Effect of Green Tea Mouthwash on Chemotherapy - Induced Oral Mucositis in Cancer Patients

Subject Areas : Journal of Chemical Health Risks

Thenmozhi Paluchamy ¹ , Daphin Steni Stephen ²

1 -
2 -

Received: 2024-02-18 Accepted : 2024-09-16 Published : 2025-01-19

Keywords: Cancer, Chemotherapy, Oral mucositis, Chemotherapy-induced oral mucositis, Green tea mouthwash ,

Abstract :

Oral mucositis presents a significant challenge for cancer patients undergoing chemotherapy for cancer. Mouth rinses such as normal saline or sodium bicarbonate solutions are commonly used to enhance oral health, and various treatment strategies are employed to manage oral mucositis during chemotherapy. Therefore, this study aimed to determine the effectiveness of green tea mouthwash in preventing and treating oral mucositis in cancer patients undergoing chemotherapy. A true experimental research design was utilized. Thirty participants meeting the inclusion criteria were selected using simple random sampling and were assigned to an experimental group (n=15) and a control group (n=15). Demographic and clinical variables were assessed, followed by a pre-test assessment of oral mucositis using the Oral Mucositis Assessment Scale for both groups. The experimental group received 5% solution of green tea mouthwash, while the control group received a sterile water mouthwash. A post-test assessment was conducted for both groups using the same tool at the end of the 14-day intervention. Out of 15 participants in the experimental group in the pre-test, 7 participants (46.67%) had lesions smaller than 1 cm², 5 (33.3%) had no lesions, and 2 (13.3%) had lesions sized 1 – 3 cm². In the control group, 6 (40%) had lesions smaller than 1 cm², and 1 (6.6%) had a lesion larger than 3 cm². The pre-test revealed that in the experimental group, 1 participant (6.67%) had severe erythema, 8 (53.3%) had mild erythema, and 6 (40%) had no erythema; in the control group, 4 (26.67%) had severe erythema, and 10 (66.6%) had mild erythema. A paired t-test revealed a significant change in ulceration and erythema in the experimental group after the intervention (p<0.001). A significant difference was also found between the experimental and control groups (p<0.001). The findings of this study suggest that administering green tea mouthwash to cancer patients undergoing chemotherapy is an effective method to prevent and treat oral mucositis.

References:

1. Brown T.J., Gupta A., 2020. Management of Cancer Therapy-Associated Oral Mucositis. JCO Oncol Pract. 16(3), 103-109.
2. Lalla R.V., Peterson D.E., 2005. Oral mucositis. Dent Clin North Am. 49(1), 167–184.
3. Duncan G.G., Epstein J.B., Tu D., El Sayed S., Bezjak A., Ottaway J., Pater J., 2005. Quality of life, mucositis, and xerostomia from radiotherapy for head and neck cancers: a report from the NCIC CTG HN2 randomized trial of an antimicrobial lozenge to prevent mucositis. Head Neck. 27(5), 421–428.
4. Naidu M.U., Ramana G.V., Rani P.U., Mohan I.K., Suman A., Roy P., 2004. Chemotherapy-induced and/or radiation therapy-induced oral mucositis--complicating the treatment of cancer. Neoplasia. 6(5), 423-31.
5. Sonis S.T., Elting L.S., Keefe D., Peterson D.E., Schubert M., Hauer-Jensen M., Bekele B.N., Raber-Durlacher J., Donnelly J.P., Rubenstein E.B., 2004. Mucositis Study Section of the Multinational Association for Supportive Care in Cancer. International Society for Oral Oncology. Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients. Cancer. 100(9 Suppl), 1995-2025.
6. Vagliano L., Feraut C., Gobetto G., Trunfio A., Errico A., Campani V., et al., 2011. Incidence and severity of oral mucositis in patients undergoing haematopoietic SCT--results of a multicentre study. Bone Marrow Transplant. 46(5), 727-32.
7. Valer J.B, Curra M., Gabriel A.F., Schmidt T.R., Ferreira M.B.C., Roesler R., Evangelista J.M.C., Martins M.A.T., Gregianin L., Martins M.D., 2021. Oral mucositis in childhood cancer patients receiving high-dose methotrexate: Prevalence, relationship with other toxicities and methotrexate elimination. Int J Paediatr Dent. 31(2), 238-246.
8. Barasch A., Peterson D.E., 2003. Risk factors for ulcerative oral mucositis in cancer patients: unanswered questions. Oral Oncol. 39(2), 91-100.
9. Cinausero M., Aprile G., Ermacora P., Basile D., Vitale M.G., Fanotto V., Parisi G., Calvetti L., Sonis S.T, 2017. New Frontiers in the Pathobiology and Treatment of Cancer Regimen-Related Mucosal Injury. Front Pharmacol. 8, 354.
10. Chen S.C., Lai Y.H., Huang B.S., Lin C.Y., Fan K.H., Chang J.T., 2015. Changes and predictors of radiation-induced oral mucositis in patients with oral cavity cancer during active treatment. Eur J Oncol Nurs. 19, 214–219.
11. De Sanctis V., Bossi P., Sanguineti G., Trippa F., Ferrari D., Bacigalupo A., Ripamonti C.I., Buglione M., Pergolizzi S., Langendjik J.A., Murphy B., Raber-Durlacher J., Russi E.G., Lalla R.V, 2016. Mucositis in head and neck cancer patients treated with radiotherapy and systemic therapies: Literature review and consensus statements. Crit Rev Oncol Hematol. 100, 147–166.
12. Rubenstein E.B, Peterson D.E., Schubert M., Keefe D., McGuire D., Epstein J., Elting L.S., Fox P.C., Cooksley C., Sonis S.T., 2004. Mucositis Study Section of the Multinational Association for Supportive Care in Cancer. International Society for Oral Oncology. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer. 100(9 Suppl), 2026-46.
13. Daugelaite G., Uzkuraityte K., Jagelaviciene E., Filipauskas A., 2019. Prevention and Treatment of Chemotherapy and Radiotherapy Induced Oral Mucositis. Medicina. 55, 25.
14. Patel P., Robinson P.D., Baggott C., Gibson P., Ljungman G., Massey N., Ottaviani G., Phillips R., Revon-Rivière G., Treister N., White M., Cabral S., Dupuis L., Sung L. C., 2021. Clinical practice guideline for the prevention of oral and oropharyngeal mucositis in pediatric cancer and hematopoietic stem cell transplant patients: 2021 Update. Eur J Cancer. 154, 92–101.
15. Ayago Flores D., Ferriols Lisart R., 2010. Effectiveness of palifermin in the prevention of oral mucositis in patients with haematological cancers. Farm Hosp. 34, 163–169.
16. de Sousa Melo A., de Lima Dantas J.B., Medrado ARAP., Lima H.R., Martins G.B., Carrera M., 2021. Nutritional supplements in the management of oral mucositis in patients with head and neck cancer: Narrative literary review. Clin Nutr ESPEN. 43, 31–38.
17. Yarom N., Ariyawardana A., Hovan A., Barasch A., Jarvis V., Jensen S.B., Zadik Y., Elad S., Bowen J., Lalla R.V., 2013. Systematic review of natural agents for the management of oral mucositis in cancer patients. Support Care Cancer. 21, 3209–3221.
18. Konuk Sener D., Aydin M., Cangur S., Guven E., 2019. The Effect of Oral Care with Chlorhexidine, Vitamin E and Honey on Mucositis in Pediatric Intensive Care Patients: A Randomized Controlled Trial. J Pediatric Nurs. 45, e95–e101.
19. Lima ICGDS., de Fátima Souto Maior L., Gueiros LAM., Leão J.C., Higino J.S., Carvalho AAT., 2021. Clinical applicability of natural products for prevention and treatment of oral mucositis: A systematic review and meta-analysis. Clin Oral Investig. 25, 4115–4124.
20. Charalambous M., Raftopoulos V., Paikousis L., Katodritis N., Lambrinou E., Vomvas D., Georgiou M., Charalambous A., 2018. The effect of the use of thyme honey in minimizing radiation-induced oral mucositis in head and neck cancer patients: A randomized controlled trial. Eur J Oncol Nurs. 34, 89–97.
21. Charalambous M., Raftopoulos V., Lambrinou E., Charalambous A., 2013. The effectiveness of honey for the management of radiotherapy-induced oral mucositis in head and neck cancer patients: A systematic review of clinical trials. Eur J Integr Med. 5, 217–225.
22. Ramsay E.I., Rao S., Madathil L., Hegde S.K., Baliga-Rao M.P., George T., Baliga M.S., 2019. Honey in oral health and care: A mini review. J Oral Biosci. 61, 32–36.
23. Munstedt K., Momm F., Hubner J., 2019. Honey in the management of side effects of radiotherapy- or radio/chemotherapy-induced oral mucositis. A systematic review. Complement. Ther Clin Pract. 34, 145–152.
24. Mathur A., Gopalakrishnan D., Mehta V., Rizwan S.A., Shetiya S.H., Bagwe S., 2018. Efficacy of green tea-based mouthwashes on dental plaque and gingival inflammation: A systematic review and meta-analysis. Indian J Dent Res. 29(2), 225-232
25. Katy Vaillancourt., Amel Ben Lagha., Daniel Grenier., 2021. A green tea extract and epigallocatechin-3-gallate attenuate the deleterious effects of irinotecan in an oral epithelial cell model. Arch Oral Biol. 126, 10513
26. Kepivance. Assessment of oral mucositis. www. kepivance. com/oral_mucositis/assessment.jsp. Accessed February 18, 2021.
27. Konishi M., Verdonschot R.G., Shimabukuro K., Nakamoto T., Fujita M., Kakimoto N., 2019. The effectiveness of mouthwashes in alleviating radiation-induced oral mucositis in head and neck cancer patients: a systematic review. Oral Radiol. 35(3), 207-223.
28. Liao Y.C., Hsu L.F., Hsieh L.Y., Luo Y.Y., 2021. Effectiveness of green tea mouthwash for improving oral health status in oral cancer patients: A single-blind randomized controlled trial. Int J Nurs Stud. 121, 103985.
29. Shirazian Sh., Manifar S., Kazemian A., Pourshahidi S., Rashtiani A., 2023. Effectiveness of green tea mouthwash on radiation-induced mucositis in patients with head and neck cancer: a randomised clinical trial. Australian Journal of Herbal and Naturopathic Medicine. 35(2), 74-78.
30. Sant Ana G., Normando A.G.C., De Toledo I., Dos Reis P.E.D., Guerra E.N.S., 2020. Topical Treatment of Oral Mucositis in Cancer Patients: A Systematic Review of Randomized Clinical Trials. Asian Pac J Cancer Prev. 21(7), 1851-1866.
31. Amanat A., Ahmed A., Kazmi A., Aziz B., 2017. The Effect of Honey on Radiation-induced Oral Mucositis in Head and Neck Cancer Patients. Indian J Palliat Care. 23(3), 317-320.
32. Shah S., Rath H., Sharma G., Senapati S.N., Mishra E., 2020. Effectiveness of curcumin mouthwash on radiation-induced oral mucositis among head and neck cancer patients: A triple-blind, pilot randomised controlled trial. Indian J Dent Res. 31(5), 718-727.