Stokman, M. A., Burlage, F.R., & Spijkervet, F.K. (2012). The effect of a calcium phosphate mouth rinse on (chemo) radiation induced oral mucositis in head and neck cancer patients: A prospective study. International Journal of Dental Hygiene, 10(3), 175–180.

To determine the effect of a calcium phosphate (CP) mouth rinse on oral mucositis

Consecutive patients were asked if they were willing to use the CP mouth rinse. Those who were willing were assigned to the CP group, and those who refused served as controls and followed the standard oral care program.  Standard care with mouth rinsing with a salt and baking soda solution at least 8 times per day. The CP rinse was used twice per day. All patients received daily oral cleansing with a normal saline pressure spray and fluoride gel applications every other day to the teeth. The study period was 6 weeks. Outcomes were compared between groups and compared with historical controls.

• The study reported on a sample of 36 patients, with a mean age of 60.3 years.
• The sample was 64% male and 46% female.
• All patients had head and neck cancer.
• Some patients had radiation with intensity-modulated radiation therapy (IMRT), while others had 3D conformal radiation therapy (CRT).
• Significant differences existed between groups in use of conventional or accelerated fractionation of radiation and use and history of smoking.

The study was conducted at a single outpatient site in the Netherlands.

Patients were undergoing the active antitumor treatment phase of care.

This was a prospective, non-random comparison study.

• The World Health Organization (WHO) mucositis grading scale was used.
• The Oral Mucositis Daily Questionnaire was used.
• Oral pain was evaluated using a visual analog scale (VAS).
• Body weight was recorded.
• Use of nasogastric feeding was recorded.

No significant differences were found between groups in any of the outcome measures. Patients in the CP group had more severe mucositis scores at most weeks, but the difference was not statistically significant.

CP mouth rinsing had no effect on frequency, severity, or duration of oral mucositis in this group of patients.

• The sample size was small with fewer than 100 patients.
• Baseline sample and group differences of importance existed.
• Risk of bias exists because no control group, blinding, or random assignment was used.
• A risk of bias exists because of the population and sample group differences including use of IMRT and smoking behavior.
• No information was provided about use of analgesics or patient compliance with oral care.

This study did not show any benefit in the use of CP mouth rinses for the prevention and management of mucositis in patients receiving radiation therapy for head and neck cancer.