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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 9  |  Issue : 2  |  Page : 207-209

A randomized control trial to assess the effectiveness of 0.2% chlorhexidine mouth was versus 1% povidone-iodine mouthwash on radiation-induced oral mucositis patients with head and neck cancer in tertiary cancer hospital, Belagavi, Karnataka


Department of Medical Surgical Nursing, KLEU's Institute of Nursing Sciences, Belagavi, Karnataka, India

Date of Web Publication29-Sep-2016

Correspondence Address:
Vanitha U Bhavanishankar
Urbailu House, Chembu Village, Sampaje Post, Dist- Madikeri, Kodagu, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-5006.191276

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  Abstract 

Background: Mucositis persists throughout radiation therapy. As radiation therapy continues mucositis worsens. It contributes to poor nutrition, low quality of life. Even though on one side radiation helps as a treatment, on the other side it has its complications that are making an issue in the developing countries. The aim of the study to assess the effectiveness of 0.2% chlorhexidine mouthwash as compared to 1% povidone-iodine mouthwash on radiation-induced oral mucositis among patients with head and neck cancer.
Materials and Methods: Simple random sampling technique through lottery method was used to select the sample for study. The experimental group and control group consisting of 50 subjects were advised to rinse their mouth with 15 ml of 1% povidone-iodine mouthwash and 0.2% chlorhexidine mouthwash respectively for 30 s, 15 min before radiation therapy, after 15 min and 4 h after radiation therapy. Postintervention assessments were made on day 1, 7, 11, and 15 after intervention with 1% povidone and 0.2% chlorhexidine mouthwash iodine mouthwash in the experimental and control group, respectively.
Results : The result showed that in the experimental group the mean oral mucositis grades obtained during I st , II nd , III rd , and IV th interventional assessment (1 st , 7 th , 11 th , and 15 th day) were 0, 0.64, 1.34, and 2.5 whereas in the control group were 0, 0.14, 0.80, and 1.6, respectively. This proved that there is a significant reduction in the oral mucositis in the control group (0.14-0.80) when compared to experimental group (0.64-2.5).
Conclusion: Study findings revealed that both mouthwashes were effective in controlling radiation induced oral mucositis however 0.2% chlorhexidine fared better

Keywords: 0.2% chlorhexidine, 1% povidone iodine, head and neck cancer, radiation-induced oral mucositis, radiation therapy


How to cite this article:
Bhavanishankar VU, Bagi DG, Madhale MD. A randomized control trial to assess the effectiveness of 0.2% chlorhexidine mouth was versus 1% povidone-iodine mouthwash on radiation-induced oral mucositis patients with head and neck cancer in tertiary cancer hospital, Belagavi, Karnataka. Indian J Health Sci Biomed Res 2016;9:207-9

How to cite this URL:
Bhavanishankar VU, Bagi DG, Madhale MD. A randomized control trial to assess the effectiveness of 0.2% chlorhexidine mouth was versus 1% povidone-iodine mouthwash on radiation-induced oral mucositis patients with head and neck cancer in tertiary cancer hospital, Belagavi, Karnataka. Indian J Health Sci Biomed Res [serial online] 2016 [cited 2022 May 17];9:207-9. Available from: https://www.ijournalhs.org/text.asp?2016/9/2/207/191276


  Introduction Top


Head and neck cancers begin from the squamous cell; it lies in the moist, mucosal surfaces inside the head and neck area. [1] Radiation therapy has become advanced, and new technology has entered. Radiation therapy uses high-energy particles or waves such as x-rays gamma rays, electron beams, or protons to destroy or damage cancer cells. [2] Even radiation therapy damages normal cells, and usually, it repairs themselves. [3] Radiation-induced mucositis starts by direct injury to basal epithelial cells, in the underlying tissue. DNA strands breaks and cells are injured or death. Non-DNA injury starts through a variety of mechanisms. [4]. Mucositis persists throughout radiation therapy. As radiation therapy continues mucositis worsens. It contributes to poor nutrition, low quality of life. Even though on one side radiation helps as a treatment, on the other side it has its complications that are making an issue in the developing countries. [4]


  Materials and Methods Top


The research design used was true experimental single blinded randomized control design.

The study subjects were instructed to rinse mouth with 1% povidone iodine 15 min before and after radiation therapy and after 4 h of radiation therapy. The control group subjects were instructed to rinse mouth with 2% chlorhexidine 15 min before and after radiation therapy and after 4 h of radiation therapy. The samples were randomized in the study by simple random sampling technique through the lottery method. The tool used was World Health Organization Oral Mucositis Grading Scale for collecting the data related to radiation-induced oral mucositis assessment the data collected were tabulated, analyzed, and interpreted using descriptive and inferential statistics.


  Results Top


Frequency and percentage distribution of head and neck cancer with radiation-induced oral mucositis was according to socio-demographic data in experimental group and control group.

Majority 46% (23) of the subjects in the experimental group were in the age group of >60 years, whereas, minority 6% (3) were in the control group in the age group of <30 years.

Majority 76% (38) of the subjects were male and 24% (12) were female in the experimental group, whereas, majority 82% (41) of the subjects was male and 18% (9) were female in the control group.

Majority 50% (25) of the subjects were farmer and minimum 6% (3) of subjects were coolie in the experimental group, whereas, in control group the majority 46% (23) of the subjects were farmer and minimum 16% (8) subjects were coolie.

A majority, 70% (35) of the subjects, were Hindu and minimum 14% (7) subjects were Christian in the experimental group, whereas in control group majority 80% (40) subjects were Hindu and minimum 6% (3) subjects were Christian in the control group.

Majority 30% (15) of the subjects were suffering from other sites head, and neck cancer, and minimum 8% (4) subjects were suffering from cancer of Nasopharynx in the experimental group. Whereas in control group majority 28% (14) subjects were suffering from other sites head and neck cancer and minimum 8% (4) subjects were suffering from cancer of nasopharynx.

Majority 46% (23) of the subjects were in Stage III, and minimum 2% (1) of the subjects were in Stage I in the experimental group. Whereas in control group majority 32% (160 of the subjects were in Stage III and minimum 10% (5) of the subjects were in Stage I.

Findings of mucositis score in experimental and control group by intervention days

The mean oral mucositis grades of study and control group in preassessment (I st day) are 0. In the experimental group, the mean oral mucositis grades obtained during II nd , III rd , and IV th posttreatment assessment (7 th , 11 th , and 15 th day) were 0.64, 1.34, 2.5 whereas in the control group were 0.14, 0.80, 1.6, respectively [Table 1] [Table 2] [Table 3]. This shows that there is a significant reduction in the mucositis in the control group (0.14-0.80) when compared to study group (0.64-2.5).
Table 1: Findings on the comparison of grades of mucositis in experimental and control group on 7th day


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Table 2: Findings on the comparison of grades of mucositis in experimental and control group on 11th day


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Table 3: Findings on the comparison of grades of mucositis in experimental and control group on 15th day


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Note: (S) - Statistically significant. Chi-square calculated value (24.45) is more than Chi-square tabulated value (10.83).

Note: (S) - Statistically significant. The calculated value (16.0336) is more than Chi-square tabulated value (13.82).

Note: Extremely statistically significant. The calculated value (31.1422) is more than Chi-square tabulated value (16.27).


  Discussion Top


The results showed that the grades of the control group in the 15 th day posttreatment were extremely statistically significant at P < 0.001. This indicates that 0.2% chlorhexidine is effective for radiation-induced oral mucositis. However, the oral mucositis grades of both groups during the pretreatment, no statistically significant difference were observed. Although both experimental and control groups had oral mucositis, there was a difference in the severity of oral mucositis.

A randomized crossover design was conducted by Cheng et al. at Nether Sole School of Nursing, the Chinese University of Hong Kong, Hong Kong, to determine the relative acceptability and tolerability of chlorhexidine and benzydamine oral rinse agents in children receiving chemotherapy proved that chlorhexidine mouthwash is determined in relative to the acceptability and tolerability. [5] Similarly, findings were seen in the study conducted by Gulvita et al. Mayo Clinic and Mayo Foundation, Rochester, which also proved that chlorhexidine mouthwash is detrimental in clinical situation. [6]


  Conclusion Top


The study findings show that there is a significant difference in the radiation therapy-induced mucositis in the control group when compared to the study group. Oral mucositis is a common and important side effect of radiation therapy. Both the mouthwashes helped in the controlling mucositis. However, 0.2% chlorhexidine was more efficient and had better patients' compliance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Cunha PJ. Head and Neck Cancer Facts; 2015. Available from: http://www.medicinenet.com. [Last cited on 2015 Jan 20].  Back to cited text no. 1
    
2.
Miller SR. What is Radiation Therapy. Conquer Cancer Foundation of the American Society of Clinical Oncology; 2013. Available from: http://www.cancer.net/24728. [Last cited on 2015 Jan 20].  Back to cited text no. 2
    
3.
Randle J. Radiotherapy. NHS Choices J 2013; 12. Available from http://www.nhs.uk/radiotherapy. [Last cited on 2015 Jan 21].  Back to cited text no. 3
    
4.
Lewis SL, Heitkemper MM, Dirksen SR, Bucher L. Textbook of Medical surgical nursing. 7 th ed. South Asia: Elsevier Publications; 2011. p. 258.  Back to cited text no. 4
    
5.
Cheng KK, Chang AM, Yuen MP. To determine the relative acceptability and tolerability of chlorhexidine and benzydamine oral rinse in children reeiving chemotherapy. Eur J Cancer 2014;40:1208-16.  Back to cited text no. 5
    
6.
Samdariya S, Lewis S, Kauser H, Ahmed I, Kumar D. A Randomized Controlled Trial Evaluating the Role of Honey in Reducing Pain Due to Radiation Induced Mucositis in Head and Neck Cancer Patients. Indian J Palliat Care 2015;21:268-73.  Back to cited text no. 6
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