Oral Flora Changes Using Topical Agents in Oropharyngeal Radiation Patients

Objectives: Radiotherapy for oropharyngeal cancer induces hyposalivation that alters the oral microbial floraThe purpose of this placebo-controlled double-blind study was to determine the beneficial effects of using a saliva substitute and an oral hygiene product for patients undergoing radiation therapy for oropharyngeal carcinoma. Methods: Thirty-eight patients comprised the controlled, blinded study. Half were assigned to the test group (Biotene Oral Balance gel and Biotene toothpaste) and half put on a conventional regimen (carboxymethylcellulose gel and Oral B toothpaste) as daily regimens. The Biotene products contained a hypothiocyanite-generating enzyme system for microbial control. Cultures for identifying and quantitating microorganisms, whole resting saliva (WRS), and visual analog measurements for comfort were taken before treatment and 4 weeks after the appearance of radiation-mucositis (erythema, ulceration). Results: Daily use of the glucose oxidase-lactoperoxidase-lysozyme enzyme systems (gel for oral lubrication and dental cleaning paste) enhanced control of microbial flora, improved salivary flow, and increased oral comfort as compared to the controls. Four weeks following mucositis: some aerobic isolates disappeared only in the test group (K pneumoniae, P aeruginosa, S aureus, S epidermidis); anaerobic isolates varied considerably; periodontal-associated bacteria were markedly decreased in the test group; candidal species were significantly lowered in the test group; even though WRS baseline was significantly lower in the test group (p=.001), after 4 weeks there was no difference between groups; visual analog scale for comfort was significantly greater in the test group (6.7 v 5. p=.007). Conclusion: The daily usage of enzyme-engineered Biotene products that assist in control of the oral microbial flora and potential infections, as well as supporting oral comfort through lubrication, appear to be useful adjuncts in aiding patients undergoing radiation therapy for oropharyngeal cancers. This study was partly supported in part by a grant from Laclede Professional Products Inc. Gardena, CA