Sodium Bicarbonate Containing Mouthwash for Preventing Radiotherapy-Induced Oral Mucositis in Patients With Locally Advanced Head and Neck Cancer

Background: In spite of all complications and disabilities due to advanced head and neck malignancies, treatment of oral mucositis following radiotherapy is mainly supportive and oral hygiene is the mainstay of treatment. In this context, mouthwash containing sodium bicarbonate can have a major role in the treatment of this complication. Objectives: The present trial assessed the value of this type of mouthwash for preventing oral mucositis following radiotherapy in patients suffered locally advanced head and neck squamous cell carcinoma. Patients and Methods: Twenty nine patients suffered locally advanced squamous cell carcinoma were consecutively entered into the study. All patients had stage III to IV head and neck malignancies. The patients were randomly assigned to receiving bicarbonate mouthwash (20 ml every 6 hours per day from the beginning to the end of the treatment) (n = 18) or placebo (n = 11). The mouthwash assessed was containing 1 vial of sodium bicarbonate, 500 ml of normal saline, and diphenhydramine 25 mg/kg). Results: A significant difference was revealed in the mucositis scoring between the intervention and placebo group so that mucositis grade III or more was observed in 7 patients in intervention group (38.9%) and in 9 patients in control group (81.8%) that the observed discrepant was significant (p = 0.024). The first evidences of oral mucositis in intervention group was found in forth weeks of treatment (sessions of 16 to 17 of treatment schedule), while the appearance of mucositis in placebo group was occurred in the middle of the third week (sessions of 13 to 14 of treatment). Conclusions: Oral care by mouthwash containing sodium bicarbonate for head and neck cancer patients undergoing radiotherapy is an effective interventional option to prevent oral mucositis.