Phenytoin mouthwash to treat cancer therapy-induced oral mucositis: A pilot studyPrimary neuroendocrine carcinoma of breast: A rare tumor.

BACKGROUND: Oral mucositis is one of the most common side effects of cancer therapy with no definite treatment. Phenytoin has positive effects on healing of mucosal and dermal wounds. In this study efficacy of 1% phenytoin mouthwash on severity of mucositis (on the basis of WHO scale), pain relief (based on Visual Analogue Scale), and improvement of patients' quality of life (on the basis of EORTC-QLQ-H and N35 questionnaire) was evaluated. MATERIALS AND METHODS: In a pilot -double-blind randomized clinical trial, eight patients in study group were given 1% phenytoin mouthwash while eight patients in control group used normal saline. Data analysis was performed by Mann-Whitney and Repeated Measured ANOVA tests. RESULTS: Reduction of mucositis severity was observed, but the difference was not significant. On the other hand, patients on phenytoin therapy had better pain relief (VAS# 6.75 ± 1.58 at the beginning of the study reached to # 3.75 ± 1.16 after 3 weeks in phenytoin group) and improvement in quality of life (score of QOL was 70.63 ± 5.5 that reached to 63.61 ± 6.39 in phenytoin group) than normal saline group significantly (P < 0.05). CONCLUSION: One percent phenytoin mouthwash caused pain relief and improvement of life quality significantly in patients with mucositis due to cancer therapy, but it did not reduce the severity of mucositis in a statistically significant scale.

Re-evaluation of the first phenytoin paste healing effects on oral biopsy ulcers.

BACKGROUND: Until now, several formulations of topical phenytoin have been used to promote wound healing. AIM: This study was aimed at re-evaluating the effects of a newly formulated phenytoin mucoadhesive paste on wound healing after oral biopsy. SUBJECTS AND METHODS: In a double-blind clinical trial, 35 consecutive patients with oral lichenoid or lichen planus lesions were randomized into two groups. After incisional biopsy, patients applied simple, or 1% phenytoin paste at least three times a day (after each meal), for 4 days. They were evaluated every other day for size of wound closure, severity of pain, and diameter of the inflammatory halo. This study was approved by Medical Ethics committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Statistical analysis was performed using Mann-Whitney U test and Ordinal Logistic Regression. RESULTS: Of 35 patients, 17 (10 [10/17, 59%]) men, 7 (7/17, 41%) women, mean age: 40 (4.11) were in phenytoin group, and 18 (9 [9/9, 50%]) men, 9 (9/9, 50%) women, mean age: 43.1 (5.15) were in placebo group. There were no significant differences between both study groups in terms of age and sex (male/female ratio) (P = 0.76, P = 0.88). As all biopsies were done by means of punch number 8, the incisions were of 10 mm length. After second and third appointments, it was observed that patients in the treatment group showed quicker wound closure and less pain compared to control group significantly (P < 0.05). Although not significant, patients treated with phenytoin paste had smaller inflammatory halo than controls. CONCLUSION: Applying 1% phenytoin mucoadhesive paste on oral biopsy incisions resulted in accelerated wound healing and decrease in pain.

Xerostomia due to systemic disease: a review of 20 conditions and mechanisms.

Xerostomia is a common complaint of nearly half of the elderly population and about one-fifth of younger adults. It causes several signs and symptoms, and compromise oral functions and health-related quality-of-life. Multiple reasons are proposed to describe the etiology of xerostomia such as local factors, psychogenic factors, and systemic diseases. In order to manage xerostomia effectively, identification of the main causality is mandatory. The aim of this review was to present systemic diseases leading to xerostomia with their mechanisms of action. We used various general search engines and specialized databases such as Google, Google Scholar, Yahoo, PubMed, PubMed Central, MedLine Plus, Medknow, EBSCO, ScienceDirect, Scopus, WebMD, EMBASE, and authorized textbooks to find relevant topics by means of Medical Subject Headings keywords such as "xerostomia," "hyposalivations," "mouth dryness," "disease," and "systemic." We appraised 97 English-language articles published over the last 40 years in both medical and dental journals including reviews, meta-analysis, original papers, and case reports. Upon compilation of relevant data, it was concluded that autoimmune diseases most frequently involve salivary glands and cause xerostomia followed by diabetes mellitus, renal failure, and graft-versus-host disease. Moreover, the underlying mechanisms of systemic disease-related xerostomia are: autoimmunity, infiltration of immunocompetent cells, granuloma formation, fibrosis and dehydration, deposition of proteinaceous substances, bacterial infection, and side-effects of medications.

Taste alteration and impact on quality of life after head and neck radiotherapy.

BACKGROUND: Dysgeusia is a relatively common complication of head and neck radiotherapy. The aim of this study was to evaluate taste condition after head and neck radiotherapy and its impact on quality of life. METHODS: In this cohort study 22 patients with head and neck cancer in Tehran University of Medical Sciences Hospital, were interviewed and examined before and 3 weeks after radiotherapy. Patients were given three consecutive concentrations of sugar, salt, citric acid and quinine sulfate solutions to evaluate their taste sensation by Whole Mouth Technique. EORTC-QLQ-H&N35 questionnaire was used before and after radiotherapy to assess the quality of life. Statistical analysis was done using Wilcoxon Signed Rank Test, Spearman's Coefficient of Correlation, Paired t-test, Multiple Ordinary and Multiple Linear Regressions. RESULTS: Significant changes were observed in concentrations and intensities of different perceived tastes before and after radiotherapy. All patients had dysgeusia after radiotherapy and 72.2% had total taste loss. Impairment was observed mainly in salt and bitter tastes followed by sour and sweet. Subjective dysgeusia reported by 3/4 of the patients, which was correlated with objective taste disorder in terms of different tastes intensity. Age, sex, radiotherapy fractions, dosage and patients level of education had no significant effects on taste alteration. Quality of life was significantly deteriorated after the occurrence of dysgeusia in both total and partial taste losers. None of the aforementioned factors had significant effects on quality of life. CONCLUSION: Head and neck radiotherapy causes impairment in taste perception, and life quality is influenced by dysgeusia.

Efficacy of topical phenytoin on chemotherapy-induced oral mucositis; a pilot study.

BACKGROUND AND THE PURPOSE OF THE STUDY: Oral mucositis is one of the most common complications of malignancy chemotherapy. As yet, no absolute treatment has been demonstrated to be effective for chemotherapy-induced oral mucositis. This study evaluates the effectiveness of phenytoin mouthwash as a wound healing agent, on the basis of stimulating effects on fibroblast proliferation. MATERIALS AND METHODS: In this multicenter, randomized, placebo-controlled clinical trial; twelve patients received phenytoin mouthwash (0.5%) or placebo for about two weeks. Oral pain severity was scored on the daily basis using a VAS (visual analogue scale) of 10 centimeters. National Cancer Institute (NCI) scale was used to grade the intensity of mucositis. To determine the effect of treatment, a quality of life questionnaire, consisting of 35 queries, was filled out for all patients. Statistical analyses of data was performed using Mann-Whitney test. RESULTS: The average time for complete remission of mucositis in phenytoin-treated group was less than that of the placebo group. The quality of life improved dramatically in the phenytoin group with the healing process being more evident in the first week. Furthermore, reduction in the wound area was greater in the phenytoin group than controls at the end of the first week of treatment. Both groups eventually demonstrated reduction in pain intensity; however no statistically significant difference was observed between two groups. CONCLUSION: Phenytoin mouthwash accelerated wound healing and resolution of mucositis and improved life quality impressively.