***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Benzydamine hydrochloride rinse was shown to prevent oral mucositis in radiation therapy . Prevention of mucositis allows reduction in morbidity of one of the therapy limiting complications of radiotherapy for cancer therapy OBJECTIVE To assess the microbiological effects of an antiseptic , non-alcohol based mouth-rinse containing chlorhexidine and cetylpyridinium chloride , in patients undergoing radiation therapy for head- and -neck cancer . STUDY DESIGN This was a parallel , double-blind , prospect i ve , r and omized clinical trial , including patients irradiated as part of the therapy of head- and -neck cancer , aged 18 - 75 , with at least 10 teeth , and willing to sign an informed consent . Cancer patients were r and omly assigned to one of the two treatments ( test mouth-rinse or a placebo ) . Three visits were scheduled ( baseline , 14 and 28 days ) . Microbiological findings were evaluated in tongue , mucosa and subgingival sample s , by means of culture . Microbiological variables were assessed by means of the Mann-Whitney , Wilcoxon and chi-square tests . RESULTS 70 patients were screened and 36 were included . The detection of C and ida species in mucosa and tongue sample s showed significant reductions in the test group . Total bacterial counts decreased in both groups from baseline to the 2-week visit , while minor changes occurred between 2 and 4 weeks ( effects on P. gingivalis , P. intermedia , C. rectus , E. corrodens ) . CONCLUSIONS Within the limitations of the small sample size , this study suggests that the use of the tested mouth-rinse may lead to improvements in microbiological parameters in patients irradiated for head- and -neck cancer Patients receiving cytotoxic antineoplastic therapy often have treatment-associated stomatitis . A 0.12 % chlorhexidine digluconate mouthrinse was evaluated ( 15 ml , three times a day ) in a prospect i ve , double-blind r and omized trial as prophylaxis against cytotoxic therapy-induced damage to oral soft tissues . Seventy subjects , forty in patients receiving high-dose chemotherapy and thirty out patients receiving high-dose head and neck radiation therapy , were evaluated .  Chlorhexidine mouthrinse significantly reduced the incidence of oral mucositis in the chemotherapy group on day 14 ( p less than 0.02 ) and at 1 week follow-up on day 28 ( p less than 0.002 ) . Mucositis in the patients undergoing chemotherapy who received chlorhexidine also resolved more rapidly . Mucositis severity was significantly less compared to the control chemotherapy group on day 14 ( p less than 0.03 ) , day 21 ( p less than 0.04 ) , and on 1 week follow-up ( p less than 0.02 ) . Concomitant trends in the reduction in oral streptococci and yeast were noted in the chemotherapy group receiving chlorhexidine mouthrinse . Although no differences were observed in oral mucositis between the control and chlorhexidine groups of patients undergoing high-dose radiotherapy , similar reductions of oral microflora to those seen in the chemotherapy population were also noted for patients undergoing radiation therapy who received chlorhexidine . Although generally not significant , some increase in gram-negative bacilli was noted in the chlorhexidine-treated patients in both the chemotherapy and radiotherapy groups , but there was no correlation with increased systemic infection . Prophylactic chlorhexidine mouthrinse reduces oral mucositis and microbial burden in patients with cancer undergoing intensive chemotherapy Oral mucosal ulceration complicating bone marrow transplantation interferes with patients ' comfort , nutrition and may lead to systemic infection derived from the mouth . The mucosal injury results from epithelial damage due to the cytotoxic effects of chemotherapy and radiation conditioning as well as from superficial oropharyngeal infection . Because chlorhexidine gluconate is a broad spectrum topical antimicrobial which has been demonstrably effective in preventing oral infection and gingivitis , we performed a r and omized , placebo controlled , double-blind trial of chlorhexidine as a mouth rinse in BMT recipients to study the severity of oral mucositis and both oral and systemic infectious complications .  One hundred patients were r and omly assigned to receive either chlorhexidine gluconate 0.12 % mouth rinse or placebo three times daily from the initiation ( day -8 ) of chemoradiotherapy conditioning until day + 35 post-BMT . Chlorhexidine use result ed in a trend toward improved oral hygiene index ( reduced dental plaque ) ( p = 0.06 ) but did not modify the oral mucositis . Patients using chlorhexidine developed a maximum ulceration of 18 + /- 22 % of their oral mucosa , while placebo patients ulcerated 25 + /- 31 % of the mouth . Ulcerative mucositis was significantly worse in adults compared with children , in individuals who received methotrexate for graft-versus-host disease prophylaxis , and was most prominent on non-keratinized epithelium . Overall , there was no clinical ly demonstrable additional therapeutic advantage to the use of chlorhexidine in either reducing the mucositis , controlling oral pain , facilitating oral nutrition , shortening hospital stay , or reducing oral infection with herpes simplex virus . There was a trend toward diminished oral c and idiasis in chlorhexidine users ( p = 0.06 ) . ( ABSTRACT TRUNCATED AT 250 WORDS PURPOSE To determine whether a chlorhexidine mouthwash could alleviate radiation-induced oral mucositis . PATIENTS AND METHODS Patients scheduled to receive radiation therapy to include greater than one third of the oral cavity mucosa were selected for study . Following stratification , they were r and omized in a double-blind manner to receive a chlorhexidine mouthwash or a placebo mouthwash . Both groups were then similarly evaluated for mucositis and mouthwash toxicity . RESULTS Twenty-five patients were r and omized to receive the chlorhexidine mouthwash , while 27 received the placebo mouthwash . Treatment arms were well balanced . There was a trend for more mucositis and there was substantially more toxicity ( eg , mouthwash-induced discomfort , taste alteration , and teeth staining ) on the chlorhexidine arm . CONCLUSION In contrast to the pre study hypothesis that a chlorhexidine mouthwash might provide benefit for patients receiving radiation therapy to the oral mucosa , this study provides strong evidence suggesting that a chlorhexidine mouthwash is detrimental in this clinical situation PURPOSE / OBJECTIVES To test the effectiveness of a nurse-initiated systematic oral hygiene teaching program-PRO-SELF : Mouth Aware (PSMA)-in conjunction with two mouthwashes ( 0.12 % chlorhexidine or sterile water ) in preventing chemotherapy-induced oral mucositis . DESIGN R and omized , double-blind , placebo-controlled , clinical trial . SETTING S 23 outpatient clinics and office practice s in California . SAMPLE 222 patients who were starting a cycle of mucositis-inducing chemotherapy . METHOD Participants were followed over three chemotherapy cycles . All patients were provided the PSMA program . R and om assignment to a mouthwash occurred prior to the development of oral mucositis . Research ers used the Oral Assessment Guide to assess the patients oral cavities monthly ( with the patients cycles of chemotherapy ) and when patients reported any oral changes between cycles . MAIN RESEARCH VARIABLES Type of mouthwash , incidence , days to onset , and severity of chemotherapy-induced oral mucositis . FINDINGS No significant differences existed between the two mouthwashes in regard to incidence , days to onset , and severity of mucositis . CONCLUSIONS Because chlorhexidine ( S20 per pint ) was no more effective than water , a substantial cost savings can be realized by rinsing with water . Interestingly , the PSMA program appeared to reduce the incidence of mucositis from on a prior estimate of 44 % to less than 26 % . IMPLICATION S FOR NURSING PRACTICE A nursing prescription of a systematic oral hygiene program using water as a mouth rinse is cost efficient and may be effective in preventing oral mucositis The goal of reducing oral complications during  chemotherapy and bone marrow transplantation has received attention at several centers . The current r and omized study of 86 adults with leukemia treated with chemotherapy or bone marrow transplantation  assessed the potential role of chlorhexidine , nystatin , and saline solution rinses to reduce the findings of oral mucositis , gingivitis , and oral infection . The results of this study did not show a reduction in mucositis with the use of these rinses . However , potential bacterial and fungal pathogens were identified less frequently in the patients using chlorhexidine rinse OBJECTIVE To assess the effects of an antiseptic , non-alcohol based mouth-rinse containing chlorhexidine and cetylpyridinium chloride , in preventing the oral complications associated to radiation therapy in head- and -neck cancer patients . STUDY DESIGN This was a parallel , double blind , prospect i ve , r and omized clinical trial . Cancer patients were r and omly assigned to one of the two treatments ( test mouth-rinse or a placebo ) . Three visits were scheduled ( baseline , 14 and 28 days ) . Different outcome variables were evaluated : mucositis , plaque and gingival indices , stimulated saliva and salivary pH. RESULTS 70 patients were screened and 36 were included . The presence and the degree of mucositis significantly increased in both groups and no significant differences were detected between groups , although the median increase in the placebo group ( 1.81 ) at 2 weeks was higher than in the test group ( 1.20 ) . CONCLUSIONS Within the limitations of the small sample size , this study suggests that the use of the tested mouth-rinse may lead to some improvements in clinical parameters in patients irradiated for head- and -neck cancer AIMS The present study was done to assess the effect of three alcohol-free mouthwashes on radiation-induced oral mucositis in patients with head and neck malignancies . MATERIAL S AND METHODS Eighty patients with head and neck malignancies , scheduled to undergo curative radiotherapy , were r and omly assigned to receive one of the three alcohol-free test mouthwashes ( 0.12 % chlorhexidine , 1 % povidone-iodine , or salt/soda ) or a control . The patients were instructed to rinse with 10 ml of the mouthwash , twice a day , for a period of 6 weeks . Mucositis was assessed at baseline and at weekly intervals during radiation therapy , using the World Health Organization criteria for grading of mucositis . The baseline demography of the four groups was matched for age , sex , stage of cancer , and whether the patient had cancer of oral or extraoral regions . A post hoc test for repeated measures was used to find the difference of mean mucositis scores between the groups at various week intervals . RESULTS Among the 76 patients who completed the study , patients in the povidone-iodine group had significantly lower mucositis scores when compared to the control group from the first week of radiotherapy . Their scores were also significantly lower when compared to the salt/soda and chlorhexidine groups from the fourth and fifth week , respectively , after radiotherapy . CONCLUSIONS This study demonstrates that use of alcohol-free povidone-iodine mouthwash can reduce the severity and delay the onset of oral mucositis due to antineoplastic radiotherapy Conditioning chemoradiotherapy damages the mucosal barrier of the mouth and throat and often produces severe oral inflammation and infection . In a prospect i ve , double-blind , r and omized study , we examined the use of a chlorhexidine digluconate mouthrinse for prophylaxis against oral mucosal complications in 51 bone marrow transplant patients . Use of chlorhexidine mouthrinse produced significant reductions in the incidence and severity of oral mucositis . Mucositis also resolved more quickly in patients receiving chlorhexidine . Concomitant reductions in total oral streptococci ( p less than 0.02-p less than 0.001 ) and oral c and ida ( p less than 0.004 ) were seen in patients using chlorhexidine .  Persistent clinical oral c and idiasis ( thrush ) was observed in 15 to 27 control group patients ( 56 % ) , but only transiently in two ( 8 % ) of 24 patients who used chlorhexidine rinse ( p less than 0.001 ) . Five of 27 control group patients ( 19 % ) had c and idemia , while no c and idemia was observed in the chlorhexidine group ( p less than 0.03 ) . Three deaths from disseminated c and idiasis occurred in the placebo group ; none occurred in patients who received chlorhexidine . Prophylactic use of chlorhexidine mouthrinse produces reductions in oral soft tissue disease and oral microbial burden in patients undergoing bone marrow transplantation . The reductions in mucositis and in oral c and ida infections observed with prophylactic chlorhexidine mouthrinse represent a significant advantage for patients undergoing marrow transplantation Mucositis induced by irradiation is the 
    Output:
    
CONCLUSIONS This systematic review found that chlorhexidine is not significantly effective in reducing the severity of mucositis ( moderate quality of evidence ) nor in preventing the incidence of mucositis ( low quality of evidence ) .