Comparative Effectiveness of Benzydamine and Salt–Soda–Bicarbonate Mouthwashes versus Routine Care on Oral Mucositis in Head and Neck Cancer Patients Undergoing Radiotherapy

Abstract

Oral mucositis (OM) is a common and debilitating side effect of radiation therapy (RT) in patients with head and neck cancer (HNC). It causes significant pain, impairs nutrition and oral function, and can lead to treatment interruptions, thereby negatively affecting therapeutic outcomes. Despite the availability of several oral care regimens, there is no standardized intervention universally accepted for its prevention or management.

This study aimed to evaluate and compare the effectiveness of benzydamine mouthwash, salt–soda–bicarbonate mouthwash, and routine oral care in reducing the severity of radiation-induced OM in patients with HNC.

A quasi-experimental pre-test post-test control group study was conducted at Dharamshila Narayana Superspeciality Hospital, Delhi. Sixty patients undergoing RT for HNC were allocated into three groups using a non-random, time-sequential allocation method (n = 20 each): Group I received benzydamine mouthwash (n = 20 each), Group II received salt–soda–bicarbonate mouthwash (n = 20 each), and the Control Group (n = 20 each) received routine oral care. Each intervention was administered three times daily for 1minute over five consecutive days. The severity of OM was assessed on Day 1 and Day 5 using the Modified Oral Mucositis Assessment Tool (OMAT). Data were analyzed using appropriate statistical tests, including analysis of variance and post hoc comparisons with Tukey's HSD.

The mean reduction in mucositis scores was highest in the salt–soda–bicarbonate group. A statistically significant difference was observed between groups (p <0.05). Post hoc analysis revealed that the salt–soda–bicarbonate group showed significantly greater reduction in mucositis scores compared with the benzydamine group (mean difference = 0.85, p <0.05) and the control group (mean difference = 1.25, p <0.05). No statistically significant difference was observed between the benzydamine group and the control group (mean difference = 0.40, p >0.05).

Both benzydamine and salt–soda–bicarbonate mouthwashes were effective in reducing the severity of OM among patients undergoing head and neck radiotherapy. However, salt–soda–bicarbonate mouthwash demonstrated comparatively greater benefit and may serve as a feasible, low-cost intervention for routine care, particularly in resource-limited settings. Further well-designed randomized controlled trials with larger sample sizes are recommended to confirm these findings.