What do systematic reviews say?

Keratinocyte growth factor (KGF), higher dose/regimen vs Keratinocyte growth factor (KGF), different (lower) dose/regimen

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  Some inconsistent evidence from which no conclusions can be drawn regarding different dosages of KGF (Analyses 2.1 to 2.8); no pooled estimate reported
  Studies not reported
  GRADE not reported

Granulocyte-macrophage colony-stimulating factor (GM-CSF), higher dose (1260 to 12,600 micrograms) vs Granulocyte-macrophage colony-stimulating factor (GM-CSF), lower dose (12.6 to 126 micrograms)

Granulocyte-macrophage colony-stimulating factor (GM-CSF), higher… led to higher oral mucositis (severe) compared with granulocyte-macrophage colony-stimulating factor (GM-CSF), lower…; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  RR 2.75 [1.07, 7.04]
  1 study · 36 participants
  GRADE not reported

Oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed ice held in the mouth during cancer treatment) vs Low-dose leucovorin rinse

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy 2015 · Cochrane All outcomes
  Oral mucositis (severe). Not estimable - no participants had developed severe oral mucositis by the fourth day after chemotherapy when the data were reported (Zhang 2011, Analysis 4.3, subgroup 3.1); 118 participants…
  1 study · 118 participants
  GRADE not reported

Oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed ice held in the mouth during cancer treatment) vs Low-dose leucovorin rinse

It is very uncertain whether oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed… changes oral mucositis (any severity) compared with low-dose leucovorin rinse (very low certainty).

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy 2015 · Cochrane All outcomes
  RR 0.67 [0.50, 0.90]
  1 study · 118 participants
  Very low

Oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed ice held in the mouth during cancer treatment) vs Low-dose leucovorin rinse

It is very uncertain whether oral cryotherapy (ice chips, ice-cold water, ice cubes or crushed… changes oral mucositis (moderate to severe) compared with low-dose leucovorin rinse (very low certainty).

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy 2015 · Cochrane All outcomes
  RR 0.18 [0.01, 3.42]
  1 study · 118 participants
  Very low

Levamisole 50 mg three times per day for days 1 and 2 vs Levamisole 50 mg three times per day for day 1 and placebo for day 2 (lower dose)

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  16 weeks
  Two patients in each group reported unwanted effects.
  1 study
  GRADE not reported

Levamisole 50 mg three times per day for days 1 and 2 vs Levamisole 50 mg three times per day for day 1 and placebo for day 2 (lower dose)

• Systemic interventions for recurrent aphthous stomatitis (mouth ulcers) 2012 · Cochrane All outcomes

  16 weeks
  A trial at high risk of bias (Zissis 1983) compared two different dose regimens of levamisole (treatment 2 days per week for 16 weeks; a third group received placebo). There was inconsistency in the presentation of the…
  1 study
  GRADE not reported

Vitamin E (topical) vs vitamin E

Vitamin E (topical) led to higher improvement in mucositis compared with vitamin E (swallowed); GRADE not reported.

• Interventions for treating oral mucositis for patients with cancer receiving treatment 2010 · Cochrane All outcomes

  5 days
  RR 15.40 [4.01, 59.21]
  1 study · 63 participants
  GRADE not reported

Vitamin E (topical) vs vitamin E

Vitamin E (topical) led to higher mucositis eradicated compared with vitamin E (swallowed); GRADE not reported.

• Interventions for treating oral mucositis for patients with cancer receiving treatment 2010 · Cochrane All outcomes
  RR 53.74 [3.41, 846.84]
  1 study · 63 participants
  GRADE not reported

Gum chewing (sugar-free) vs No chewing gum

Gum chewing reduced self-reported thirst in most studies (6 of 7 positive, 1 no effect); not meta-analyzed.

• The effect of gum chewing on xerostomia and salivary flow rate in elderly and medically compromised subjects: a… 2023 All outcomes

  Various (preoperative period to 3 + 1 months) · Haemodialysis units, elderly / geriatric care, cancer and palliative care, and xerostomia / hyposalivation clinics (studies from multiple countries)
  Narrative vote-count: of 7 studies measuring thirst, 6 found gum chewing reduced thirst [16,20,21,26,27,31] and 1 detected no effect [29].
  7 studies
  GRADE not reported

Gum chewing (sugar-free) vs Within-subject before/after comparison of soft gum vs hard gum (no no-gum control)

One small study found that chewing hard (but not soft) gum increased oral mucosal moisture.

• The effect of gum chewing on xerostomia and salivary flow rate in elderly and medically compromised subjects: a… 2023 All outcomes

  2-week chewing period (soft then hard gum, with 2-week wash-out) · Haemodialysis units, elderly / geriatric care, cancer and palliative care, and xerostomia / hyposalivation clinics (studies from multiple countries)
  Single study [22] (Nakagawa 2017): chewing hard gum significantly increased oral mucosal moisture whereas chewing soft gum did not.
  1 study · 12 participants
  GRADE not reported

Gum chewing (sugar-free) vs No chewing gum

Gum chewing was linked with improved self-reported xerostomia / dry mouth in most studies (12 of 17 positive, 5 no effect); heterogeneous instruments precluded meta-analysis.

• The effect of gum chewing on xerostomia and salivary flow rate in elderly and medically compromised subjects: a… 2023 All outcomes

  Various (single session to 3 months) · Haemodialysis units, elderly / geriatric care, cancer and palliative care, and xerostomia / hyposalivation clinics (studies from multiple countries)
  Narrative vote-count: of 17 studies measuring self-reported xerostomia / dry mouth, 12 found a positive effect of gum chewing [18,19,21,23,24,25,26,27,30,31,38,40] and 5 detected no effect [17,29,33,34,37]. No study…
  17 studies
  GRADE not reported

Bethanechol vs Artificial saliva

Bethanechol showed no clear difference in xerostomia (dry mouth, yes/no) compared with artificial saliva; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  8 to 40 weeks postRT
  RR 0.56 [0.30, 1.05]
  1 study · 30 participants
  GRADE not reported
• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT
  RR 0.63 [0.30, 1.29]
  1 study · 36 participants
  GRADE not reported

Keratinocyte growth factor (KGF; palifermin or repifermin), intravenous vs placebo

Palifermin showed no clear difference in progression-free survival compared with placebo; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  42 to 72 months from baseline
  HR 1.06 [0.80, 1.42]
  3 studies
  GRADE not reported

Bethanechol vs Artificial saliva

Bethanechol showed no clear difference in overall survival compared with artificial saliva; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  40 weeks postRT
  RR 1.59 [0.43, 5.84]
  1 study · 43 participants
  GRADE not reported

Amifostine vs no treatment/placebo

Amifostine showed no clear difference in dysphagia (grade >= 3, 0-4 scale) compared with no treatment/placebo; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT; up to 3 months postRT
  RR 0.50 [0.17, 1.48]
  2 studies · 73 participants
  GRADE not reported

Polaprezinc vs Azulene oral rinse

The review found no eligible studies for this question.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No data on adverse events were reported.
  0 studies
  No studies found

Polaprezinc vs Azulene oral rinse

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  Tumour response by RECIST criteria reported for a specific group of patients only; no usable survival data (Watanabe 2010)
  1 study
  GRADE not reported

Keratinocyte growth factor (KGF; palifermin or repifermin), intravenous vs placebo

Palifermin showed no clear difference in xerostomia (grade >= 2, 0-4 scale) compared with placebo (low certainty).

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  Up to and including 3 months postRT
  RR 0.97 [0.77, 1.22]
  3 studies · 471 participants
  Low

Antiseptic mouthrinse vs placebo

Antiseptic mouthrinse showed no clear difference in drooling (hyposialosis) compared with placebo; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  4 weeks from baseline
  RR 1.43 [0.46, 4.39]
  1 study · 24 participants
  GRADE not reported