Discussion
oral mucositis, ®, cancer, non-cytotoxic, mucositis
ORAL MUCOSITIS, CANCER, MUCOSITIS, CAVITY, ORAL CANDIDIASIS
Because of their highly antimicrobial efficacy, CHG and OCT are often used in antiseptic mouth rinses. However, these conventionally used rinses showed cytotoxic effects impeding their use in the context of oral mucositis. An alternative mouth rinse containing Citroxx revealed only low antimicrobial effects with a reduction of 0.22–1.36 lg levels [In the presented study, we tested Granudacyn® with 50 ppm hypochlorous acid and 50 ppm sodium hypochlorite for a potentially use in patients suffering oral mucositis. Intentionally, only orally healthy volunteers were allowed to take part in the trial to first verify the efficacy and compatibility in a pre-test to ensure a potential use in cancer patients.The use of hypochlorous acid mimics the naturally occurring antibacterial defense of macrophages and is therefore considered to be non-cytotoxic [The study revealed a significant reduction of microorganisms (total aerobic bacteria count) in the oral cavity and importantly an effectiveness lasting up to 60 min with only a slight decrease. The prolonged effect of hypochlorite confirms results of Gottardi and Nagl [Since the study functions as a pre-test, only the total bacteria count was evaluated. However, a distinction of bacteria genera or even species would have been given more insight into the mode of action of both mouth rinses. Since hypochlorous acid is part of the natural defense of pathogens, a diverse reaction towards different bacteria genera may be possible. Since oral candidiasis seems to be a risk factor for early development of severe oral mucositis [A further limitation is the assessment of the antiseptic only on buccal mucosa and saliva but not at the dorsum of the tongue, which would have given further insights into the efficacy of the rinses especially on anaerobic microorganisms. But, even with its lower antimicrobial efficacy in comparison to Octenidol® md, Granudacyn® might be preferred since its higher biocompatibility on the already stressed oral mucosa [However, all conducted analyses were endpoint analyses after a single application. On the one hand, using healthy volunteers thus enables a cross-over study directly comparing the efficacy of the mouth rinses, on the other hand, mucositis in cancer patients may progress over time, thus a long-term application without cross-over design may provide a more realistic insight.Furthermore, the slightly chlorous taste of Granudacyn® described by the volunteers repeatedly subsided very fast after mouth rinsing and therefore was classified as tolerable. Octenidol® md, in contrast, influenced the taste for several hours, caused by its characteristic long-lasting and bitter taste.