; 101 unrelated donors; 13 antigen-mismatched, unrelated donors

• SITE: Single-site
• SETTING TYPE: Inpatient
• LOCATION: Karolinska University Hospital in Huddinge, Sweden

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics, elder care

Quasi-experimental

• World Health Organization (WHO)
• Visual Analog Scale (VAS) for pain
• National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE v3)
• Oral function (ability to swallow)
• Subjective opinion of function of saliva

Patients treated with the oral protocol in 2011 had significantly lower OM scores than those treated with the previous protocol (p = 0.013).

MAC conditioning was correlated with significantly higher OM scores (p < 0.001). Lower OM scores were associated with the intensive oral protocol intervention. Patients treated in later years (2011) demonstrated a decrease in OM scores, which were caused by an increased use of RIC and improved standards of oral care.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement/methods not well described
• Other limitations/explanation: The actual sample size for the oral care intervention was only 29 participants. In addition, the authors began the article comparing different conditioning regimens then added in the oral care intervention.

Oral mucositis is a side effect of the conditioning regimens for HSCT. This study revealed that with consistent assessment, support, and a more intensive oral care protocol using ice and normal saline rinses, there is a potential to reduce the severity of this side effect. More nursing research is needed in this area.