Effects of a mouth-moisturizing gel on mucositis during hepatopoietic-cell transplantation

Objectives: Oral mucositis and xerostomia are frequent complications during hematopoietic cell transplantation used for leukemia treatment with chemotherapy and irradiation. Severe mucositis with xerostomia is not only associated with intolerable pain but also with possible risk for systemic infection related to bacteremia. Mouth-moisturizing reagent is often used to relief xetostomia with oral prophylaxis. Microbiological evaluation should be needed to avoid increase of bacteria to establish an efficient oral care during the transplantation. Methods: Eighteen patients were enrolled in this study. Conditions of the oral mucositis and its pain were examined as described previously (Groenwald, 1993, Wong, 2001) during oral prophylaxis. Humidity of oral mucosa was measured using Moisture Checker for Mucus(R) (Yoshida, Tokyo, Japan). A mouth moisturizing reagent, oralbalance(R) Mouth Moisturizing Gel (Laclede, CA, USA) was applied to oral mucosa on request of patients. Bacterial flora and total bacterial number were examined by culture and quantitative amplification of 16S rRNA genes (Maeda, 2003). Results: All of the patients examined suffered from xerostomia. Oral mucositis with ulcer occurred in 60% patients, between 3-14 days following the transplantation. Mucosal pain became severe as mucositis aggravated. Seven out of 18 patients complained oral mucosal pain, and the pain decreased by use of the gel. Bacterial flora and total bacteria on the buccal mucosa remained at the same level before and after the use of the gel. Conclusion: These results suggest the needs of intensive oral care between 3-14 days following hematopoietic cell transplantation, and that mouth moisturizing gel used in this study is one of the effective methods to alleviate oral mucosal pain.