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Mucositis and stomatitis 257
diphenydramine,andmagnesium/aluminum hydroxide. Magic mouthwash is
often recommended for CTAM. 22 However, data reveal that magic mouthwash
is no better than simpler mixtures, and substantially inferior to morphine rinses.
An RCT in CTAM found magic mouthwash no more effective than mouth rinses
with either chlorhexidine or salt plus soda (½ teaspoon of table salt and 2
teaspoons of baking soda in four cups of water). 23 Another CTAM trial, compar-
ing morphine rinse with magic mouthwash, found the latter substantially
inferior in pain relief, with nearly half of patients receiving the magic mouth-
wash complaining of local side effects. 6 Cochrane review concluded that there
is no benefit to magic mouthwash in CTAM. 2
Though a previously cited trial found chlorhexidine rinses were as effective as
magic mouthwash, results from CTAM trials focusing on chlorhexidine are
disappointing. The topical antimicrobial, in the form of a mouth rinse or
antibiotic oral lozenge, is generally ineffective in the treatment of CTAM. 2,17,18,23
Sucralfate is no more effective than placebo or salt plus soda mouthwash
in reducing the pain of CTAM. 2,24–26
MUCOSITIS NOT ASSOCIATED WITH CANCER TREATMENT
Most of the data dealing with non-CTAM mucositis addresses aphthous ulcer
(AU) treatment; assumptions about viral stomatitis therapy generally represent
extrapolation from AU trials. While opioids are acknowledged to be
superior for the severe pain of CTAM, agents with lesser potency (e.g.
NSAIDs) may be effective for the milder pain of viral stomatitis or AU. 22
Approaches that are not effective for CTAM may, in fact, have some utility
for other, non-oncologic etiologies of mucositis.
Topical sucralfate is an example of an approach that is not successful in
CTAM but which is found useful in AU. A crossover RCT found sucralfate to
be more effective than either antacids or placebo in the treatment of AU. 27
Supporting evidence for sucralfate’s effectiveness in non-CTAM mucositis is
found in a RCT in patients with Behçet’s disease, which demonstrated effective
pain control with sucralfate suspension. 28
For some treatments found not useful for CTAM, there is simply insufficient
evidence to support use in AU or viral stomatitis. Magic mouthwash (see