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Oropharyngeal mucositis occurs in virtually all patients with head and neck cancer receiving radiochemotherapy. The manipulation of the oral cavity microbiota represents an intriguing and challenging target. A total of 75 patients were enrolled to receive Lactobacillus brevis CD2 lozenges or oral care regimen with sodium bicarbonate mouthwashes. The primary endpoint was the incidence of grade 3 or 4 oropharyngeal mucositis during radiotherapy treatment. There was no statistical difference in the incidence of grade 3-4 oropharyngeal mucositis between the intervention and control groups (40.6% vs. 41.6% respectively, p=0.974). The incidence of pain, dysphagia, body weight loss and quality of life were not different between the experimental and standard arm. Our study was not able to demonstrate the efficacy of L. brevis CD2 lozenges in preventing radiation-induced mucositis in patients with head and neck cancer. Although modulating homeostasis of the salivary microbiota in the oral cavity seems attractive, it clearly needs further study.

The posterior oral cavity serves as an entry point to both the digestive and respiratory systems. Optimal oral hygiene, particularly by means of gargling, has been shown to effectively reduce transmission and duration of respiratory illnesses (Clinical Trials registration: NCT06479226). Previous studies have demonstrated the effectiveness of gargling with an antimicrobial mouthwash in preventing the development of respiratory symptoms. To assess the impact of using an antimicrobial mouthwash for gargling in lowering the incidence of upper respiratory symptoms. A total of 150 individuals were recruited and randomly assigned to two groups: Control group: participants were requested to brush their teeth twice daily for two minutes using a commercially available fluoride toothpaste; and the Test Group, which also brushed their teeth twice daily for two minutes with a commercially available fluoride toothpaste and additional gargling twice a day with a mouthwash containing 0.075% Cetylpyridinium chloride and 0.28% Zinc Lactate (CPC+Zn). Individuals were asked to complete the WURSS-21 Daily Symptom Report over the course of the three-month study period using a diary. Regular gargling with the mouthwash containing CPC+Zn was efficacious in decreasing both the frequency (21.5% lower) and severity (11% lower) of respiratory symptoms throughout the study. Additionally, individuals that performed consistent cleansing of the posterior oral cavity with mouthwash had greater interference in daily activities, which should be further investigated. Adding gargling with a mouthwash containing 0.075% CPC + 0.28% Zn to a normal oral hygiene routine proves beneficial in lowering the incidence of upper respiratory symptoms commonly associated with cold and the flu. Trial registration: ClinicalTrials.gov NCT06479226

To investigate whether preoperative chlorhexidine mouthwash can reduce the risk of postoperative pulmonary complications(PPCs) in elderly patients with tracheal intubation under general anesthesia. 78 elderly patients undergoing elective surgery under general anesthesia and endotracheal intubation were randomly divided into the chlorhexidine group (CH group, n  = 39) and the normal saline group (NS group, n  = 39). Nurses instructed patients to gargle with 15 ml saline or compound chlorhexidine mouthwash the night before surgery, on the morning of surgery, and upon entering the operating room. The primary outcome was lung ultrasound score (LUS) on postoperative day 1 (D 1 ). The secondary outcome was LUS on the preoperative day (D 0 ) and postoperative day 3 (D 3 ), bacterial colony count at the tip of the endotracheal tube, inflammatory markers (IL-1β, IL-6, TNF-α), and the incidence of postoperative fever, pneumonia, cough severity and sputum production. The CH group had significantly lower D 1 LUS compared to the NS group, whereas there was no significant difference in D 3 LUS between the groups. Within three postoperative days, there were no significant differences between the groups in cough severity, sputum production, fever, inflammatory markers, or pneumonia incidence. Bacterial colony counts on the endotracheal tube at extubation were lower in the CH group than in the NS group. Post hoc sensitivity analysis revealed that in patients with oral frailty, the number of colonies cultured at D 1 LUS, D 3 LUS, and the catheter tip in the CH group was lower than that in the NS group. However, there was no significant difference between the two groups in terms of the incidence of pneumonia and other aspects. Exploratory subgroup analysis showed that chlorhexidine mouthwash significantly reduced postoperative LUS in patients with oral frailty, while there were no significant differences in gender, smoking and age subgroups. Preoperative chlorhexidine mouthwash improved early postoperative LUS in elderly patients by reducing oropharyngeal bacterial colonization, particularly in those with oral weakness, though clinical outcomes like pneumonia showed no significant differences. Chinese clinical trial registration number: ChiCTR2400089898.

Chlorhexidine (CHX) is the most commonly used mouthwash with proven antiplaque and antibacterial activity. The aim is to evaluate the effect of vitamin C (VitC) in CHX mouthwash on plaque accumulation and gingivitis, and to compare it with CHX alone mouthwash and antiseptic phenol-containing mouthwashes. This study conducted as a multicenter, randomized, controlled, double-blind, parallel design clinical study. Sixty patients were included, randomly divided into three groups. 1. Antiseptic phenol agent (P, Phenol), 2. Antiseptic bisbiguanide agent CHX-only (CHX) and 3. Antiseptic bisbiguanide agent CHX + VitC mouthwash (CHX + VitC). The study assessed oral hygiene and periodontal health status, followed by scaling and root planning (SRP) and subsequent polishing. After using the mouthwash for 60 s twice daily along 14 days, patients recalled for evaluation of plaque index (PI), gingival index (GI), bleeding on probing (BOP) and staining. One-way analysis of variance (ANOVA) was used to compare the differences formed between groups and Tukey multiple comparison analysis was used to determine groups that showed the differences. Statistical significance was determined using a p -value threshold of 0.05. There were no significant differences between the groups regarding baseline PI, GI and BOP ( p  > 0.05). Changes at 14th day in PI, GI and BOP in all groups were similar and no significant differences were observed ( p  > 0.05). Regarding ‘all surfaces’, staining density of two mouthwashes containing CHX was significantly higher than that of P mouthwash. CHX, CHX + VitC, and P mouthwashes appeared to exhibit comparable effects as oral hygiene adjuncts to periodontal mechanical treatment, with the exception of staining, which was more noticeable in the CHX groups compared to the P group . Adding vitamin C did not enhance the effects of CHx alone.

Introduction Mental fatigue is a psychobiological state caused by prolonged periods of demanding cognitive activity that has negative implications on many aspects in daily life. Caffeine and carbohydrate ingestion have been shown to be able to reduce these negative effects of mental fatigue. Intake of these substances might however be less desirable in some situations (e.g., restricted caloric intake, Ramadan). Rinsing caffeine or glucose within the mouth has already been shown to improve exercise performance. Therefore, we sought to evaluate the effect of frequent caffeine-maltodextrin (CAF-MALT) mouth rinsing on mental fatigue induced by a prolonged cognitive task. Methods Ten males (age 23 ± 2 years, physical activity 7.3 ± 4.3 h/week, low CAF users) performed two trials. Participants first completed a Flanker task (3 min), then performed a 90-min mentally fatiguing task (Stroop task), followed by another Flanker task. Before the start and after each 12.5% of the Stroop task (eight blocks), subjects received a CAF-MALT mouth rinse (MR: 0.3 g/25 ml CAF: 1.6g/25 ml MALT) or placebo (PLAC: 25 ml artificial saliva). Results Self-reported mental fatigue was lower in MR ( p  = 0.017) compared to PLAC. Normalized accuracy (accuracy first block = 100%) was higher in the last block of the Stroop in MR ( p  = 0.032) compared to PLAC. P2 amplitude in the dorsolateral prefrontal cortex (DLPFC) decreased over time only in PLAC ( p  = 0.017). Conclusion Frequent mouth rinsing during a prolonged and demanding cognitive task reduces mental fatigue compared to mouth rinsing with artificial saliva.

(1) Background: Carbohydrate mouth rinsing (CMR) stimulates the central nervous system and improves motor control. However, no studies have examined the effects of CMR on softball batting performance. The purpose of this study was to investigate the effect of CMR on softball batting performance. (2) Methods: Fifteen trained female collegiate softball players (age: 20.6 ± 0.9 years; height: 159.5 ± 5.2 cm; body weight: 58.1 ± 6.9 kg) completed two trials in a randomization crossover trail, in which they rinsed their mouths for 20 s with 25 mL of either 6.4% maltodextrin (CMR) or a placebo (PLA). After rinsing, the Posner cueing task and grip force, counter-movement jump (CMJ) and batting tests were performed in sequence. A tanner tee was utilized to hit five sets of five balls at a time, with a minimum 3 min rest between sets. The batting test recorded the average exit velocity, maximum exit velocity and launch angle consistency. The standardized standard deviation (SD) for launch angle represents the standardized variability. (3) Results: The consistency of the launch angle of the CMR trial was significantly greater (p = 0.025; Cohen’s d = 0.69) than that of the PLA trial. There were no significant differences in the Posner cueing task, grip strength, vertical jump, or exit velocity. (4) Conclusions: The findings of this study indicate that CMR enhances the launch angle consistency of all-out-effort batting, but does not influence the exit velocity of softball hitting.

Background: Carbohydrate mouth rinsing (CHOmr), a nutritional intervention for delaying fatigue and meeting the energy demands of soccer, and the motivational strategy of coach encouragement (CE) are widely recognized as effective approaches for enhancing athletic performance in soccer. Objectives: This study aimed to compare the effects of CHOmr + CE, CHOmr, and CE on heart rate (HR) and kinematic profiles during four-a-side small-sided soccer games (SSGs). Methods: Twenty-four young soccer players (age: 17.2 ± 0.8 years) played six bouts of four-a-side SSGs with CHOmr + CE, CHOmr, or CE at 3-day intervals in a randomized, single-blinded, placebo-controlled, or crossover study design. The HR and kinematic responses were continuously recorded during all games. Results: There were no statistically significant differences between the groups in peak heart rate (HRpeak) (p ≥ 0.05, F = 0.326, p = 0.723, η2 = 0.014) and mean heart rate (HRmean) (p ≥ 0.05, F = 0.845, p = 0.436, η2 = 0.035). No significant differences were found for distances in Zone 1 (p ≥ 0.05, F = 1.21, p = 0.306, η2 = 0.050), Zone 4 (p ≥ 0.05, F = 0.310, p = 0.735, η2 = 0.013), Zone 5 (p ≥ 0.05, F = 1.02, p = 0.368, η2 = 0.042), or Zone 6 (p ≥ 0.05, F = 0.161, p = 0.211, η2 = 0.055), nor acceleration (p ≥ 0.05, F = 0.208, p = 0.137, η2 = 0.083) and deceleration (p ≥ 0.05, F = 0.790, p = 0.460, η2 = 0.033). Similarly, although no significant differences were observed in the distance in Zone 3 (p ≥ 0.05, F = 3.12, p = 0.054, η2 = 0.119) or repeated sprint distance (p ≥ 0.05, F = 2.96, p = 0.062, η2 = 0.114), the CHOmr +CE group exhibited higher average values for these variables. However, a statistically significant difference was observed in the distance covered in Zone 2 (p ≤ 0.05, F = 3.89, p = 0.028, η2 = 0.145), with the CHOmr +CE group performing better, as confirmed by the post-hoc analyses. Conclusions: Although our findings indicate that CE alone may influence kinematic profiles during SSGs, similar to CHOmr or its combination with CE, further research should explore the underlying mechanisms and potential contextual factors influencing these outcomes. Therefore, we suggest that coaches prefer CE because it is easy to implement.

Athletes require proper nutrition to enhance training and performance. Studies indicate that alternative sources of caffeine, such as caffeinated chewing gum, mouth rinses, energy gels, and coffee can improve performance. Therefore, this study investigated the impact of consuming caffeinated gum (CG) and repeated coffee mouth rinsing (CMR) on professional male table tennis players' aerobic capacity and explosive power. A randomized, cross-over, placebo-controlled, and double-blinded study was conducted with eighteen male table tennis players (Age: 21.86 ± 2.40 yr, Height: 173.80 ± 6.88 cm, Weight: 61.81 ± 10.32 kg). In each test session, the participants were randomly placed in one of the three conditions including i) Chewing caffeinated gum (CG,  = 6), ii) Coffee mouth rinsing (CMR,  = 6), iii) Starch capsule as a placebo (PLA,  = 6). All participants consumed caffeine with an average dose of ∼3 to 4.5 mg·kg . Also, a one-week interval was considered a washout period for each condition. First, the participants were given the required supplement and performed functional tests such as throwing medicine balls and Sargent's jump tests. Then, the maximum oxygen consumption (VO ), time to exhaustion (TTE), oxygen consumption equivalent at primary ventilatory threshold (VO at VT ), and oxygen consumption equivalent at respiratory compensation point (VO at RCP) were measured during the Bruce test. All data were analyzed using SPSS Windows software, repeated measure analysis ANOVA, and Bonferroni post hoc tests at  < 0.05. The current study's findings illustrated that TTE significantly increased in CG (  = 0.000) and CMR (  = 0.012) conditions compared to PLA, but no significant difference was observed between CMR and CG (  = 1.00). VO at VT was significantly higher in CG (  = 0.004) and CMR (  = 0.000) compared to PLA; however, no significant difference was observed between CMR and CG (  = 0.335). VO at RCP increased significantly in CG (  = 0.000) and CMR (  = 0.000) compared to the PLA condition, and despite this, no significant difference was observed between CG and CMR (  = 1.000). Nevertheless, there were no significant differences between the three conditions in VO , throwing a medicine ball, and Sarjent's jump height. The study found that CMR and CG had a relatively positive impact on male table tennis players' aerobic capacity; however, they did not significantly improve their explosive power.

There is growing interest in the potential of alternative modes of caffeine administration for enhancing sports performance. Given that alternative modes may evoke improved physical performance via distinct mechanisms, effects may not be comparable and studies directly comparing the erogenicity of alternative modes of caffeine administration are lacking. To address this knowledge gap, the present study evaluated the effect of 3 mg·kg caffeine delivered in anhydrous form via capsule ingestion, chewing gum or mouth rinsing on measures of muscular strength, power, and strength endurance in male Rugby Union players. Twenty-seven participants completed the study (Mean ± SD: Age 20 ± 2 yrs; daily caffeine consumption 188 ± 88 mg). Following assessments and reassessment of chest press (CP), shoulder press (SP), Deadlift (DL), and Squat (SQ) 1-repetition maximum (1RM) and familiarization to the experimental procedures, participants completed six experimental trials where they were administered 3 mg.kg caffeine (Caff) or placebo (Plac) capsule , chewing gum or mouth rinse in a randomized, double-blind and counterbalanced fashion prior to force platform assessment of countermovement jump, drop jump and isometric mid-thigh pull performance. Strength endurance was measured across two sets of CP, SP, DL, and SQ at 70% 1RM until failure. Pre-exercise perceptions of motivation and arousal were also determined. Caffeine increased perceived readiness to invest mental effort (  = .038; ηp =.156), countermovement jump height (  = .035; ηp =.160) and SQ repetitions until failure in the first set (  < .001; d = .481), but there was no effect of delivery mode (  > .687; ηp <.015). Readiness to invest physical effort, felt arousal, drop jump height, countermovement jump, drop jump and isometric mid-thigh pull ground reaction force-time characteristics and repetitions until failure in CP, SP and DL were not affected by caffeine administration or mode of caffeine delivery (  > .0.052; ηp < .136). 3 mg.kg caffeine administered via capsule, gum or mouth rinse had limited effects on muscular strength, power, and strength endurance. Small effects of caffeine on CMJ height could not be explained by changes in specific ground reaction force-time characteristics and were not transferable to DJ performance, and effects specific to the SQ RTP exercise underpin the complexity in understanding effects of caffeine on muscular function. Novel modes of caffeine administration proposed to evoke benefits via distinct mechanisms did not offer unique effects, and the small number of effects demonstrated may have little translation to a single performance trial when data examining direct comparison of each caffeine vehicle compared against a mode matched placebo is considered.

Background We aimed to determine whether preoperative chewing gum is non-inferior to Chlorhexidine (CHX) mouthwash in reducing halitosis in patients undergoing elective general anesthesia with endotracheal intubation. Methods We conducted a randomized, single-blind, non-inferiority controlled trial involving patients undergoing surgery requiring endotracheal intubation for ≤ 3 h. Participants were randomly assigned to either the CHX mouthwash group (Group M) or the chewing gum group (Group N). Thirty minutes before general anesthesia, patients in Group M rinsed their mouths with 10 ml of CHX mouthwash, while those in Group N chewed Trident mint gum. The primary outcome was the incidence of halitosis in both groups, assessed before endotracheal intubation and at extubation. Results A total of 733 patients were included, with 365 patients in Group M and 368 patients in Group N. The incidence of halitosis in both groups was significantly reduced compared to baseline. Before extubation, the improvement in halitosis was greater in Group N than in Group M ( P  < 0.05). After extubation, the improvement in halitosis in Group N was non-inferior to that in Group M ( Z  = 1.96, 95% CI : -0.0898 to 0.0944, p  = 0.0023). Conclusions In patients undergoing elective general anesthesia with endotracheal intubation, chewing gum was found to be non-inferior to CHX mouthwash in improving postoperative halitosis. Trial registration Chictr.org.cn ChiCTR2400082035 (date of registration: 19/03/2024).