Priority 12 from the Oral and Dental Health PSP

UNCERTAINTY: What are the best ways of managing oral conditions associated with cancer treatment? (JLA PSP Priority 12)
Overall ranking 12
JLA question ID 0079/12
Explanatory note

Not available for this PSP


There are several systematic reviews evaluating the management of oral conditions associated with cancer treatment. Oral conditions assessed include mucositis, candidiasis, xerostomia/salivary gland dysfunction and herpes simplex virus.

With regard to the prevention of mucositis there is high quality evidence that oral cryotherapy leads to large reductions in oral mucositis of all severities in adults receiving 5FU for solid cancers. There is also high quality evidence that KGF is beneficial in the prevention of oral mucositis in adults who are receiving: a) radiotherapy to the head and neck with cisplatin or fluorouracil; or b) chemotherapy alone for mixed solid and haematological cancers. There is weaker evidence for the following interventions: oral cryotherapy in adults receiving high-dose melphalan before HSCT; low level laser; glutamine; KGF in adults receiving bone marrow/stem cell transplant after conditioning therapy for haematological cancer; aloe vera, amifostine, granulocyte-colony stimulating factor (G-CSF), honey, polymixin/tobramycin/amphotericin (PTA) antibiotic pastille/paste and sucralfate.

With regard to the treatment of oral mucositis is weak evidence that allopurinol mouthwash, granulocyte macrophage-colony stimulating factor, immunoglobulin or human placental extract improve or eradicate mucositis and low level laser. There is no evidence that patient controlled analgesia (PCA) is better than continuous infusion method for controlling pain.

For the prevention of candidiasis there is strong evidence that drugs absorbed or partially absorbed from the GI tract prevent oral candidiasis in patient receiving treatment for cancer. There is also evidence that these drugs are significantly better at preventing oral candidiasis than drugs not absorbed from the GI. There is weak and unreliable evidence that the absorbed drug, ketoconazole, may eradicate oral candidiasis

There is low‐quality evidence to suggest that amifostine prevents the feeling of dry mouth in people receiving radiotherapy to the head and neck (with or without chemotherapy) in the short‐ (end of radiotherapy) to medium‐term (three months postradiotherapy). There is insufficient evidence to show that any other intervention (saliva substitutes/mouthcare systems, hyperthermic humidification, acupuncture, acupuncture-like transcutaneous electrical nerve stimulation, low-level laser therapy, biperiden plus pilocarpine, bethanechol, selenium, antiseptic mouthrinse, antimicrobial lozenge, polaprezinc, azulene rinse, and Venalot Depot (coumarin plus troxerutin) and herbal medicine) is beneficial.

For full details of the evidence checked, please see the spreadsheet of data held on the JLA website.

Health Research Classification System category  Oral and gastrointestinal
Extra information provided by this PSP
Original uncertainty examples  Original questions touch on managing during- and post- cancer treatment oral conditions, such as dry mouth and mucositis. 
Submitted by  3 x patients, carers or members of public, 2 x health professionals
PSP information
PSP unique ID 0079
PSP name Oral and Dental Health
Total number of uncertainties identified by this PSP 38  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 12 December 2018