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Comparative evaluation of the efficacy of herbal and benzydamine mouthwashes in preventing radiation-induced oral mucositis among head and neck cancer patients: a systematic review and network meta-analysis

Evidence-Based Dentistry volume 26, page 118 (2025)Cite this article

Subjects

Abstract

Background

Benzydamine mouthwash is beneficial in avoiding radiation-induced oral mucositis (RIOM) in patients with head and neck cancer, but it is also expensive and has negative side effects, while herbal mouthwashes offer a potential, easily accessible alternative with less side effects and bioactive characteristics. Hence, the aim of the systematic review and network meta-analysis was to assess and compare the efficacy of herbal mouthwash and benzydamine mouthwash in preventing RIOM among head and neck cancer patients.

Methods

After searching Scopus, PubMed, Cochrane, Science Direct, EBSCO Host, Lilacs, Science Direct, Web of Science, and Google Scholar from the earliest available year till July 15, 2024, 79 articles were obtained. Four full-text publications met the eligibility requirements and underwent additional processing for data extraction. PICO Strategy: P: Head and neck cancer patients, I: Herbal mouthwash, C: Benzydamine mouthwash, O: Reduction in radiation-induced oral mucositis. The review only comprised randomised controlled trials. The risk of bias assessment and quality of evidence were assessed using the RoB-2 Tool and GRADE Tool respectively.

Results

Curcumin mouthwash was most effective in reducing the incidence of oral mucositis followed by sumac-rose and turmeric mouthwash. Curcumin, turmeric, and sumac-rose mouthwashes were found to be effective in delaying the onset of oral mucositis as compared to the benzydamine group. Turmeric mouthwash followed by curcumin and sumac-rose mouthwash were found to be more effective in reducing the severity of oral mucositis.

Conclusion

The current review concludes that curcumin, turmeric, and sumac-rose mouthwashes are more effective than benzydamine mouthwash in preventing RIOM. These natural alternatives show promising results for improving patient outcomes and should be investigated further to be used clinically.

PROSPERO Registration Number

CRD42024570913

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Fig. 1: PRISMA Flowchart.
Fig. 2: Risk of bias assessment using the RoB-2 tool.
Fig. 3: Network meta-analysis.
Fig. 4: Litmus Rank-O-Gram.

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Data availability

The data supporting this systematic review’s findings are available from the corresponding author upon reasonable request. The datasets generated and analyzed during the current study are not publicly available due to privacy restrictions but are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India

    Rahul Mohandas

  2. Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, 411018, India

    Subhashree Mohapatra

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  2. Subhashree Mohapatra
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RM: concept, design, and definition of intellectual content, literature search, data acquisition, data analysis, manuscript preparation. SM: data acquisition, manuscript editing and manuscript review.

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Correspondence to Subhashree Mohapatra.

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Mohandas, R., Mohapatra, S. Comparative evaluation of the efficacy of herbal and benzydamine mouthwashes in preventing radiation-induced oral mucositis among head and neck cancer patients: a systematic review and network meta-analysis. Evid Based Dent 26, 118 (2025). https://doi.org/10.1038/s41432-025-01117-8

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