Medical management of paraquat induced oral mucositis: A systematic Review

Paraquat is an extremely corrosive and lethal herbicide. After intentional or unintentional ingestion, paraquat causes extensive mucosal damages extending through the upper gastrointestinal tract which are characterized by pain, inflammation, ulceration, bleeding, and sloughing of the associated mucosa. The aim of this systematic review is to compile and evaluate evidence based studies in relation to the effectiveness of different methods of management of oral mucositis induced by paraquat in terms of reduction of associated pain and duration of symptoms.We undertook computerized electronic searches through both English and Chinese databases so as to identify all published articles in the subject. We also searched reference lists from relevant articles for any related articles. This review is not registered.A total of 10 relevant randomized controlled trials (RCTS) were selected after the electronic searches after satisfying our inclusion criteria. They were published between the 2000s and 2020. The primary outcome measurement assessed an improvement in the healing time/recovery time or adequate pain management. Interventions from all the studies highlighted the use of multi-agent management that included either oral care by the use of bland and multi-agent mouth rinses, corticosteroids, Chinese herbal remedies, growth factors, smectites or anti-oxidant therapy. The main findings were that the main method of management was the implementation of a multi-drug regimen, through the use of compounded preparations or a polydrug system. In addition, herbal and natural remedies, if used appropriately, can play a beneficial role in the management of paraquat induced oral mucositis.