Total bacterial counts on oral mucosa after using a commercial saliva substitute in patients undergoing hematopoietic cell transplantation

Purpose: The commercial saliva substitute Oralbalance® has been reported to alleviate symptoms of postradiotherapy xerostomia in head and neck cancer patients. Oralbalance® may also be effective for xerostomia in patients undergoing hematopoietic cell transplantation (HCT) with high-dose chemotherapy and total-body irradiation. However, HCT patients are in a severely compromised condition, and saliva substitute must not promote infection. We reported previously that Oralbalance® has antimicrobial effects against microbial species detected during HCT in vitro. This study was performed to determine the in vivo effects of Oralbalance® on oral mucosal total bacterial counts in patients undergoing HCT. Methods: A total of 18 neutropenic patients undergoing HCT were enrolled in this study. Before and after 1 week of Oralbalance® use, bacterial samples were obtained from patients by wiping an area of ω1 cm on the buccal mucosa with sterilized cotton swabs. Total bacterial counts of the obtained samples were examined by quantitative polymerase chain reaction amplification of the bacterial 16S ribosomal RNA gene. As controls, bacterial samples were also obtained from ten healthy subjects, and total bacterial counts were examined. Results: No significant increase in bacterial count was observed with use of Oralbalance®. None of the patients showed bacterial counts above the range found in healthy controls after using Oralbalance®. Conclusions: In neutropenic patients undergoing HCT, Oralbalance® did not increase the total counts of oral mucosal bacteria beyond the range found in healthy controls. Oral care using Oralbalance® may alleviate the symptoms induced by hyposalivation without promoting infection.