Tavakoli Ardakani, M., Ghassemi, S., Mehdizadeh, M., Mojab, F., Salamzadeh, J., Ghassemi, S., & Hajifathali, A. (2016). Evaluating the effect of Matricaria recutita and Mentha piperita herbal mouthwash on management of oral mucositis in patients undergoing hematopoietic stem cell transplantation: A randomized, double blind, placebo controlled clinical trial. Complementary Therapies in Medicine, 29, 29–34. 

To evaluate the effectiveness of an herbal mouthwash containing Matricaria recutita and Mentha piperita to placebo for the control of oral mucositis among patients undergoing hematopoietic cell transplantation (HCT)

Patients were randomized to placebo or the herbal mouthwash. The herbal mouthwash was formulated with 1% peppermint oil, 1% dried extract of Matricaria recutita (chamomile) and ethanol. The placebo was similar in taste, odor, and color. Both formulations were tested to ensure sterility. One week prior to HCT, patients began the intervention, diluting the mouthwash in preboiled water. They were instructed to gargle with the mouthwash for 30 seconds and then spit it out. The mouthwash was used three times daily after meals. All patients were instructed in oral care and used salt and chlorhexidine mouthwashes three times daily.

• N = 60   
• MEAN AGE = 36.44 years
• MALES: 44.3%, FEMALES: 55.7%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: All were undergoing HCT. Cancers were leukemia, lymphoma, and multiple myeloma.

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Iran

PHASE OF CARE: Active antitumor treatment

Double-blind, placebo-controlled, randomized, controlled trial

• Common Terminology Criteria for Adverse Events (CTCAE) mucositis scale
• Oral mucositis daily assessment
• Symptom severity measured on 0–10 numeric rating scale

No difference in incidence of oral mucositis or time of onset existed between groups. The duration of mucositis was less in the treatment group (p < 0.0001). Patients in the treatment group had lower maximum grades of mucositis (p = 0.006) and lower average daily mucositis grades (p = 0.04). Pain (p = 0.009), oral dryness (p = 0.04), and dysphagia (p = 0.0009) were less severe in the treatment group. Fewer patients in the treatment group required additional treatments, such as narcotics for pain or parenteral nutrition (p < 0.05).

Oral rinses with a chamomile and peppermint mouthwash was associated with a lower severity and shorter duration of oral mucositis.

• Small sample (< 100)
• Measurement/methods not well described
• Timing of study measures and analysis of repeated measures were not well described.

The findings suggest that an oral rinse containing chamomile and peppermint may be helpful for the management of oral mucositis in patients undergoing HCT. Oral mucositis is a common toxicity with high-dose chemotherapy, and few interventions have been shown to be effective. Additional research on the use of chamomile for oral rinses is warranted, and research should include evaluation of oral rinses as an adjunct to other interventions shown to have efficacy.