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Survey of topical oral solutions for the treatment of chemo-induced oral mucositis.

PURPOSE: The objectives of this study were (1) to describe the usage of topical oral solutions in patients experiencing chemotherapy-induced oral mucositis (CIOM); and (2) to survey the care of oral mucositis provided to patients by clinical oncology pharmacists in institutional settings. METHODS: Surveys were distributed to institutional pharmacists in the US, who were asked to provide the components of their 'magic mouthwash'. Other questions included whether an institutional mucositis management guideline is available and what is the involvement of clinical pharmacy in mucositis care. RESULTS: Forty institutions returned surveys during the study period. The top five ingredients used to compound the magic mouthwash are diphenhydramine, viscous lidocaine, magnesium hydroxide/aluminum hydroxide, nystatin and corticosteroids. Most institutions administer the mouthwash every 4 hours (36%) or every 6 hours (36%). Of the surveyed institutions, 33% currently possess guidelines for the management of CIOM. CONCLUSIONS: Most institutions in the country formulate their topical solution, or magic mouthwash, with a variety of ingredients. There is a need to standardize the ingredients used to compound the magic mouthwash, in order to fully evaluate the efficacy of the solution to manage CIOM.

Administration, Buccal↗

Efficacy of preprocedural rinsing with an antiseptic in reducing viable bacteria in dental aerosols.

This double-blind, controlled, cross-over, clinical study evaluated the effect of preprocedural rinsing with an antiseptic mouthrinse on the level of recoverable viable bacteria in an aerosol generated during a typical dental procedure. Eighteen subjects participated. Following 24 hours of abstention from all oral hygiene procedures, subjects received a 10-minute ultrasonic scaling of a randomly selected one-half of their mouth which served as the unrinsed control. They were then randomly assigned either antiseptic mouthwash or a control rinse and rinsed with 20 ml for 30 seconds, after which the remaining half mouth (experimental side) was scaled ultrasonically for 10 minutes. During each 10-minute scaling period aerosolized bacteria were collected on a sterile filter using a modified vacuum air-sampling device. Microbes captured on the sterile filter were quantitated by overlaying the filters onto trypticase soy agar, incubating the filters aerobically at 37 degrees C for 24 to 72 hours, and counting the resulting colony forming units (CFU). Preliminary experiments had confirmed that neither the collection method nor residual antiseptic mouthwash in the aerosol adversely affected the number of viable bacteria recovered from the filter. Rinsing with the antiseptic mouthwash produced a 94.1% reduction in recoverable CFUs compared to the non-rinsed control, while the control rinse produced a 33.9% reduction. The difference between the mouthwash and control was statistically significant (P < .001). This study indicates that preprocedural rinsing with an antiseptic mouthwash can significantly reduce the microbial content of aerosols generated during ultrasonic scaling and may have potential in-office use as part of an infection control regimen.

Adult↗

Buccal cell DNA yield, quality, and collection costs: comparison of methods for large-scale studies.

There is considerable interest in noninvasive and cost-effective methods for obtaining DNA in large-scale studies. In this randomized crossover study of 22 participants, we compared the DNA yield, quality, and associated costs of buccal cell DNA collected using cytobrushes (three brushes per collection) and swish (i.e., mouthwash) in self-administered procedures. There was a nonstatistically significant higher yield from the mouthwash compared with cytobrush collections (15.8 microg versus 12.0 microg, respectively; P = 0.53). PCR reactions that required short (0.3 kb) or intermediate (1.1 kb) DNA fragments were 100% successful for DNA from brush and mouthwash, whereas PCRs for reactions that required long fragments (7.8 kb) failed for all of the participants from cytobrush DNA and were 81% successful for DNA from the mouthwash source. The brush collections provided sufficient DNA for an estimated 150-225 PCR reactions requiring short and intermediate DNA fragments. The estimated per person costs for buccal brush DNA collections in large studies were less then half (8.50 dollars) those for the mouthwash method (18 dollars). In addition, we tested whether cytobrush instructions to rub cheeks before collection or collect cells only in the morning increased DNA yield and whether repeat brushings of the same cheek reduced DNA yield. These variations resulted in no significant differences in DNA yields. We conclude that the collection of DNA with cytobrushes using simple instructions is cost effective in large-scale studies, and yields sufficient quantity and quality of DNA for genotyping.

Cost-Benefit Analysis↗

Mouthrinses and periodontal disease.

It is known that mouthwashes can influence gingivitis; however, their role in the three different kinds of periodontitis is unclear. Some solutions have demonstrated some effect on necrotising periodontitis, yet none have been shown to influence early onset periodontitis. The literature provides us with a wide range of in vitro concentrations of substances used pure or in various mixtures in mouthwashes. Although only a few solutions can be used in a curative approach, most mouthwashes represent an essential tool in prophylaxis and thus also in post-periodontal treatment (maintenance phase). However, severe qualitative differences exist between the diverse families of mouthwashes. Many studies have shown that the use of a mouthwash associated with regular tooth cleaning was more beneficial than the utilisation of mouthrinse alone.

Aggressive Periodontitis↗

Interventions for replacing missing teeth: maintaining health around dental implants.

BACKGROUND: To maintain healthy tissues around dental implants it is important to institute an effective preventive regimen (supportive therapy). Different maintenance regimens have been suggested, however it is unclear which are the most effective. OBJECTIVES: To test the null hypothesis of no difference between different interventions for maintaining healthy tissues around dental implants. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 oral implant manufacturers and an internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 2 February 2004. SELECTION CRITERIA: All randomised controlled trials of oral implants comparing agents or interventions for maintaining or recovering healthy tissues around dental implants. DATA COLLECTION AND ANALYSIS: We carried out a quality assessment of the included RCTs in duplicate and contacted the authors for missing information. We independently extracted the data in duplicate. We followed the Cochrane Oral Health Group's statistical guidelines. MAIN RESULTS: Fourteen RCTs were identified. Five of these trials, which reported results from a total of 127 patients, were suitable for inclusion in the review. Two trials evaluated the efficacy of powered and sonic toothbrushes, respectively, when compared to manual toothbrushing and showed no statistically significant differences. One RCT compared Listerine versus placebo mouthwashes showing a reduction of 54% in plaque and 34% in marginal bleeding compared with the placebo. One trial compared self administered subgingival chlorhexidine irrigation versus chlorhexidine mouthwash. The group using chlorhexidine irrigation resulted in statistically significantly lower mean plaque scores and a marginal bleeding index than the group using chlorhexidine mouthwash, however the mouthwash was given at a suboptimal dosage. One study compared etching gel with mechanical debridement showing no statistical differences. Follow ups ranged between 6 weeks and 5 months. It was not possible to make any meta-analysis as each trial assessed different interventions. REVIEWERS' CONCLUSIONS: There is only little reliable evidence for which are the most effective interventions for maintaining health around peri-implant tissues. There was no evidence that the use of powered or sonic toothbrushes was superior to manual toothbrushing. There is weak evidence that Listerine mouthwash, used twice a day for 30 seconds, as adjunct to routine oral hygiene is effective in reducing plaque formation and marginal bleeding around implants. There was no evidence that phosphoric etching gel offered any clinical advantage over mechanical debridement. These findings are based on RCTs having short follow-up periods and few subjects. There is not any reliable evidence for the most effective regimens for long term maintenance. More RCTs should be conducted in this area. In particular, there is a definite need for trials powered to find possible differences, using primary outcome measures and with much longer follow up. Such trials should be reported according the CONSORT guidelines (http://www.consort-statement.org/).

Dental Implants↗

[Plak-out and Broxojet 3007. Clinical study].

It is known that chlorhexidine, a plaque preventing agent, can cause discolorations and other side effects when used in mouthwashes at the concentration of 0.1% or more. By diluting the amount of chlorhexidine used in a mouthwash in the much greater volume of water used in a pulsating device, one could try to avoid these side-effects and, possible keep the antiplaque properties of chlorhexidine. Furthermore, it was interesting to check whether plaque, which is normally not removed by the mechanical action of a pulsating device, could be removed when the water of the device contains chlorhexidine. In the first part of the study, the effectiveness of chlorhexidine given by mouthwash (10 ml at 0.1%) has been compared to that of the same amount of chlorhexidine diluted in 400 ml of water of a pulsating device (conc. 0.0025%). The average gingival index of inflammation and plaque index, as well as the amount of gingival fluid have been measured, by previously standardized procedures, in a group of 18 students with healthy gingivae before and after a 7-days period of no-brushing. One third of the students used chlorhexidine solution in daily mouthwashes, one third used chlorhexidine in the Broxojet and the last 6 students used Broxojet with a placebo. The part of the study concerning the Broxojet was carried out in double blind. At the concentration of 0.1% in mouthwashes, chlorhexidine was found, as expected, to inhibit plaque formation. The same amount of drug diluted in the liquid of a pulsating device was, on the contrary, much less effective. Staining was noticed in most of the volunteers. The second part of the study was similarly designed and performed in the aim of checking whether higher amounts of chlorhexidine were effective in preventing plaque when used in the Broxojet: in the pulsating device, chlorhexidine was found to be effective only at the concentrations of 0.025%.

Biguanides↗

Efficacy of treatment to relieve mucositis-induced discomfort.

To determine the efficacy of a mouthwash in relieving mucositis-induced discomfort in patients receiving chemotherapy, 31 (16 male, 15 female) with a mean age of 45 (range 16-80) were given an in-house three-drug (lidocaine, diphenhydramine and sodium bicarbonate in normal saline) mouthwash when they developed mucositis of any severity. The complications were assessed on the CALGB (Cancer and Leukemia Group B) scale. The response to the mouthwash was reported on a self-assessment scale. Patients' response data were analyzed with reference to: (1) relief throughout the duration of mucositis and (2) relief during the worst stage (for each episode) of mucositis. Five patients with fungal, viral or bacterial oral infection were excluded from study. Overall, 4 patients had grade I, 16 patients had grade II, 10 patients had grade III and 1 patient had grade IV mucositis. The average duration of mucositis was 7.9 days (range 3-23 days), and the mean duration of the worst stage of mucositis was 4.81 days (range 2-13 days). The mean mucositis severity score was 1.9 (range 1-4), and the average self-assessment (response) score was 0.81 (range 0-2). The mean mucositis score during the worst stage of mucositis was 2.25 (range 1-4), and the average self-assessment (response) score during the worst stage of mucositis was 0.91 (range 0-2.7). These results suggests that this three-drug mouthwash provides effective symptomatic relief in patients with chemotherapy-induced mucositis.

Adolescent↗

Comparison of methods for collection of DNA samples by mail in the Black Women's Health Study.

PURPOSE: The authors compared approaches to participants and methods of collecting buccal cell samples by mail in the Black Women's Health Study, a follow-up study of geographically dispersed African-American women. Outcomes of interest were within group participation rates, yield of DNA, and PCR success. METHODS: Six hundred fifty six participants were randomized to four groups: Groups 1 and 2 used the cheek swab method and Groups 3 and 4 used the mouthwash swish method. Groups 1 and 3 were mailed collection kits together with consent forms, whereas Groups 2 and 4 were mailed a kit only after returning a signed consent. RESULTS: Participation rates were similar regardless of the method used for sample collection or mailing of the kits: samples were returned by 40% of Group 1, 37% of Group 2, 36% of Group 3, and 35% of Group 4. The median DNA yield was 3693 ng/sample for the swab method and 10,077 ng/sample for the mouthwash swish method (p<0.001). PCR analyses were successful in 98% of mouthwash samples and 94% of swab samples. CONCLUSION: Because of its higher yield of DNA, the mouthwash swish method is preferable for collection of buccal cell samples by mail.

Adult↗

Evidence-based control of plaque and gingivitis.

Most adults brush and floss inadequately, and constant education and/or reinforcement is often required. Bacteria are usually left behind with mechanical oral health routines, and chemotherapeutic agents may have a key role as adjuncts to daily home-care. To date, two antiseptic mouthwashes have received the ADA Seal of Acceptance: Peridex (Zila Pharmaceuticals, Phoenix, AZ, USA; CHX, chlorhexidine) and Listerine (Pfizer Consumer Healthcare, Morris Plains, NJ, USA; essential oil (EO) mouthwash). CHX has a strong affinity for tooth and tissue surfaces, but can cause brown staining on the teeth and tongue. Patients must also wait until all traces of toothpaste are removed before rinsing with CHX. Long-term use of an EO mouthwash is microbiologically safe, with no changes observed in the bacterial composition of supragingival plaque, and no evidence of antimicrobial resistance. A number of trials have demonstrated the long-term plaque- and gingivitis-reducing properties of both CHX and EO mouthwashes. These studies clearly demonstrate that these agents have lasting efficacy, and can access hard-to-reach areas.

Adult↗

Management of oral malodour.

Halitosis is a common problem. Its aetiology is multifactorial, but oral malodour is usually caused by microbial metabolism from the tongue, saliva or dental plaque. Mouthwashes are only effective against halitosis caused by intraoral factors. The principal causative agents of oral malodour are volatile sulphide compounds (VSCs), including hydrogen sulphide, methyl mercaptan and dimethyl sulphide. Data suggest that oral VSC levels correlate with the depth of periodontal pockets. Trials have shown that both mechanical oral care and mouthwash use can reduce halitosis levels. The majority of studies involving mouthwashes have investigated chlorhexidine and essential oil mouthwashes, although comparative studies are sparse.

Anti-Infective Agents, Local↗

Investigation of bacteremia after orthodontic banding and debanding following chlorhexidine mouth wash application.

This study investigates the prevalence of bacteremia after orthodontic banding and debanding, following the application of a 0.2% chlorhexidine gluconate mouthwash. The banding and debanding groups were each composed of 40 young adult patients. In the banding group, patients were asked to rinse their mouth with chlorhexidine gluconate for 60 seconds just prior to fitting of the bands. In the debanding group, they were asked to use the mouthwash immediately before removal of bands and brackets. In both groups pre- and post-treatment blood samples were obtained with a strict aseptic technique. In the banding group, no bacteremia was detected in the pretreatment sample and 2.5% post-treatment bacteremia was detected in the post-treatment sample. In the debanding group, 2.5% bacteremia was found in both the pre- and post-treatment samples. The prevalence of post-treatment bacteremia found in the present study were compared with the findings of 2 preliminary studies in which the prevalence of bacteremia had been investigated after banding and debanding without a prior application of chlorhexidine mouthwash. The application of chlorhexidine mouthwash resulted in a decrease in the prevalence of bacteremia after banding and debanding, but the decrease was not statistically significant.

Adolescent↗

The effects of a 0.12% chlorhexidine-digluconate-containing mouthrinse versus a placebo on plaque and gingival inflammation over a 3-month period. A multicentre study carried out in general dental practices.

Several previous studies have evaluated the effects of 0.12% chlorhexidine digluconate (ChD) mouthrinses on plaque and gingival inflammation. However, previously, none have been based in general dental practices. The aim of this study was to evaluate the potential to conduct controlled periodontal clinical trials in co-operation with general dental practitioners (gdps). The project took place in 5 general dental practices in the South of England. 121 healthy subjects (24 at 4 sites and 25 at the 5th), aged 18-65 years, mean 35 +/- 12) years participated in a double-blind, randomised study during which they received full mouth assessments for plaque and gingival bleeding at baseline, 6 and 12 weeks. 60 subjects were randomly assigned to use the 0.12% ChD mouthwash and 61 the placebo. The assessments were carried out by 5 gpds, who had previously achieved inter-examiner kappa scores of 0.78-0.85 (mean 0.81) for the plaque index (PII), and of 0.73-0.94 (mean 0.87) for a modified gingival index (mGI), and who maintained kappa scores of 0.51-0.90 for PII and of 0.73-1.00 for mGI during the 12 months required to complete the study. 98 subjects (48 ChD and 50 placebo) completed the study. Even though the baseline levels of plaque and gingivitis were low, by week 12, mean whole mouth plaque score of the ChD mouthwash users had fallen from 1.33 at baseline to 0.96 and was significantly lower (p < 0.001) than for the placebo users, 1.31 at baseline to 1.13. Whole-mouth gingival bleeding score fell from 0.56 to 0.42 in the ChD mouthwash group but was unchanged (0.54-0.55) in the placebo group. A subsidiary data analysis which considered the effects at sites indicated that within these overall differences, the ChD users experienced almost 2 x the reduction from plaque score 2 at baseline at proximal molar sites over a 12-week period (50.6% ChD versus 27.6% placebo). It was concluded that 0.12% ChD mouthwash reduced plaque accumulation by 28% and gingival inflammation by 25% over a 12-week period, that it is feasible for a group of gdps to maintain high levels of inter-examiner consistency in the use of PII and mGI, that it is also feasible to carry out such a multicentre study in general dental practice, and that the use of mean mouth scores per subject to analyse the effects of mouthrinses may well mask variations in response throughout the mouth.

Adolescent↗

Effect of amine fluoride/stannous fluoride-containing toothpaste and mouthrinsings on dental plaque, gingivitis, plaque and enamel F-accumulation.

The aim of the study was to assess the effect of an amine fluoride/stannous fluoride toothpaste and mouthwash on dental plaque and gingivitis, plaque F- accumulation, F- content and acid solubility of dental enamel. Participants in the 12-week double-blind study were 92 schoolchildren, with a mean age of 12.4 years, randomly distributed to four groups: (1) AmF/SnF2 toothpaste, (2) placebo toothpaste, (3) AmF/SnF2 toothpaste plus AmF/SnF2 mouthwash, (4) placebo toothpaste plus AmF/SnF2 mouthwash. Analyzing the results, the mean values of dental plaque (Silness-Löe index) and of the sulcus bleeding index decreased statistically significantly in all groups except the placebo toothpaste users. Plaque F- and enamel F- content increased considerably only in the two groups using the AmF/SnF2 toothpaste. A decrease in acid solubility was significant only in the group of both test toothpaste and test mouthwash users. Thus the clinical efficacy of the tested AmF/SnF2 toothpaste might be increased by the combined use of mouthrinsings containing the same substances.

Amines↗

The effect of a dental unit waterline treatment regimen on the shear bond strength of resin-based composite.

BACKGROUND: Numerous methods of disinfecting dental waterlines have been suggested. This study evaluates the effects of one disinfecting technique on the strength of resin-based composite's bond to enamel and to dentin. METHODS: The authors bonded resin-based composite cylinders to enamel and dentin surfaces similarly mounted and prepared using three irrigation solutions. After undergoing acid etching, the tooth surface was rinsed with either distilled water, water from a municipal water source or a mixture of distilled water and mouthwash concentrate. The authors shear-tested the samples and analyzed the data statistically. RESULTS: The group rinsed with distilled water mixed with mouthwash exhibited the lowest shear bond strengths. However, a one-way ANOVA indicated no statistically significant differences in the mean values among the treatment groups for either enamel (P = .295) or dentin (P = .393). Specimens bonded to enamel demonstrated primarily adhesive fracture at the tooth/composite interface. Those bonded to dentin showed a similar pattern, with some sites of cohesive fracture in the resin-based composite. CONCLUSIONS: There was no significant difference in shear bond strengths of resin-based composite to tooth structure when rinsed with distilled water mixed with mouthwash, distilled water or water from a municipal source. CLINICAL IMPLICATIONS: Dental unit waterlines disinfected using a diluted mouthwash solution may be used while bonding resin-based composite to either enamel or dentin.

Acid Etching, Dental↗

Gingival degerming by povidone-iodine irrigation: bacteremia reduction in extraction procedures.

The purpose of this study was to find out whether or not a certain mouth wash, i.e. povidone-iodine, will reduce the incidence of bacteremia following tooth extraction. The sample was composed of twenty-six patients who were given gingival sulcus irrigation and rinsing prior to tooth extraction. Thirteen patients used povidone-iodine mouthwash and the other 13 patients with an identically matched placebo. Prior to irrigation and rinse, first blood sample is drawn and first gingival sulcus sample is taken. To complete the whole procedure, the patient rinsed with 10-20 ml of assigned coded mouthwash for 30 seconds and then repeated the rinsing after 2 minutes followed by 60 second irrigation with 10-20 ml of the same coded mouthwash, administered in the gingival sulcus and surrounding mucosa of the tooth to be extracted. A second gingival sulcus sample is taken then extraction is performed. A second blood sample is drawn within 3 minutes of extraction. Growth and reduction in bacteremia were determined before, during and after extraction procedure. Results indicated significant reduction in incidence of post-operative bacteremia with povidone-iodine as compared with placebo (P = .01558) and significant reduction in growth of gingival cultures with povidone iodine as compared with placebo (= .65337). Povidone-iodine mouthwash used as a rinse and gingival sulcus irrigant reduced the growth of gingival cultures and the incidence of post-operative bacteremia in more specimen compared to the placebo.

Anti-Infective Agents, Local↗

[Feasibility of genetic polymorphisms analysis using genomic DNA obtained from human buccal cells].

BACKGROUND & OBJECTIVE: Using DNA samples obtained from buccal cells for genetic polymorphism analysis in molecular epidemiological studies has been repeatedly reported, but whether DNA from food remnants in mouth influences the result is still concerned. This study was to compare genetic polymorphisms of buccal cell DNA with those of buffy coat DNA, and with plant and animal DNA from foods to rule out the possibility of interference from food remnants, to improve technique of buccal cell collection and elevate DNA yield. METHODS: Buccal cells were collected from mouthwash (40 ml/case) of 62 subjects, and fixed with isopropyl alcohol; buffy coats of peripheral blood were collected from 30 of these subjects. Common foods (rice, greengrocery, soybean, apple, pork, beef, chicken, and duck) were also collected. DNA of all samples was extracted by chloroform-phenol method. NAT2, GSTM1, GSTT1, CYP1A1, and CYP2E1 genetic polymorphisms were assayed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Alu (human mutual DNA sequence) was also tested. RESULTS: DNA yield of 62 individual mouthwash samples was (135.15+/-64.30) microg (22.36-330.70 microg); 30 individual mouthwash samples contained 75%-95% oral epithelial cells with DNA yield of (143.44+/-61.64) microg (51.01-283.58 microg). DNA yield of 30 buffy coat samples was (91.19+/-38.01) microg (30.83-178.63 microg). Electrophoresis showed that all 62 buccal cell samples and 30 buffy coat samples contained DNA fragments in high molecular weight; beta-globin, Alu, NAT2, GSTM1, GSTT1, CYP1A1, and CYP2E1 gene fragments were successfully amplified from 61 buccal cells samples and 30 buffy coat samples, which showed no difference between the 2 kinds of samples from individual collections; these gene fragments were not amplified from all food DNA samples. CONCLUSIONS: The majority of DNA from mouthwash is human-origin. A little amount of food remnants would not influence the measurements of genetic polymorphisms. The genetic polymorphisms show no difference between buccal cell samples and buffy coat samples.

Aged↗

[Investigation of people's attitudes and reactions towards oral malodour. A preliminary survey conducted on dental hygienics students].

As part of the study on the prevention of oral malodour, people's attitudes and reactions towards oral malodour were investigated in this study. As a preliminary survey, investigation was made by questionnaire on a total of 179 students at three dental hygienics schools in November 1988. The findings are as follows: 1. Of the total number of the students questioned, 47% sometimes feel uneasy about their own oral malodour, while 35% have never thought about it. Only 6% have been told they had oral malodour. 2. Although 98% of the respondents felt sick when they became aware of another person's oral malodour, 53% of them told the other person of their discomfort when the person with oral malodour was a parent, brother, sister, or a very close friend. 3. About half (52%) of the students said, they practice the prevention of oral malodour by brushing their teeth, and 50% like to use mouthwashes. Of the total, 88% wished to know whether they had oral malodour or not. 4. Overwhelming majority knew of mouthwashes through TV commercials and advertisements in magazines, 80% of those could name any one of the tradenames of the mouthwashes. 5. These findings indicated that dental health education on oral malodour and mouthwashes would be important in future.

Attitude of Health Personnel↗

Randomized clinical trial of chlorhexidine versus placebo for prevention of oral mucositis in patients receiving chemotherapy.

PURPOSE/OBJECTIVES: To test the effectiveness of a nurse-initiated systematic oral hygiene teaching program-PRO-SELF: Mouth Aware (PSMA)-in conjunction with two mouthwashes (0.12% chlorhexidine or sterile water) in preventing chemotherapy-induced oral mucositis. DESIGN: Randomized, double-blind, placebo-controlled, clinical trial. SETTINGS: 23 outpatient clinics and office practices in California. SAMPLE: 222 patients who were starting a cycle of mucositis-inducing chemotherapy. METHOD: Participants were followed over three chemotherapy cycles. All patients were provided the PSMA program. Random assignment to a mouthwash occurred prior to the development of oral mucositis. Researchers used the Oral Assessment Guide to assess the patients oral cavities monthly (with the patients cycles of chemotherapy) and when patients reported any oral changes between cycles. MAIN RESEARCH VARIABLES: Type of mouthwash, incidence, days to onset, and severity of chemotherapy-induced oral mucositis. FINDINGS: No significant differences existed between the two mouthwashes in regard to incidence, days to onset, and severity of mucositis. CONCLUSIONS: Because chlorhexidine (S20 per pint) was no more effective than water, a substantial cost savings can be realized by rinsing with water. Interestingly, the PSMA program appeared to reduce the incidence of mucositis from on a prior estimate of 44% to less than 26%. IMPLICATIONS FOR NURSING PRACTICE: A nursing prescription of a systematic oral hygiene program using water as a mouth rinse is cost efficient and may be effective in preventing oral mucositis.

Adult↗