Total bacterial counts on oral mucosa after using a commercial saliva substitute in patients undergoing hematopoietic cell transplantation

Abstract

2 AbstractPurpose: The commercial saliva substitute Oralbalance® has been reported to alleviate symptoms of post-radiotherapy xerostomia in head and neck cancer patients. Oralbalance® may also be effective for xerostomia in patients undergoing hematopoietic cell transplantation (HCT) with high-dose chemotherapy and total-body irradiation. However, HCT patients are in a severely compromised condition, and saliva substitute must not promote infection. We reported previously that Oralbalance® has anti-microbial effects against microbial species detected during HCT in vitro. This study was performed to determine the in vivo effects of Oralbalance® on oral mucosal total bacterial counts in patients undergoing HCT.Methods: A total of 18 neutropenic patients undergoing HCT were enrolled in this study. Before and after 1 week of Oralbalance® use, bacterial samples were obtained from patients by wiping an area of φ1 cm on the buccal mucosa with sterilized cotton swabs. Total bacterial counts of the obtained samples were examined by quantitative polymerase chain reaction amplification of the bacterial 16S ribosomal RNA gene. As controls, bacterial samples were also obtained from 10 healthy subjects, and total bacterial counts were examined.Results: No significant increase in bacterial count was observed with use of Oralbalance®. None of the patients showed bacterial counts above the range found in healthy controls after using Oralbalance®. Conclusions:In neutropenic patients undergoing HCT, Oralbalance® did not increase the total counts of oral mucosal bacteria beyond the range found in healthy controls. Oral care using Oralbalance® may alleviate the symptoms induced by hyposalivation without promoting infection.

Efficacy of artificial salivary substitutes in treatment of xerostomia: A systematic review

“…Regarding the country of origin of the 10 studies, three[131921] were conducted in Iran, two[1420] in Thailand, one study in each of the following: Italy,[16] Croatia,[17] Japan,[18] and Germany. [22] In one study, the trial site is not clearly mentioned.…”

“…[15] Four studies received funding. [141819202122] In one study, no financial support was received. [13] No information is available regarding any financial support in five studies.…”

“…[20]Oral balance: Commercially available artificial saliva substitute. [18]bioXtra gel (Laclede, Inc., Rancho Dominguez, CA, USA), (commercial synthetic saliva substitute, combination of lactoferrin, lysozyme, and lactoperoxidase). [21]DC161-DP0292 aqueous solution (Pierre Fabre Medical Devices) (glycerol, povidone K30, copovidone, xanthan gum, potassium chloride, xylitol, marshmallow concentrated hydroglycerined extract, anhydrous disodium hydrogen phosphate, potassium dihydrogen phosphate, macrogolglycerol 40 hydroxystearate, potassium sorbate, benzylic alcohol, and pure water) and Aequasyal oily solution (Carilène Laboratory, Montesson, France) (94.4% tri-esters of glycerol oxidized fatty acids of vegetal origin [corn oil]; silicium dioxide; food aromas: orange, grapefruit, and mint; and aspartame).…”

With regard to our manuscripts on the commercial saliva substitute, Oralbalance®—its formula has been changed

“…To the editor, Previously, we published two articles in Supportive Care in Cancer on the in vitro and in vivo antibacterial effects of a commercial saliva substitute, Oralbalance® (Laclede, Inc., Rancho Dominguez, CA, USA; now GlaxoSmithKline, UK), which was a historic product for over 20 years and contributed to oral management for cancer patients with side effects such as xerostomia. The first report was entitled "Antimicrobial effects of the saliva substitute, Oralbalance, against microorganisms from oral mucosa in the hematopoietic cell transplantation period" (Sugiura Y et al, Support Care Cancer, 2008 [2]), and the other was "Total bacterial counts on oral mucosa after using a commercial saliva substitute in patients undergoing hematopoietic cell transplantation" (Sugiura Y et al, Support Care Cancer, 2010 [3]). Recently, however, the formula for this product has been changed.…”

“…From our in vivo results, in neutropenic patients undergoing HCT, Oralbalance® did not increase the total counts of oral mucosal bacteria beyond the range found in healthy controls. Oral care using Oralbalance® may alleviate the symptoms induced by hyposalivation without promoting infection [3]. These antibacterial results were related to the enzymes present in the formulation.…”