Sixty-two studies were included in the review, of which 17 included unique interventions. Thus, 45 studies were included in the meta-analyses (n=4,115).
Basic oral care (2 studies).
In both RCTs additional oral care had a positive attenuation effect on the development of mucositis compared with standard care, although due to the limited data in one study no meta-analysis was performed.
Topical antiseptic and antimicrobial agents (16 studies).
Chlorhexidine (7 studies): there was no significant difference between groups treated with chlorhexidine and control groups (OR 0.70, 95% confidence interval, CI: 0.43, 1.12).
Providone-iodine (1 study): Mucositis was significantly decreased in radiotherapy patients treated with providone-iodine mouthrinse than the control group.
Iseganan (3 studies): a meta-analysis of 2 RCTs showed no effect of iseganan in the prevention of ulcerations (OR 0.75, 95% CI:0.55, 1.02); the third study also found no significant benefit of iseganan.
Combination antimicrobials (5 studies): there was a significant benefit for radiotherapy patients of combination antimicrobials in the prevention of ulcerations (OR 0.61, 95% CI: 0.39, 0.96), but no significant impact on the prevention of mucositis.
Anti-inflammatory agents (3 studies).
Benzydamine (1 study): patients treated with benzydamine had a higher incidence of ulcer-free outcomes and lower incidence of ulceration and erythema than controls.
Prostaglandins (1 study): conflicting outcomes were reported for this study.
Corticosteroids (1 study): there were no significant differences between the corticosteroid and control groups.
Cytokines and/or growth factors (13 studies).
Ten studies were included in the meta-analyses.
Systemic intervention (6 studies): there was a significant benefit of cytokines and/or growth factors compared with control in preventing mucositis (OR 0.53, 95% CI: 0.33, 0.87).
Topical intervention (4 studies): there was no significant difference between the groups in the incidence of mucositis (OR 0.32, 95% CI 0.06, 1.67).
Locally applied non-pharmacological methods (5 studies).
Oral cooling (2 studies): chemotherapy patients given oral cooling showed a significantly lower incidence of mucositis than those in the control group (OR 0.3, 95% CI: 0.16, 0.56).
Low-energy helium-neon laser (3 studies): all 3 studies reported significantly reduced severity and duration of oral mucositis in radiotherapy and chemotherapy patients.
Mouth-coating agents (sucralfate) (13 studies).
Nine studies were included in the meta-analysis. There were no significant differences between the groups in occurrence of mucositis and ulcerations (OR 0.82, 95% CI: 0.05, 1.33).
Radical scavengers (amifostine) (9 studies).
Seven studies were included in the meta-analysis. There was a significantly lower incidence of grades 3 and 4 mucositis in patients treated with amifostine than in the control groups (OR 0.37, 95% CI: 0.15, 0.89).
Amino acids (glutamine) (5 studies).
Two studies were included in the meta-analysis. There was no difference between groups of radiotherapy and chemotherapy patients treated with glutamine and control groups in the incidence of mucositis (OR 1.25, 95% CI: 0.61, 2.59).
Antioxidants (3 studies).
Antioxidants such as azelastine hydrochloride, vitamin E and zinc sulphate appear to be interesting interventions for the prevention of mucositis.
Antineoplastic agent antagonists (allopurinol) (1 study).
There were no significant differences in mucositis between the allopurinol and placebo groups.
Immunomodulatory drugs (pentoxifylline) (2 studies).
Neither trial found a significant difference between the pentoxifylline and the control group in the incidence of mucositis in chemotherapy patients.
Anticholinergic agents (1 study).
One crossover trial showed a significant decrease in the development of chemotherapy-induced mucositis with pilocarpine hydrochloride.
Miscellaneous (5 studies).
Traumeel mouthwash (1 study): Traumeel mouthwash significantly reduced the severity and duration of mucositis in chemotherapy patients compared with placebo.
Honey (1 study): a significant reduction in grade 3 and 4 mucositis was found in radiotherapy patients treated with honey compared with the control group.
Calcium phosphate mouthrinse (1 study): patients treated with mouthrinse had a lesser duration and severity of mucositis than those in the control group.
Aloe vera gel (1 study): there were no significant differences between the aloe vera gel and control groups.
Chamomile mouthwash (1 study): there were no significant differences between the chamomile mouthwash and control groups.