Potting, C.M., Uitterhoeve, R., Scholte Op Reimer, W., & Van Achterberg, T. (2006). The effectiveness of commonly used mouthwashes for the prevention of chemotherapy-induced oral mucositis: A systematic review. European Journal of Cancer Care, 15, 431–439.

Databases searched were MEDLINE and CINAHL (1992 to fall 2004).

Search keywords were mucositis, stomatitis, and chemotherapy in combination with prevention, mouthwashes, antiseptic, oral infection, chlorhexidine, chamomile, povidone-iodine, and sodium bicarbonate.

Studies were included in the review if they

• Were randomized studies of the effect of mouthwashes for the prevention and amelioration of oral mucositis in adult patients undergoing chemotherapy.
• Involved mouthwashes for oral mucositis, had a controlled study design, and included an outcome measure of the severity of mucositis.

Seven studies met the criteria. Five investigated chlorhexidine, one investigated iodine mouthwash, and one investigated chamomile solution. All studies randomly allocated participants to either an intervention or a comparison group. One study assigned patients by stratified block randomization. Most studies used a placebo mouthwash or sterile water as a control.

• Patients were adults with a mean age of 53.6 years.
• Among the patients included across all studies, 72% of the patients received chemotherapy, 6% of the patient received hematopoietic stem cell transplantation, and 22% had unknown treatments.

• The five studies investigating chlorhexidine mouthwash showed no significant effect (weighted mean difference = 0.22; 95% CI = –0.20, 0.63). I
• n the chamomile study, no differences were found between the chamomile group and the control group in either incidence or severity of mucositis.
• In the povidone-iodine study, the iodine group had significantly less severe mucositis and shorter duration compared with the control group; however, the sample size (n = 40; power ≤ 80) was too small to be confident in the findings.

Povidone-iodine was the only agent to show activity for preventing mucositis. Because of the effects of chlorhexidine (e.g., teeth discoloration, bitter taste, unpleasant sensations), the authors concluded that sterile water, 0.9% saline solution, or sodium bicarbonate all are better alternatives.