Oral Mucositis During Cancer Treatment and the Mouth Rinses Tested Against It

Chemotherapy, radiation to the head and neck, and the very high-dose treatment given before a stem-cell transplant can strip the lining of the mouth until it is raw and ulcerated. Doctors call this oral mucositis; older trials call it stomatitis. It is one of the most common and most painful side effects of cancer treatment, and for decades researchers have tested rinses, ice, light, a growth-factor drug, honey, supplements and herbs against it.

This page sets out how often mucositis happens with each kind of treatment, how it is graded, how it develops, and what each approach showed when it was tested. The positions of the international mucositis guideline panel are given as the panel's own, and trial results are reported as they were published, null results included. Chamomile rinses have their own page, Chamomile Mouthwash and Mouth Sores From Cancer Treatment, and fingerroot's wider research is on Fingerroot Benefits.

Table of Contents

  1. What Oral Mucositis Is
  2. How Often It Happens With Each Kind of Treatment
  3. The World Health Organization Grading Scale
  4. How It Develops: The Five-Phase Model
  5. Effects on Eating, Infection and Cancer Treatment
  6. Oral Care Routines and Salt or Bicarbonate Rinses
  7. Ice in the Mouth (Oral Cryotherapy)
  8. Low-Level Laser and Light (Photobiomodulation)
  9. Palifermin, a Growth Factor Given by Vein
  10. Benzydamine Mouthwash
  11. Honey, Zinc and Glutamine
  12. Herbal Rinses: Chamomile and Fingerroot
  13. The Guideline Panel's Positions in One Place
  14. What Is Not Known
  15. Key Research Papers
  16. Connections
  17. Featured Videos

What Oral Mucositis Is

Radiation and most chemotherapy drugs do not single out cancer cells. A 1998 review of how mucositis is scored explains that both treatments interfere with normal cells as well as malignant ones, and that the cells hit hardest are the fast-dividing ones lining the mouth and gut and making blood in the bone marrow. In the mouth, losing those cells leads to a thinned lining (atrophy), dead tissue (necrosis) and open sores (ulceration). The same review notes that healing after treatment is generally uneventful, but that severe mucositis can be life-threatening, especially when dehydration or a secondary infection sets in.

A 2019 review in the National Cancer Institute's monograph series describes oral mucositis as an inflammation of the mouth's mucous membranes, with many changes both in the surface layer and in the tissue beneath it. The same review notes that mucositis has also been reported with newer kinds of cancer drugs, not only with conventional chemotherapy and radiation.

Three treatment settings produce most of the research on it:

Mucositis is not the same as an ordinary canker sore, which is a single small ulcer that comes and goes on its own. It is also separate from oral thrush, a yeast infection, though the two can occur together during treatment, and from dry mouth, which follows damage to the salivary glands.

How Often It Happens With Each Kind of Treatment

The Cochrane reviews of mucositis prevention open with the same statement: oral mucositis affects over 75% of high-risk patients. How often it happens depends heavily on the treatment.

The World Health Organization Grading Scale

Trials grade mucositis on several scales. The one used most often, and the one named in the US label for palifermin, is the World Health Organization (WHO) oral toxicity scale. A 2025 Brazilian trial report writes it out as follows:

"Severe" mucositis in most trials and reviews means grade 3 or 4. Other trials use different tools, such as the Oral Mucositis Assessment Scale used in the 2018 benzydamine trial described below. The 1998 scoring review found that direct comparisons between scoring systems had rarely been made and that little data existed on how consistently different examiners, or the same examiner twice, would score the same mouth. Results from trials that used different scales are therefore not always directly comparable.

How It Develops: The Five-Phase Model

The 1998 scoring review explains mucositis mainly through the loss of fast-dividing surface cells. Reviews by the oral medicine researcher Stephen Sonis describe a model in which the whole thickness of the lining takes part: a 2004 review calls the condition the culmination of a dynamic sequence of events that involve all the cells and tissues of the mucosa, and a 2007 review sets the sequence out in five phases:

  1. Initiation. Radiation or the drug injures cells in the lining. The review describes reactive oxygen species, unstable oxygen molecules released by the injury, as part of this first step.
  2. Primary damage response. The injured cells switch on internal signalling and gene-control pathways (the review's "transduction and transcription pathways").
  3. Signalling and amplification. Messenger molecules (the review's “signalling and functional mediators”) carry the injury signal through the tissue and amplify it.
  4. Ulceration. The surface breaks down into open, painful sores. The review describes bacteria living in the mouth as taking part in this stage.
  5. Healing. Once the treatment pauses or ends, the lining regrows.

The 2007 review identifies the stem cells of the lining's surface layer (epithelial stem cells) as the targets of this process. A 2004 review by the same author states that applying the model has helped researchers develop treatments aimed at particular steps in it. Palifermin, described below, is one example: it is a manufactured form of keratinocyte growth factor, and the 2017 Cochrane review describes growth factors of this kind as possibly helping the cells lining the mouth to regenerate.

Effects on Eating, Infection and Cancer Treatment

The pain is only the start. The Cochrane reviews describe ulceration that can cause severe pain and difficulty eating and drinking, which may require opioid painkillers, hospital admission and feeding through a nose tube or a vein. A 2004 review adds the effect on daily functioning, well-being and quality of life.

Eating and pain medicine. In the placebo group of the 2004 stem-cell transplant trial, 55% of patients needed total parenteral nutrition (feeding by vein), and the median opioid use was 535 mg of morphine equivalents.

Infection. Open sores are a way in for germs while the immune system is suppressed. The Cochrane reviews state that there is a risk of death from sepsis if pathogens enter the ulcers of people with weakened immunity. In the 2003 study of chemotherapy for solid tumours, infections were significantly more common during cycles with mucositis than without (73% vs. 36%), and after allowing for how low and how long the blood counts fell, oral mucositis was linked with infection (odds ratio 2.4). The mean hospital stay was 4 days in cycles without mucositis and 6 days in cycles with oral mucositis.

Treatment delays. Severe mucositis can force doctors to cut, delay or stop the cancer treatment itself. In the 2003 head and neck review, 11% of patients in the five studies that reported it (1,267 patients) had their radiotherapy interrupted or modified because of mucositis, and hospital admission for mucositis, reported in three studies (700 patients), was 16% overall and 32% among patients given altered-fractionation radiotherapy. The Cochrane reviews state that such interruptions may reduce survival, and the 2019 National Cancer Institute review that they may adversely affect the outlook.

Dehydration and infection are the two complications the 1998 scoring review names as making severe mucositis potentially life-threatening. Cancer units treat fever, an inability to swallow fluids, or bleeding from the mouth during treatment as urgent signs, because they can mean dehydration or an infection while blood counts are low.

Oral Care Routines and Salt or Bicarbonate Rinses

The main international guideline for mucositis comes from the Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO). Its 2020 update covers evidence from 1,197 publications. For each treatment in each setting the panel reaches one of three determinations: a recommendation, a suggestion, or "no guideline possible", depending on the level of evidence. The update produced 13 new guidelines, confirmed 11 earlier ones after reviewing new evidence, and carried over 13 for which there was no new evidence.

The panel's 2019 systematic review of basic oral care examined 17 new papers across six measures. Its findings, as stated in the abstract:

Salt-water and bicarbonate rinses are widely used anyway, and they often serve as the comparison in trials of newer rinses. A 2022 Thai trial described normal saline with sodium bicarbonate as the current standard it was comparing herbal rinses against (see below), and a 2018 Thai trial found that benzydamine produced lower mucositis scores than a sodium bicarbonate rinse.

The broadest summary of the trial record is the 2011 Cochrane review of all preventive measures. It included 131 studies with 10,514 randomised participants, but judged only 8% of those studies to be at low risk of bias. Ten measures with more than one trial showed some statistically significant evidence of benefit, sometimes weak, against placebo or no treatment: aloe vera, amifostine, ice cooling, granulocyte-colony stimulating factor, intravenous glutamine, honey, keratinocyte growth factor, laser, an antibiotic pastille or paste (polymyxin, tobramycin and amphotericin) and sucralfate. The reviewers noted that benefits may be specific to particular cancers and treatments.

Ice in the Mouth (Oral Cryotherapy)

Oral cryotherapy means holding ice chips or ice-cold water in the mouth while a chemotherapy drug is being given. In the 1996 chamomile trial described below, every patient held ice in the mouth for 30 minutes with each dose of 5-fluorouracil; the trial's authors note that stomatitis was still a major dose-limiting side effect of bolus 5-fluorouracil (the drug given as a quick injection) despite this cooling.

The 2015 Cochrane review. It included 14 randomised trials with 1,280 participants. All were judged at high risk of bias, and most participants were receiving chemotherapy rather than head and neck radiation. Its findings, with the reviewers' quality grades:

The guideline panel's 2020 review. After merging new papers with its 2013 database and reviewing 36 papers, the panel upgraded its position for patients having an autologous stem-cell transplant with high-dose melphalan conditioning to a recommendation for cryotherapy to prevent mucositis, and confirmed its recommendation for patients receiving bolus 5-fluorouracil for solid tumours. No guidelines were possible for other clinical settings.

The Cryotherapy hub covers the many other medical uses of cold.

Low-Level Laser and Light (Photobiomodulation)

Photobiomodulation (PBM) means shining low-power red or near-infrared light from a laser or a light-emitting diode onto the inside of the mouth, and sometimes onto the skin of the face and neck, on a set schedule during cancer treatment. It used to be called low-level laser therapy. It is not the cutting or burning kind of laser. The Red-Light Therapy page covers the wider use of these devices.

The guideline panel's 2019 review made recommendations for photobiomodulation to prevent mucositis and its pain in three groups: stem-cell transplant patients, head and neck radiotherapy without chemotherapy, and head and neck radiotherapy with chemotherapy. For each it named one or two protocols with demonstrated clinical effect, and stated that all the parameters of the chosen protocol need to be followed. Because the evidence was inadequate, no guideline was possible for treating mucositis that has already developed, or for chemotherapy-related mucositis. The reviewers noted that the clinical settings in the trials were extremely variable, which limited how far the data could be combined.

A 2026 meta-analysis of randomised trials published from 2020 onward included seven studies with 329 patients and found that photobiomodulation reduced mucositis (risk ratio 0.50, 95% confidence interval 0.35 to 0.73), with moderate variation between studies. The protocols differed: laser wavelengths ranged from 635 to 980 nanometres, most often 660 nanometres inside the mouth, and application times inside the mouth ranged from 3 to 20 seconds. All seven trials graded mucositis on the World Health Organization scale.

One device against another. A 2025 Brazilian trial of 60 chemotherapy patients compared a conventional low-intensity red laser protocol with a high-energy light-emitting device. Median pain and mucositis scores were low in both groups, and the difference between them was not statistically significant.

Cochrane published a protocol in 2024 for a new review of photobiomodulation for preventing mucositis in head and neck, other solid and blood cancers; that record describes the planned review, not its results.

Palifermin, a Growth Factor Given by Vein

Palifermin is a manufactured version of human keratinocyte growth factor; its label calls it a mucocutaneous epithelial human growth factor, meaning a growth factor for the cells that line the skin and mucous membranes. It is given as an injection into a vein, not as a rinse. US initial approval was in 2004.

What the US label covers. According to its label on DailyMed, palifermin is indicated to decrease the incidence and duration of severe oral mucositis in patients with blood cancers receiving bone-marrow-damaging (myelotoxic) therapy followed by their own stem cells (autologous stem-cell support), as supportive care for conditioning regimens expected to cause World Health Organization grade 3 or higher mucositis in most patients. The label's limitations of use state that:

Dosing, as the label gives it: 60 mcg/kg per day as an intravenous bolus injection for 3 consecutive days before and 3 consecutive days after the myelotoxic therapy, 6 doses in total, with the third dose 24 to 48 hours before that therapy begins and the first of the last three on the day of the stem-cell infusion, at least 7 days after the most recent dose. The label states that palifermin is not given within 24 hours before, during, or within 24 hours after myelotoxic chemotherapy, because in a clinical trial dosing within 24 hours of chemotherapy increased the severity and duration of mucositis.

The label's warnings and side effects. The label carries no boxed warning and lists no contraindications. Its warning section concerns possible stimulation of tumour growth: palifermin enhanced the growth of human epithelial tumour cell lines in cells in the laboratory and increased the rate of tumour growth in an animal model carrying human carcinoma cells, and its effect on tumours carrying the keratinocyte growth factor receptor in patients is not known. In the label's pooled trials (409 patients on palifermin, 241 on placebo), the adverse reactions that differed by at least 5 percentage points included rash (62% vs. 50%), itching (35% vs. 24%), skin redness (32% vs. 22%), swelling (28% vs. 21%), fever (39% vs. 34%), mouth or tongue thickness or discoloration (17% vs. 8%), altered taste (16% vs. 8%) and raised blood amylase (62% vs. 54%). In a post-approval trial with high-dose melphalan, reported infections occurred in 50% and 47% of the two palifermin groups and 25% of the placebo group. In a post-marketing safety study, cataracts were numerically more common with palifermin. Based on animal studies, the label states that palifermin may cause fetal harm, and that breastfeeding is not recommended.

The 2004 placebo-controlled trial. A 2004 double-blind trial gave palifermin (60 micrograms per kilogram per day) or placebo by vein for three days before total-body irradiation plus high-dose chemotherapy and for three days after an autologous transplant, in 212 patients with blood cancers. World Health Organization grade 3 or 4 mucositis occurred in 63% of the palifermin group and 98% of the placebo group. Grade 4 mucositis fell from 62% to 20%. Among patients who reached grade 3 or 4, the median duration was 6 days with palifermin and 9 days with placebo. The median opioid dose was 212 mg of morphine equivalents with palifermin and 535 mg with placebo, and feeding by vein was needed by 31% and 55%. Side effects, mainly rash, itching, redness, mouth and tongue changes and altered taste, were mild to moderate and temporary.

The 2017 Cochrane review of growth factors pooled 35 trials with 3,102 participants. For keratinocyte growth factor it found a possible reduction in moderate to severe mucositis in adults having a stem-cell transplant after conditioning therapy for blood cancers (risk ratio 0.89, 95% confidence interval 0.80 to 0.99; low-quality evidence); a very likely reduction in severe mucositis in adults having head and neck radiotherapy with cisplatin or fluorouracil (risk ratio 0.79, 95% confidence interval 0.69 to 0.90; high-quality evidence); and a likely reduction in moderate to severe mucositis in adults having chemotherapy alone for mixed solid and blood cancers (risk ratio 0.56; moderate-quality evidence). There was no evidence in children, and no serious adverse effects appeared in the trials reviewed. The head and neck and solid-cancer findings lie outside the US label, which states that safety and efficacy have not been established in cancers other than blood cancers.

The guideline panel's 2020 review confirmed its earlier recommendation for intravenous keratinocyte growth factor-1 in patients having an autologous stem-cell transplant conditioned with high-dose chemotherapy and total-body irradiation. It kept its suggestion against topical granulocyte-macrophage colony-stimulating factor, another growth factor applied in the mouth, for preventing mucositis in high-dose chemotherapy followed by a stem-cell transplant.

Benzydamine Mouthwash

Benzydamine is an anti-inflammatory drug used as a mouthwash. It is the rinse with the firmest guideline position for head and neck radiotherapy.

The guideline panel's 2019 review of anti-inflammatory agents examined 11 new papers across five agents. Its recommendation for benzydamine mouthwash to prevent radiotherapy-induced mucositis remained unchanged, and it added a new suggestion for benzydamine to prevent mucositis during chemoradiotherapy. No guideline was possible for any other anti-inflammatory agent because the evidence was inadequate or conflicting.

A 2009 placebo-controlled trial in Iran randomised 100 patients with head and neck cancers to a benzydamine or placebo rinse during radiotherapy; 19 were excluded from the analysis because they did not use the rinse for the assigned period. Grade 3 or worse mucositis occurred in 43.6% of the benzydamine group and 78.6% of the placebo group (P = 0.001). In both groups mucositis rose to grade 2 by the fourth week of treatment; in the benzydamine group it then stayed about level, while in the placebo group it rose to grade 3. The median time until grade 2 or worse appeared was 28 days with benzydamine and 24 days with placebo, a difference that was not statistically significant (P = 0.12).

A 2018 multicentre Thai trial randomised 60 patients with locally advanced head and neck cancer, treated with high-dose radiotherapy plus platinum-based chemotherapy, to benzydamine or a sodium bicarbonate rinse from the first day of treatment until two weeks after it ended. The median total score on the Oral Mucositis Assessment Scale was significantly lower with benzydamine (p < 0.001). Pain scores did not differ (p = 0.52). Nineteen percent of the bicarbonate group needed antifungal medicine for the mouth, compared with none of the benzydamine group (p = 0.06). The need for tube feeding and completion of the cancer treatment did not differ between the groups.

Honey, Zinc and Glutamine

Honey

The guideline panel's 2020 review of natural and miscellaneous agents identified 78 papers, included 49 and merged them with 9 from the previous update. It made a new suggestion in favour of honey, used both on the mouth and swallowed, to prevent mucositis in head and neck cancer patients receiving radiotherapy with or without chemotherapy. Honey was the only natural product in that review to receive a guideline in favour.

Two meta-analyses of honey in head and neck radiotherapy have since been published:

The two analyses disagree on weight loss. The 2011 Cochrane review also listed honey among the ten measures with some evidence of benefit. The Manuka Honey for Digestive Health and Sore Throat page covers honey in the throat more broadly.

Zinc

The guideline panel's 2019 review of vitamins, minerals and nutritional supplements reversed its earlier suggestion for zinc in head and neck cancer patients treated with radiotherapy or chemoradiotherapy to no guideline possible. A 2026 meta-analysis that set out to explain the conflicting results pooled five randomised trials with 332 head and neck radiotherapy patients. Overall, zinc reduced the risk of severe mucositis (risk ratio 0.35, 95% confidence interval 0.17 to 0.73). Split by route, a zinc mouthwash showed a strong effect (risk ratio 0.16, 95% confidence interval 0.05 to 0.49), while zinc swallowed as a supplement showed a borderline result (risk ratio 0.52, 95% confidence interval 0.27 to 1.01, p = 0.055). The authors called their route findings exploratory and hypothesis-generating, because there are so few trials and patients. Zinc itself is covered on the Zinc page.

Glutamine

Glutamine is an amino acid. The same 2019 guideline review made a new suggestion for glutamine taken by mouth to prevent mucositis in head and neck cancer patients receiving radiotherapy with chemotherapy, and re-established its earlier recommendation against glutamine given by vein (parenteral glutamine) for preventing mucositis in stem-cell transplant patients. The 2011 Cochrane review had listed intravenous glutamine among the measures with some evidence of benefit; the guideline panel's position on it in transplant patients is the opposite one.

Two meta-analyses of oral glutamine in head and neck radiotherapy point in different directions:

The amino acid itself is covered on the Glutamine page.

Herbal Rinses: Chamomile and Fingerroot

The guideline panel's 2020 review of natural agents found that numerous natural products and herbal remedies have been studied for mucositis, but no guideline was possible for any of them other than honey. It also made a new suggestion that chewing gum is not effective for preventing mucositis in children having chemotherapy for blood or solid cancers. Aloe vera appeared among the ten measures with some evidence of benefit in the 2011 Cochrane review.

Chamomile

The largest and most rigorous chamomile trial was published in 1996. It was a phase III, double-blind, placebo-controlled trial in patients starting their first cycle of 5-fluorouracil-based chemotherapy. Every patient held ice in the mouth for 30 minutes with each 5-fluorouracil dose, and each was randomised to a chamomile or placebo mouthwash three times a day for 14 days. Among 164 evaluable patients, the authors reported no suggestion of any difference in stomatitis between the groups and no suggestion of side effects from chamomile. They concluded that the data did not support the idea that chamomile could reduce 5-fluorouracil stomatitis. Because every patient also had ice cooling, the trial tested whether chamomile added anything on top of cooling. The smaller trials that followed, several of them positive, are set out in full on Chamomile Mouthwash and Mouth Sores From Cancer Treatment.

Fingerroot and payayor

Fingerroot (Boesenbergia rotunda) is a ginger-family root used in Thai cooking and traditional medicine. Payayor (Clinacanthus nutans) is a Thai medicinal plant. Two Thai trials have tested them as rinses in head and neck cancer:

Neither fingerroot trial used a placebo rinse, and both came from Thailand.

The Guideline Panel's Positions in One Place

These are the guideline panel's positions for the measures on this page, as stated in the abstracts of the panel's 2019 and 2020 reviews. They are the panel's determinations, listed here as information.

Recommendations in favour

Recommendation against

Suggestions in favour

Suggestions against

No guideline possible

What Is Not Known

Decisions about any rinse, supplement or device during cancer treatment belong with the treating oncology team, who know the drugs, the blood counts and the infection risks involved.

Key Research Papers

  1. Elad S, Cheng KKF, Lalla RV, Yarom N, Hong C, Logan RM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126(19):4423-4431. PubMed PMID: 32786044
  2. Hong CHL, Gueiros LA, Fulton JS, Cheng KKF, Kandwal A, Galiti D, et al. Systematic review of basic oral care for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2019;27(10):3949-3967. PubMed PMID: 31286232
  3. Correa MEP, Cheng KKF, Chiang K, Kandwal A, Loprinzi CL, Mori T, et al. Systematic review of oral cryotherapy for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2020;28(5):2449-2456. PubMed PMID: 31836937
  4. Zadik Y, Arany PR, Fregnani ER, Bossi P, Antunes HS, Bensadoun RJ, et al. Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2019;27(10):3969-3983. PubMed PMID: 31286228
  5. Logan RM, Al-Azri AR, Bossi P, Stringer AM, Joy JK, Soga Y, et al. Systematic review of growth factors and cytokines for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2020;28(5):2485-2498. PubMed PMID: 32080767
  6. Ariyawardana A, Cheng KKF, Kandwal A, Tilly V, Al-Azri AR, Galiti D, et al. Systematic review of anti-inflammatory agents for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2019;27(10):3985-3995. PubMed PMID: 31286230
  7. Yarom N, Hovan A, Bossi P, Ariyawardana A, Jensen SB, Gobbo M, et al. Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and clinical practice guidelines-part 1: vitamins, minerals, and nutritional supplements. Support Care Cancer. 2019;27(10):3997-4010. PubMed PMID: 31286229
  8. Yarom N, Hovan A, Bossi P, Ariyawardana A, Jensen SB, Gobbo M, et al. Systematic review of natural and miscellaneous agents, for the management of oral mucositis in cancer patients and clinical practice guidelines - part 2: honey, herbal compounds, saliva stimulants, probiotics, and miscellaneous agents. Support Care Cancer. 2020;28(5):2457-2472. PubMed PMID: 32056010
  9. Worthington HV, Clarkson JE, Bryan G, Furness S, Glenny AM, Littlewood A, et al. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev. 2011;2011(4):CD000978. PubMed PMID: 21491378
  10. Riley P, Glenny AM, Worthington HV, Littlewood A, Clarkson JE, McCabe MG. Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy. Cochrane Database Syst Rev. 2015;2015(12):CD011552. PubMed PMID: 26695736
  11. Riley P, Glenny AM, Worthington HV, Littlewood A, Fernandez Mauleffinch LM, Clarkson JE, et al. Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors. Cochrane Database Syst Rev. 2017;11(11):CD011990. PubMed PMID: 29181845
  12. Lewis SR, Riley P, Deligianni E, Glenny AM, Glick M, O'Malley L, et al. Interventions for preventing oral mucositis in people receiving cancer treatment: photobiomodulation. Cochrane Database Syst Rev. 2024;12(12):CD016068. PubMed PMID: 39625051
  13. Sonis ST. Pathobiology of oral mucositis: novel insights and opportunities. J Support Oncol. 2007;5(9 Suppl 4):3-11. PubMed PMID: 18046993
  14. Sonis ST. Oral mucositis in cancer therapy. J Support Oncol. 2004;2(6 Suppl 3):3-8. PubMed PMID: 15605918
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  17. Trotti A, Bellm LA, Epstein JB, Frame D, Fuchs HJ, Gwede CK, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol. 2003;66(3):253-62. PubMed PMID: 12742264
  18. Elting LS, Cooksley C, Chambers M, Cantor SB, Manzullo E, Rubenstein EB. The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis. Cancer. 2003;98(7):1531-9. PubMed PMID: 14508842
  19. Spielberger R, Stiff P, Bensinger W, Gentile T, Weisdorf D, Kewalramani T, et al. Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med. 2004;351(25):2590-8. PubMed PMID: 15602019
  20. Souza MA, De Carli JP, De Conto AB, Schneider AI, da Costa Longhi AV, Bratz BÁ, et al. Prevention of pain and oral mucositis in patients undergoing chemotherapy through the use of a high-energy light source: A randomized clinical study. Lasers Med Sci. 2025;40(1):443. PubMed PMID: 41114890
  21. G R, R EP, A D, G TÁ, P MG, Fm S, et al. Photobiomodulation for the treatment and prevention of chemotherapy- and/or radiotherapy-induced oral mucositis in cancer patients: a systematic review and meta-analysis of randomized clinical trials published in the last six years. Support Care Cancer. 2026;34(6):515. PubMed PMID: 42098536
  22. Kazemian A, Kamian S, Aghili M, Hashemi FA, Haddad P. Benzydamine for prophylaxis of radiation-induced oral mucositis in head and neck cancers: a double-blind placebo-controlled randomized clinical trial. Eur J Cancer Care (Engl). 2009;18(2):174-8. PubMed PMID: 19267733
  23. Chitapanarux I, Tungkasamit T, Petsuksiri J, Kannarunimit D, Katanyoo K, Chakkabat C, et al. Randomized control trial of benzydamine HCl versus sodium bicarbonate for prophylaxis of concurrent chemoradiation-induced oral mucositis. Support Care Cancer. 2018;26(3):879-886. PubMed PMID: 28942587
  24. An W, Li S, Qin L. Role of honey in preventing radiation-induced oral mucositis: a meta-analysis of randomized controlled trials. Food Funct. 2021;12(8):3352-3365. PubMed PMID: 33900311
  25. Li CP, Gau SY, Chen CC, Kao CH, Tsai RY, Yang HJ. Honey in Alleviating Severe Oral Mucositis Among Head and Neck Cancer Patients Undergoing Radiation Therapy. In Vivo. 2024;38(3):1397-1404. PubMed PMID: 38688612
  26. Tsao CS, Wang KY, Liao CY. The Route of Administration Determines the Efficacy of Zinc in Preventing Radiation-Induced Oral Mucositis: A Systematic Review and Meta-Analysis. Curr Oncol. 2026;33(6):371. PubMed PMID: 42346271
  27. Shuai T, Tian X, Xu LL, Chen WQ, Pi YP, Zhang L, et al. Oral Glutamine May Have No Clinical Benefits to Prevent Radiation-Induced Oral Mucositis in Adult Patients With Head and Neck Cancer: A Meta-Analysis of Randomized Controlled Trials. Front Nutr. 2020;7:49. PubMed PMID: 32363198
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  31. Sanguanboonyaphong P, Lapmag A, Silaon W, Opanasopit P, Thiramontre W, Khiewvarn S, et al. Boesenbergia rotunda extract-based mucoadhesive mouth gargle for chemoradiation-induced oral mucositis: A prospective randomized controlled study. Support Care Cancer. 2026;34(10):1052. PubMed PMID: 42828556

Drug label: palifermin injection, US prescribing information, DailyMed (National Library of Medicine), version published December 19, 2025. DailyMed label

PubMed Topic Searches

  1. PubMed: oral mucositis and cryotherapy
  2. PubMed: oral mucositis and photobiomodulation
  3. PubMed: palifermin and oral mucositis
  4. PubMed: benzydamine and oral mucositis
  5. PubMed: honey and oral mucositis
  6. PubMed: glutamine and oral mucositis
  7. PubMed: zinc and oral mucositis
  8. PubMed: herbal mouthwash and oral mucositis
  9. PubMed: MASCC/ISOO mucositis guidelines

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