American Academy of Nursing

View all recommendations from this society

Released April 23, 2015

Don’t use mixed medication mouthwash, commonly termed “magic mouthwash,” to prevent or manage cancer treatment-induced oral mucositis.

Oral mucositis is a painful and debilitating side effect of some chemotherapeutic agents and radiation therapy that includes the oral mucosa in the treatment field. Painful mucositis impairs the ability to eat and drink fluids and impacts quality of life. Oral mucositis can result in the need for hospitalization for pain control and provision of total parenteral nutrition in order to maintain adequate nutritional intake during cancer treatment.Mixed medication mouthwash, also commonly known by other names such as “magic mouthwash,” “Duke’s magic mouthwash,” or “Mary’s magic mouthwash,” is commonly used to prevent or treat oral mucositis. These are often compounded by a pharmacy, are expensive and may not be covered by health insurance. Research has shown that magic mouthwash was reported to cause taste changes, irritating local side effects and is no more effective than salt and baking soda (sodium bicarbonate) rinses. Instead, frequent and consistent oral hygiene and use of salt or soda mouth rinses can be used.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a health professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician or nurse.

How The List Was Created

The American Academy of Nursing has convened a workgroup of member fellows who are leaders of professional nursing organizations representing a broad range of clinical expertise, practice settings and patient populations. The workgroup collaboratively identifies nursing/interdisciplinary interventions commonly used in clinical practice that do not contribute to improved patient outcomes or provide high value. An extensive literature search and review of practice guidelines is conducted for each new proposed recommendation for the list. The supporting evidence is then reviewed by the respective nursing organization(s) with the most relevant expertise to each recommendation. The Academy workgroup fellows narrow the recommendations through consensus, based on established criteria. The final recommendations are presented to the American Academy of Nursing’s Board of Directors for approval to be added to the Choosing Wisely list created by the Academy.

The American Academy of Nursing’s conflict of interests and disclosures policy can be found at www.AANnet.org.

Sources

Dodd MJ, Dibble SL, Miaskowski C, MacPhail L, Greenspan D, Paul SM, Shiba G, Larson P. Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Jul;90(1):39-47.

Eilers J, Harris D, Henry K, Johnson LA. Evidence-based interventions for cancer treatment-related mucositis: putting evidence into practice. Clin J Oncol Nurs. 2014 Dec;18 Suppl:80-96.

Kuk, JS, Parpia S, Sagar SM, Tsakiridis T, Kim D, Hodson DI, Zywine C, Wright JR. A randomized phase III trial of magic mouthwash and sucralfate versus benzydamine hydrochloride for prophylaxis of radiation-induced oral mucositis in head and neck cancer. J Clin Oncol. 2011 May 20 ASCO Annual Meeting Abstracts Part 1:29(15);5521.

Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, McGuire DB, Migliorati C, Nicolatou-Galitis O, Peterson DE, Raber-Durlacher JE, Sonis ST, Elad S; Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO).MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014 May 15;120(10):1453-61.

Peterson DE, Bensadoun RJ, Roila F; ESMO Guidelines Working Group. Management of oral and gastrointestinal mucositis: ESMO Clinical Practice Guidelines. Ann Oncol. 2010 May;21 Suppl 5:v261-5.

Mucositis [Internet]. Pittsburgh (PA): Oncology Nursing; 2015 [cited 2015 Apr 6]. Available from: https://www.ons.org/practice-resources/pep/mucositis.