Oral mucositis is an important side effect of chemotherapy and head and neck radiotherapy. A number of treatments for the treatment and/or prevention of oral mucositis have been tested including, laser therapy, cryotherapy, professional oral hygiene, antimicrobial agents, Royal jelly, Lactobacillus brevis lozenges, zinc supplementation and benzydamine. While the MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy (Elad et at 2020) suggests implementing multi-agent oral care protocols.
The aim of this review was to assess the effectiveness of sodium bicarbonate in the prevention and management of oral mucositis.
Methods
Searches were conducted in the PubMed/Medline, Cochrane Library, Embase and the Web of Knowledge databases. Randomised controlled trials (RCTs) of sodium bicarbonate for the prevention and treatment of oral mucositis published in English were considered. Two reviewers independently selected studies with a single review undertaking data extraction and verified by a second reviewer. Risk of bias was assessed using the Cochrane tool (RoB2). A narrative summary was presented.
Results
- 11 studies were included 4 with a prevention focus and treatment.
- 5 RCTs were considered to be at low risk of bias, 4 at high risk and 2 at some risk
- Sodium bicarbonate was compared against propolis, benzydamine hydrochloride, lacto- bacillus brevis CD2 and aloe-vera for prevention.
- The table below summarises the findings from the 7 RCTs evaluating sodium bicarbonate (SB) mouthwash for treatment of oral mucositis.
| Comparison | No of patients | Outcome |
| CHX mw 0.12% v lidocaine solution 0.5%, diphenhydramine hydrochloride and aluminium hydroxide suspension v salt and soda mw | 142 | No differences |
| Micronized sucralfate mouthwash v salt and soda mw | 30 | No differences |
| Triclosan mw v SB mw | 24 | Triclosan had a greater effect |
| CHX + SB mw v SB mw | 48 | More ulceration in sodium bicarbonate only group |
| SB 5% aqueous solution + Plantago major extract v SB 5% aqueous solution + CHX v SB 5% aqueous solution + SB 5% aqueous solution | 45 | No differences |
| CHX mw 0.12% + SB 5% aqueous solution+ nystatin 5000U/mL and supersaturated calcium phosphate rinse v CHX mw 0.12% + SB 3% aqueous solution+ nystatin 5000U/mL and an extra-soft toothbrush v CHX mw 0.12% + SB 3% aqueous solution+ nystatin 5000U/mL | 45 | No differences |
| Zinc chloride mouthwash 0.2% v SB mouthwash 5% v sterile water mouthwash.
|
144 | Mucositis severity decreased in the SB and zinc chloride groups performed better in first week, but the zinc chloride group performed better |
mw = mouthwash, SB = Sodium bicarbonate, CHX = Chlorhexidine
Conclusions
The authors concluded: –
The results presented in this study have revealed that the evidence for supporting sodium bicarbonate in the treatment of oral mucositis (that is, management and prevention) were limited and of low quality. There was a paucity of RCT in the literature, in which the efficacy of sodium bicarbonate against other medical/natural agents was compared.
Comments
No protocol for the review for published and while a good range of databases have been searched restricting inclusion criteria to publications in English may have excluded some relevant studies. Only 11 RCTs met the inclusion criteria with only 5 being considered to be at low risk of bias. The studies were mainly small with some involving 3 groups. The studies were heterogenous with sodium bicarbonate being tested against a wide range of other agents. Previously we have looked at other reviews assessing cryoprevention, lasers and oral supplementation for the prevention and treatment and management of oral mucositis (see Dental Elf – Oral Mucositis blogs). Most of the reviews can only draw on a relatively small number of high quality, well conducted RCTs so there is clearly a need for more research in this area to bring greater clarity to the treatment options available for adult and child patients for the prevention and treatment of oral mucositis.
Links
Primary Paper.
Di Fede O, Canepa F, Maniscalco L, Tozzo P, Matranga D, Giuliana G. Prevention and the treatment of oral mucositis: the efficacy of sodium bicarbonate vs other agents: a systematic review. BMC Oral Health. 2023 Jan 3;23(1):4. doi: 10.1186/s12903-022-02586-4. PMID: 36597048; PMCID: PMC9811717.
Other references
Elad, S, Cheng, KKF, Lalla, RV, Yarom, N, Hong, C, Logan, R M., Bowen, J, Gibson, R, Saunders, DP, Zadik, Y, Ariyawardana, A, Correa, ME, Ranna, V, Bossi, P; for the Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO). MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020: 126: 4423– 4431. https://doi.org/10.1002/cncr.33100
Dental Elf – Oral Mucositis blogs
