Multicenter Randomized Trial of Chewing Gum For Preventing Oral Mucositis in Children Receiving Chemotherapy

Abstract

The properties of saliva led us to hypothesize that the salivary flow increase induced by gum chewing might protect the oral mucosa from lesions due to cancer chemotherapy. We conducted a multicenter randomized trial to evaluate the efficacy of chewing gum in preventing oral mucositis in 145 children receiving chemotherapy regimens expected to induce WHO grade 3-4 oral mucositis in at least 30% of patients. Patients were allocated at random to standard oral care with or without 5 gum pieces per day. No overall reduction in severe oral mucositis occurred in the gum arm (51%) compared with the standard arm (44%). VIDE, COPADM, and multidrug intensive chemotherapy caused severe oral mucositis in 75% of patients in both arms. In patients receiving less toxic regimens, a decrease in WHO grade 1-4 oral mucositis was noted in the gum arm compared with the standard arm (49% vs. 72%, P=0.03). In the multivariate analysis, the risk of oral mucositis was related only to the type of chemotherapy regimen, suggesting that further strategies for preventing oral mucositis could be mainly based on these criteria.

Pretherapeutic Plasma Pro- and Anti- Inflammatory Mediators Are Related to High Risk of Oral Mucositis in Pediatric Patients with Acute Leukemia: A Prospective Cohort Study

“…The role of neutropenia has been controversial with regard to the development of oral mucositis [11], [29], [30]. In the current study, the occurrence of neutropenia was evaluated strictly only before the time point of oral mucositis appearance.…”

Prospective evaluation of HSV, Candida spp., and oral bacteria on the severity of oral mucositis in pediatric acute lymphoblastic leukemia

“…Oral mucositis is a common collateral effect among the secondary complications resulting from chemotherapy [1][2][3]. Key clinical manifestations of oral mucositis include painful erythema and ulceration [4].…”

Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation

“…Single studies of topical vitamin E,37 transforming growth factor-β2-enriched feeding,38 chewing gum,39 chlorhexidine gluconate,40 sucralfate41 and a preventive oral disease protocol42 were not effective in reducing mucositis. Given that our focus was on the identification of effective interventions to prevent or reduce mucositis, we did not make strong or weak recommendations against the use of any of these agents.…”