Post Date: 17th Jan, 2010 - 11:00am
/ Post ID: #
Mouth Wash vs Warm Salt Water
Comments: Here is a quote for mouthcare with cancer patients. The salt water mix is more towards the bottom, but the mouthwash part is still an interesting read...
Anti-Bacterial Mouth Rinses
Most of us came home from the hospital after our child's initial diagnosis with instructions to have our children rinse their mouth after each meal and before bed with Peridex. Peridex is a prescription drug, generic name: Chlorhexidine gluconate. Peridex is a particularly bad tasting concoction.
Dr. Mark, what do use for your son to prevent mouth sores during chemotherapy for ALL?
"David's oncologist wanted him on Peridex and I said "Not if I can help it!" I asked the doc if we could substitute 0.63% stannous fluoride rinse. He said it was okay. For the laymen here, they do the same thing, but the stannous fluoride does not stain teeth as bad or taste as bad, it prevents cavities (because of the fluoride), and the patient is more likely to comply."
"As a dentist I knew Peridex would taste terrible and stains teeth. Peridex tastes so bad that they put a flavoring agent in it. Problem is if you rinse your mouth out after taking Peridex, you rinse out the flavoring agent and it tastes worse."
"The stannous part of the fluoride is antimicrobial - it kills the bacteria that give you mouth sores. Also kills the bacteria that build up the plaque and tartar and destroy the gums. The reason you use Peridex or 0.63% stannous fluoride is to kill the microbes in the mouth. These two meds have substantivity, which means they stick around killing the bugs for about 8 hours. Mouthwashes in general will kill on contact, but don't stay around. I use the 0.63% stannous fluoride because of the above properties, but also because I think it is kinder to the mouth tissues. My son has not had one sore since being on chemo with the 0.63% stannous fluoride."
So, where do we get stannous fluoride for our kids?
"It is prescription. A lot of dentists dispense this. Usually the fluoride that is dispensed from a dentist tastes better than the fluoride one picks up at the pharmacy. At the pharmacy, they are generically filling the prescription. You still get 0.63% stannous fluoride, but they fill the prescription with the cheapest one, hence it does not taste that good. Let me rephrase that. The dentist dispensed fluoride, in my experience, tastes better because we want you to keep using it."
"I am using Stanimax, manufactured by SDI Labs Inc., out of Glenview IL 60025. It comes in mint and tropical. Used to use PerioMed, manufactured by Omni International. They have mint, and cinnamon. One mixes 1/8 oz. Of concentrate with warm water, making 1 oz. (This is enough for two adult mouth rinses. You may want to cut that down.) Swish for 1 minute (time it!) and spit. This needs to be used by kids who are old enough to where they won't accidentally swallow it."
"The salesman for the PerioMed had a daughter with leukemia on the 0.63% Fluoride Rinse and said she never did have a mouth sore!"
"Your oncologist could probably prescribe stannous fluoride. However, Stanimax and PerioMed are only sold to dentists -- NOT pharmacies. I am sure that the pharmacists carry or can get someone's brand of 0.63% stannous fluoride, I just can't guarantee the taste if it's not Stanimax or PerioMed. Best bet would be to contact your dentist, but alas, not all of these guys dispense this stuff either."
"I offer this as an alternative to Peridex. If your child tolerates the Peridex, stick with it. If your child's onc insists on Peridex, stay with it. My child's onc said it was ok to use the 0.63% stannous fluoride instead of Peridex. I knew my child is picky about bad tasting medicines, and I wanted to smooth out his roller coaster. It is something I could do."
"My son has no problem taking this. He is 6 yrs. Old. He is only taking it before he goes to bed. If and when he starts developing mouth sores, he will take it AM and PM."
Wait Dr. Mark, I thought you said that Peridex and stannous fluoride are preventatives. Now you are saying you would use it if mouth sores developed, too?
"If the mouth ulcers are chemo induced, I personally don't think the Peridex or fluoride will help. But they will keep ulcers down from bacteria and reduce opportunistic secondary infections due to low counts. So what I am saying here is use the Peridex or 0.63% Stannous fluoride daily, as a preventative and as a therapeutic agent."
Doesn't fluoride cause mottling of the teeth if it is used daily?
"You only swish with the 0.63% stannous fluoride and then spit it out, so mottling of the teeth from too much fluoride should not be a problem. This concentration of fluoride used in this home rinse is different than the fluoride you get after a cleaning in the dental office. So if your kid has ever puked after taking fluoride at the dentist's, the Stanimax or PerioMed is not as bad."
"Stannous fluoride is used in dentistry all the time as a therapeutic agent in the treatment of periodontal disease, sensitivity, and controlling bleeding after cleanings. This fluoride is more powerful than one would find in an over the counter toothpaste or mouthwash."
Our oncologist advised us to have our son rinse with warm salt water. What does this do?
"Salt water rinses are good because they alkalinize the mouth (opposite of acidify, which is what the bacteria create.) Use one-half teaspoon each of baking soda and salt in a cup of warm water. The alkalinity helps decrease the bacteria count because they like an acid environment. As far as hot or cold, I'm not sure it matters. The rise in pH (alkalinity) is temporary. That is why the docs are promoting the Peridex, because they last longer."
And what about over-the-counter rinses, like Listerine?
They kill bacteria, they just do not work as long as Peridex and stannous fluoride.
Anti-fungal Mouth Rinses
Patients under intense chemo are at risk for fungal and yeast as well as bacterial infections. Some oncologists prescribe Nystatin to prevent fungal infections; other oncologists only prescribe Nystatin after infections occur. These infections are evidenced by white patches in the mouth. Other names for the medicine are Mycostatin or Nilstat rinses, or Mycelex lozenges. The rinses are known as "swish and swallow", since the kids do not spit them out because this type of infection can occur down the throat passage as well as in the mouth. After "swish and swallow", the child should not eat, drink, or rinse their mouth for 30 minutes so that the medicine can have time to act.
Different brands of this medicine taste differently, as reported by child-patients. Ask your pharmacist to order a different brand if your child cannot tolerate this medicine.
Source 1: Pediatric Oncology Resource Center