Oral Stomatitis Research Articles

The Antifungal Effects of Hypericum perforatum Nanoemulsion against Candida albicans

Background Oral stomatitis is one of the common infections related to dentures (complete or partial), which is seen in the form of diffuse inflammation, mainly with Candida albicans. The aim of the present study was to investigate the antifungal effects of Hypericum perforatum nanoemulsion against Candida albicans. Materials and Methods The microdilution technique has been used in order to determine the antifungal effects of Hypericum perforatum nanoemulsion. The study has involved four groups: Hypericum perforatum oil, Hypericum perforatum nanoemulsion, distilled water as a negative control, and nystatin as a positive control. The first concentration of nanoemulsion in which no clear fungal growth was observed in the culture medium has been considered as the Minimum Inhibitory Concentration (MIC) and the first concentration in which the fungal growth was completely stopped and no fungal growth was observed in the culture medium has been considered as the Minimum Fungicide Concentration (MFC). One-way Analysis of Variance (ANOVA) has been employed to compare the results between the groups. Tukey's post-hoc test has been used to make comparisons between the groups. The significance level has been considered at less than 0.05. Results Both Hypericum perforatum oil and Hypericum perforatum nanoemulsion have been found to exhibit good antifungal activity against Candida albicans. The MIC and the MFC of the nanoemulsion form have been found to be lower than the non-nanoemulsion form (P<0.05). Among the studied groups, the nystatin group had been found to have the best effect (P<0.05). Conclusion Considering the different antifungal mechanisms and also the different resistance mechanisms of nystatin and Hypericum perforatum nanoemulsion, the prepared nanoemulsion can be used to treat and reduce the population of nystatin-resistant Candida albicans strain. However, the efficiency of these materials needs to be confirmed in larger studies on resistant strains.

Bevacizumab Erlotinib Switch Maintenance in Chemo-Responsive Advanced Gallbladder and Cholangiocarcinoma (BEER BTC): A Multicenter, Open-Label, Randomized, Phase II Trial.

Patients with chemotherapy-responsive advanced biliary tract cancers (BTCs) are usually observed after 6 months of gemcitabine-based therapy. There is limited prospective evidence for maintenance strategies after chemotherapy. This investigator-initiated, open-label, randomized, integrated phase II-III study enrolled adult patients with advanced BTC from two cancer centers in India. Patients with histologically confirmed advanced biliary tract adenocarcinoma who had at least disease stabilization after 6 months of gemcitabine-based chemotherapy were randomly assigned (1:1) to either active surveillance or switch maintenance, which was a combination of bevacizumab 5 mg/kg intravenous once every 21 days plus erlotinib 100 mg once daily. Both arms were continued until disease progression, unacceptable toxicity, or patient decision to withdraw. The primary end point of the phase II component of the trial was investigator-evaluated progression-free survival. This trial is registered with Clinical Trials Registry of India (CTRI/2019/05/019323I). From May 2021 to November 2022, 98 patients were randomly assigned to active surveillance (n = 49) or bevacizumab-erlotinib (n = 49). A majority of patients had gallbladder cancer (80%). The median follow-up was 13.4 months. The median progression-free survival was 3.1 months (95% CI, 2.47 to 3.64) in the active surveillance group versus 5.3 months (95% CI, 3.53 to 7.04) in the bevacizumab-erlotinib group (hazard ratio, 0.51 [95% CI, 0.33 to 0·74]; P = .0013). The most common grade 3 class-specific adverse events associated with bevacizumab-erlotinib were acneiform rash 1 (2%) and oral stomatitis 1 (2%) with erlotinib and bleeding 1 (2%) with bevacizumab. The combination of bevacizumab and erlotinib as switch maintenance improves progression-free survival with an acceptable safety profile compared with active surveillance in patients with advanced BTCs in this phase II study. The trial moves on to the phase III component to evaluate improvement in overall survival.

Anti-inflammatory and wound healing effects of mouth gel containing kaempulchraol K from Kaempferia galanga rhizomes

Ethnopharmacological relevanceKaempferia galanga L. is one of the important medicinal plants and has been used in Thailand for treating inflammation and wound. Aim of the studyThis study aimed to investigate the efficacy of the compound from K. galanga on wound healing and anti-inflammatory activities and develop a new product in gel form to maximize the benefits of this plant. Materials and methodThe mouth gel containing kaempulchraol K (KG2) was prepared by using 1.5% carbopol 934 as a gelling agent. Formulations of mouth gel containing KG2 at 0.10%, 0.25%, and 0.50% w/w were evaluated for color, smell, pH values, viscosity, and separation. Also, the chemical and biological stabilities of mouth gel containing KG2 were evaluated by heating-cooling test. The anti-inflammatory activity was tested against RAW 264.7 cells nitric oxide (NO) production and wound healing assay was performed using human gingival fibroblasts (HGF). ResultsCompound KG2 exhibited anti-NO production with an IC50 value of 66.8 μM and the wound healing activity of compound KG2 showed cell viability in the range of 90.9–111.4%. In addition, compound KG2 at a concentration of 3 μM induced the highest proportion of cell migration on day 3 at 90.2 ± 2.4%. The mouth gel containing KG2 both before and after the heating-cooling test exhibited good consistency, with pH values in the range of 6.64–6.71 (before) and 6.63–6.68 (after). Meanwhile, the viscosity was 81,700–96,700 cP (before) and 78,300–93,300 cP (after). For the chemical stability test of the active ingredient of mouth gel, the compound showed good stability after mixing with the gel base. The mouth gel exhibited anti-inflammation with IC50 values > 1000 μg/ml both before and after accelerating conditions. The wound healing activity of mouth gel containing KG2 (0.50% w/w) showed the highest % cell viability at 128.6% (before) and 123.8% (after). For cell migration, the result suggested that the mouth gel containing KG2 at 0.10%, 0.25%, and 0.50% w/w (3 μg/ml) on day 3 enhanced cell migration higher than that of the positive controls both before (85.0–96.8%) and after (and 84.4–94.3%) the accelerating conditions. ConclusionThe present study shows that mouth gel containing 0.50% KG2 is the most appropriate with good physical, chemical, and biological stabilities and might be one of the alternative sources for treatment of mouth ulcers (oral stomatitis) derived from aphthous ulcers, chemotherapy, and radiotherapy treatments.

The Impact of the Addition of Vitamins on a Silicone Lining Material to the Oral Mucosa Tissue-Evaluation of the Biocompatibility, Hydrolytic Stability and Histopathological Effect.

Background and Objectives: One's quality of life depends on overall health, and in particular, oral health, which has been and continues to become a public health issue through frequent manifestations in various forms, from simple oral stomatitis (inflammations of the oral cavity) to the complicated oral health pathologies requiring medical interventions and treatments (caries, pulp necrosis and periodontitis). The aim of this study focused on the preparation and evaluation of vitamins (vitamin A, B1 and B6) incorporated into several silicone-based lining materials as a new alternative to therapeutically loaded materials designed as oral cavity lining materials in prosthodontics. Materials and Methods: Silicone-based liners containing vitamins were prepared by mixing them in solution and becoming crosslinked, and then they were characterized using Fourier-transform infrared (FT-IR) spectroscopy to confirm the incorporation of the vitamins into the silicone network; scanning electron microscopy (SEM) to evidence the morphology of the liner materials; dynamic vapor sorption (DVS) to evaluate their internal hydrophobicity, swelling in environments similar to biological fluids and mechanical test to demonstrate tensile strength; MTT to confirm their biocompatibility on normal cell cultures (fibroblast) and mucoadhesivity; and histopathological tests on porcine oral mucosa to highlight their potential utility as soft lining materials with improved efficiency. Results: FT-IR analysis confirmed the structural peculiarities of the prepared lining materials and the successful incorporation of vitamins into the silicone matrix. The surface roughness of the materials was lower than 0.2 μm, while in cross-section, the lining materials showed a compact morphology. It was found that the presence of vitamins induced a decrease in the main mechanical parameters (strength and elongation at break, Young's modulus) and hydrophobicity, which varied from one vitamin to another. A swelling degree higher than 8% was found in PBS 6.8 (artificial saliva) and water. Hydrolytic stability studies in an artificial saliva medium showed the release of low concentrations of silicone and vitamin fragments in the first 24 h, which increased the swelling behavior of the materials, diffusion and solubility of the vitamins. The microscopic images of fibroblast cells incubated with vitamin liners revealed very good biocompatibility. Also, the silicone liners incorporating the vitamins showed good mucoadhesive properties. The appearance of some pathological disorders with autolysis processes was more pronounced in the case of vitamin A liners. Conclusions: The addition of the vitamins was shown to have a beneficial effect that was mainly manifested as increased biocompatibility, hydrolytic stability and mucoadhesiveness with the mucosa of the oral cavity and less of an effect on the mechanical strength. The obtained lining materials showed good resistance in simulated biological media but caused a pronounced autolysis phenomenon, as revealed by histopathological examination, showing that these materials may have broad implications in the treatment of oral diseases.

Dexamethasone to prevent everolimus-induced stomatitis (Alliance MIST Trial: A221701)

mTOR inhibitors such as everolimus may cause oral stomatitis, often a dose-limiting toxicity. Prior clinical research has suggested that a dexamethasone mouth rinse might help prevent and/or treat this. Alliance A221701 was a randomized phase III trial of patients initiating 10 mg daily oral everolimus that compared dexamethasone mouthwash taken preventively (initial dexamethasone group) versus therapeutically (initial placebo group) to assess two coprimary endpoints: the incidence of mTOR inhibitor-associated stomatitis (mIAS), and the area under the curve (AUC) of mIAS-associated pain over an 8-week treatment period. A Fisher's exact test was used to compare the incidences while a Wilcoxon rank-sum test was used to compare the AUCs. In addition, we performed an exploratory analysis of the association of everolimus trough concentrations and toxicity using a Mann-Whitney U test. Due to slow accrual, this study closed after 39 patients were randomized (19 to upfront placebo and 20 to upfront dexamethasone). There were no significant differences between groups seen in either of the coprimary endpoints; furthermore, we found no association between whole blood everolimus trough concentrations and toxicity. Although limited by poor enrollment, the results of this study do not suggest that prophylactic dexamethasone mouthwash is superior to therapeutic dexamethasone mouthwash (initiated at the first sign of mouth pain) for reducing the incidence or severity of mIAS from everolimus.

Sunitinib promotes apoptosis via p38 MAPK activation and STAT3 downregulation in oral keratinocytes.

Sunitinib, a targeted cancer drug, inhibits tyrosine kinases receptors and is widely used as first-line treatment for metastatic renal cell carcinoma. Patients undergoing chemotherapy with sunitinib frequently have oral mucosal complications, such as oral stomatitis, though cytotoxic effects of the drug on oral keratinocytes remain unknown. The effects of sunitinib on immortalized oral keratinocytes, RT7 cells, in regard to cell injury and apoptosis, as well as apoptosis-mediated signaling pathways were investigated. Sunitinib treatment caused a significant increase in lactate dehydrogenase (LDH) in RT7 cells and primary oral keratinocytes. Additionally, the drug induced apoptosis-related events, such as DNA fragmentation, decreased anti-apoptotic Bcl-2 protein expression, and induction of cleaved PARP and caspase 3/9 in RT7 cells. Furthermore, phosphorylation of p38 MAPK, but not of ERK or JNK, was increased. On the contrary, constitutive phosphorylated STAT3 was decreased by sunitinib treatment, which was recovered by exposure to SB203580, a p38 MAPK inhibitor. Finally, SB203580 was found to reduce sunitinib-induced cell injury and apoptosis. The present results indicate that sunitinib promotes cell injury and apoptosis in oral keratinocytes via p38 activation and STAT3 downregulation. Sunitinib-mediated oral complications may be associated with cytotoxic effects of the drug on oral keratinocytes.

Efficacy of Cryotherapy and Hangeshashinto for Radiation-induced Oral Stomatitis: Preliminary Study.

Radiation-induced stomatitis is one of the main acute disorders in patients with head and neck cancer. Since its treatment is often delayed or discontinued, the control of perioperative oral function is necessary. It has been reported that Hangeshashinto (Japanese traditional herbal medicine) and cryotherapy (known as frozen therapy) alleviate oral stomatitis and the accompanying pain. In the present study, the combination effect of Hangeshashinto and cryotherapy on radiation-induced stomatitis in patients with head and neck cancers was investigated for the first time. Fifty patients with head and neck cancer were subjected to radiation therapy with concomitant administration of anticancer drugs. They were separated into two groups, matched according to age, stage of cancer progression, total radiation dose, and type of concomitant anticancer drugs. One group was orally administrated frozen Hangeshashinto, while another group was not. Oral mucosal damage was assessed by the grade classification CTCAE v4.0 of the National Cancer Institute of the United States (Japanese JCOG version). Duration time of radiation-induced stomatitis was determined by the appearance of grade 1 redness to its disappearance. Frozen Hangeshashinto significantly alleviated, delayed the onset, and reduced the duration time of the radiation-induced stomatitis. Cryotherapy in combination with Hangeshashinto can be used for the treatment of radiation-induced oral stomatitis.

Assessment of the effect of honey and chlorhexidine on radiation-induced oral stomatitis with head-and-neck cancer patients

Assessment of the effect of honey and chlorhexidine on radiation-induced oral stomatitis with head-and-neck cancer patients

Role of purified beta-glucanase from lactobacillus acidophilus in disruption of biofilm formation by candida spp. causing of denture stomatitis

Chronic periodontitis is a chronic inflammatory disease, caused by bacteria and characterized by destruction of connective tissue and bone support of the teeth. Lactobacillus fermentum, Lactobacillus acidophilus, Streptococcus mutant and Staphylococcus aureus were among the causing subgingival plaques. These bacterial generacan create extracellular β-glucanase, but Lactobacillus acidophilus revealed higher level in β-glucanase production than other genera. β-glucanase purified by 50 % ammonium sulfate saturation and sephacryl S-200 matrix for gel filtration with a yield of 62.24 %. Denture stomatitis or oral stomatitis that caused by Candida spp. and lead to development of candidiasis and Candida albicans was the predominant species (10 isolates, 28.5 %), followed by Candida dubliniensis and Candida glabrata (3 each, 8.5 %), Candida parapsilosis (2 isolats, 5.7 %) and C. tropicalis. The screening for biofilm formation byCandida spp. revealed that all Candida species produced biofilm but in different levels. C. albicans isolates were the strongest producer for biofilm, followed by C. dubliniensis. In contrast, Candida glabrata isolates were the poorest producers among all Candida species. The purified β-glucanase inhibited biofilm formation by Candida spp. With higher inhibition percentage 70.5–57.1 % for Candida albicans isolates. On the other hand, lower inhibition percentage ranged from 31.2 to 45.8 % for Candida glabrata isolates, so that β-glucanase has a promising benefit forprospective usein the dental industryby eliminating and preventing biofilm development.

Effect of using Chamomilla Recutita on Management of Radiation Induced Stomatitis in Cancer Patients

Background: Oral Stomatitis is a common inflammatory complication amongst cancer patients enduring radiation therapy. Stomatitis may consequence in discomfort pain and, difficulty in ingestion which may lead to nutritional deficiency. It is a serious side effect, which can consequence in a secondary infection (fungal, viral, or bacterial); it can lead to an interruption in treatment schedule and sometimes even patient drawing from treatment. So, it is important to use chamomilla recutita as preventative measures, and appropriate management measures when stomatitis does occur. This study aimed to determine the effect of using Chamomilla Recutita on the management of radiation-induced stomatitis in cancer patients. Design: A randomized controlled trial research design was utilized. Subjects: 60 adult patients were randomly selected and distributed into two groups equally (Study groups) who received routine care and mouthwash with a liquid extracted from Chamomilla Recutita at 1% and (Control group) who received routine hospital care only. A daily evaluation was done using the measurement scales of oral toxicities defined by the World Health Organization (WHO). Results: A significant difference was found in oral assessments’ scores between the two groups. analysis and comparison of data mean a statistically significant difference between both studied groups as regards the decrease of pain level in the Chamomilla Recutita group faster and better than the other group. There was a statistically significant difference in the change in weight between both studied groups, and that meant that body weight improved much more in the Chamomilla Recutita group than it was in the other one. Recommendation: It is important to enhance the awareness level among the public, patients, and also the health care providers regarding the importance of performing oral hygiene using Chamomilla Recutita especially during receiving radiotherapy. Regular educational programs to continuously update the nurses knowledge with the advanced and effective practice of oral hygiene, early detection of stomatitis, and proper treatment to avoid or decrease oral infection as well as enforcing adequate nutrition rich in proteins, that promote healing and minimize infection.

MO239ORAL FUNGAL INFECTION IN ESRD PATIENTS

Abstract Background and Aims Chronic Kidney Disease is an increasing health alarm worldwide with systemic signs like hematologic changes, bone metabolic error, and compromised immune status presenting to a dental practitioner with oral complications. Hence a study was done to assess the oral health condition, cytological changes, and presence or absence of candida in patients with chronic renal disease undergoing dialysis aged between 30 to 65 years and controls in South India. Method A cross sectional study was conducted among 80 adults with CKD and controls, attending KMC and MCODS, Mangalore. Oral manifestations and oral hygiene were assessed; Cytological smears were taken for morphometric analysis of buccal mucosal cells from the subjects. Oral smears were cultured to check for the growth of fungal species in subjects and controls. Statistical analysis was done using SPSS Version 13. Chi square test was used to compare categorical variables between the groups. Results There was a significant difference in oral hygiene status and cytological changes in patients with CKD. Oral Fungal Infection was found in 32% of our patients on dialysis and oral lesions, defined as clinical signs associated with OFI such as erythematous oral stomatitis, membranous candidiasis, or angular cheilitis, were found in 37% of the patients with OFI, while 5% of the patients without findings of fungal infection presented oral lesions associated with OFI (p=0.0002). Furthermore, patients with self-reported mouth dryness were three times more likely (p=0.02) to be diagnosed with OFI. Conclusion Hemodialysis patients are found to have significantly more OFI than controls. Oral dryness and dental plaque formation also seem to be at risk of developing OFI. Detection of oral lesions associated with OFI should be combined with a histopathological diagnosis before antifungal treatment. The prevalence of oral candida in these cases is alarming and can be a predictor of a poor prognostic index. As medicine advances, oral health care professionals should have a holistic approach to the management of patients with complex medical problems especially to diseases of the renal system as it is pivotal in maintaining a stable internal environment and homeostasis.

Healing effects of rebamipide on oral stomatitis in 5-fluorouracil-untreated and -treated Golden Syrian hamsters

Healing effects of rebamipide on oral stomatitis in 5-fluorouracil-untreated and -treated Golden Syrian hamsters

Effect of Long-term Use of Steroidal Anti-inflammatory Drugs on the Periodontal State: A Review

Corticosteroids are chemically similar to endogenous cortisol and mostly prescribed for their antiinflammatoryand immunosuppressive properties, which are due to the inhibition of phospholipase A2activity. These drugs are extensively used in the treatment of a plethora of autoimmune disorders suchas rheumatoid arthritis, various breathing disorders and also disorders of connective tissue. In the fieldof dentistry these drugs are prescribed in most of the mucocutaneous disorders such as they are mostlyused in inflammatory diseases such as oral lichen planus, pemphigus, and oral stomatitis to alleviate postoperativediscomfort and swelling. These drugs can be administered systemically,topically or asinhalationaltherapy. Evidence concludes that short term corticosteroids possess antiresorptive properties and its localapplication shows a favourable effect on the periodontal ligament, but when administered systemically fora long period could lead to periodontal diseases as it has shown to increase attachment with alveolar boneand destruction of transseptalfibers. Oral manifestations are dependent on duration,dose and frequency ofuse. It is commonly associated withmoniliasis, dental caries,altered taste sensation, ulceration of the tongue,buccal mucosa, and gingiva due to xerostomia,gingival inflammation, periodontal inflammation,and immunesuppression. They can either cause dramatic improvement or dramatic adverse reactions which can lead toa considerable increase in the distributionof periodontal disorders. In patients on long-term corticosteroidtherapy, oral health is generally not given importance during management. Hence this review explains aboutvarious effects of different types of corticosteroids on periodontium used in dentistry.

CHRONIC PARACOCCIDIOIDOMYCOSIS WITH ORAL MANIFESTATION: A CASE SERIES

Paracoccidioidomycosis (PCM) is a deep mycosis caused by Paracoccidioides brasiliensis or P. lutzii fungi, endemic in the male population of the rural zone of Brazil and Latin American countries. The presence of oral moriform stomatitis is a common finding in actively infected patients and can be the first sign of the disease. We report 7 cases of chronic PCM diagnosed with oral lesion incisional biopsies, discussing their clinical and histopathologic features. Most of the patients were male and presented with multiple oral lesions with lymph nodes involvement. The diagnosis was based on clinical signs (cough, dyspnea, weight loss, and presence of mucocutaneous lesions) and complementary exams (chest radiograph, analyses of lymph node aspirates, incisional biopsies, and fungi culture). The patients were mostly treated by azoles, sulfonamides, or amphotericin B. The prognosis depended on the stage of the disease. A description of the follow-up of the aforementioned cases is also made.

Effect of Photodynamic Disinfection on milled acrylic flexural strength (an-in vitro study)

Background: Photodynamic disinfection is a new efficient specific method of disinfection of the denture surface which should be highly polished with high mechanical properties to prevent further colonization of bacteria that may cause starting from oral stomatitis up to pneumonia. The aim of this study is to investigate the effect of Photodynamic disinfection on milled acrylic flexural strength after 3 years of usage. Material& method: Preparing of 2mm × 2mm × 25mm 50 samples of milled acrylic , applying of a continuous 3 days,19 hours and 15 minute of disinfection = 12 month of use (15 minutes a day) ,7 days, 14 hours and 30 minute = 24 months and finally at the end of the 11 days, 9 hours and 45 minutes day of disinfection which simulate 3 years of disinfection with photodynamic method and compare it with +ve control (1%NaCl disinfection ) and -ve control (distilled water) groups and preparing 50 sample of heat cured acrylic with the same parameters and propose them to the same conditions and comparing them to milled samples then flexural strength is tested after each interval and compared to base line specimens with no disinfection at all . Results: The mean value of each disinfectant group flexural strength show insignificant effect in flexural strength compared to other control groups. Conclusion: From the results of the current study, we found that Photodynamic disinfection can be used safely to disinfect complete dentures but further studies are required due to lack of literature about this field.

Are Intraoral Stents Effective for Reducing the Severity of Oral Mucositis During Radiotherapy for Maxillary and Nasal Cavity Cancer?

The intraoral stent (IOS) is an individualized mouth opening device that can be used during radiotherapy (RT) for head and neck cancer to prevent unnecessary irradiation to normal tissues. The purpose of the present study was to compare the severity of oral mucositis (OM) between patients using and not using an IOS during RT for maxillary and nasal cavity cancer. We designed and implemented a retrospective cohort study. The study sample included patients with maxillary and nasal cavity cancer who had undergone RT. The primary predictor variable was IOS application, and the outcome variable was the grade of OM. The IOS group included 18 patients with an IOS and the control group, 16 patients without an IOS. The parameters of the dose-volume histogram included the median dosage covering 1mL (D1mL) for the tongue and the mean dosage. The D1mL (36.2 vs 65.4Gy) and mean dosage (4.9Gy vs 25.9Gy) were both significantly lower in the IOS group than in the control group (P<.005). The incidence of OM using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0, were significantly different between the oral stomatitis grade and the use of an IOS (P=.028). A significant difference was found in opioid use between the IOS and control groups (P=.009). The use of an IOS decreased the radiation dosage to the tongue, the grade of OM, and opioid usage during RT.

Relationship among perceived stress, oral health status, stomatitis, and xerostomia in the community during the COVID-19 pandemic: A cross-sectional survey

Aim: The aim of the study was to analyze the relationship between self-reported stress, oral health status, xerostomia, and stomatitis in the community during the COVID-19 pandemic.Materials and Methods: This is a cross-sectional study of 380 community respondents from the city of Bandung, Indonesia, consisting of 82 men and 298 women. Data obtained from online questionnaires using consecutive sampling method showed that the respondents agreed to participate in the study by filling in the informed consent. Furthermore, demographic data including age, education level, occupation, and total income were recorded. The variables measured by a questionnaire are self-reported stress, oral health status, xerostomia inventory, and stomatitis. Data distribution was performed by a descriptive statistic, χ2 test, Phi, and Spearman rank test for correlation analysis.Results: There was a significant correlation between perceived stress scale with oral health status (r’s = 0.135; P = 0.003), with stomatitis (r’s = 0.176; P = 0.015), and with xerostomia (r’s = 0.296; P = 0.022). In addition, age, education level, and total income also showed a significant correlation with stress level.Conclusion: From the findings of this study, it can be concluded that oral health status, xerostomia, and stomatitis were associated with levels of stress. Higher stress indicates poor oral health status, as well as severe xerostomia and stomatitis.

Beyond Head and Neck Cancer: The Relationship Between Oral Microbiota and Tumour Development in Distant Organs.

An altered oral microbiota has been linked with the development of several oral diseases, such as dental caries, periodontal disease, and oral stomatitis. Moreover, poor oral health has been linked to head and neck cancer, particularly oral cancer. In recent years a growing number of studies indicate that oral microbiota could be involved in the development of primary tumours outside of head and neck region. The aim of this article is to review the recent studies based on high-throughput technology to present evidences of a relationship between oral microbiota and “non-head and neck tumours.” Oral dysbiosis seem to be more pronounced in patients with tumours of gastrointestinal tract, in particular oesophageal, gastric, pancreatic, and colorectal cancers, paving the way for developing specific oral microbiota test to allow early cancer detection. Regarding other tumour types, the results are promising but highly preliminary and still debated. Currently, there are several factors that limit the generalization of the results, such as the small sample size, the lack of adequate clinical information about patients, the different sequencing techniques used, and biological sample heterogeneity. Although only at the beginning, the analysis of oral microbiota could be the next step in the evolution of cancer therapy and will help clinicians to develop individualised approaches to cancer prevention and treatment.

Treatment and prevention of oral mucositis: A literature review

AbstractOral health is a cardinal element of nutritional as well as systemic well-being and plays a substantial part in sustaining optimum general health condition. Various factors influence oral health including metabolic diseases such as endocrine, hematological, gastrointestinal, cutaneous, and neurological diseases. The intent of this review is to highlight the treatment as well as prevention strategies for one of the most devastating repercussions of chemotherapy (CT) and radiotherapy (RT) on the oral cavity in the form of oral mucositis (OM). A review of literature was performed using relevant key words (“Mucositis” OR “Oral Mucositis” OR “Oral Stomatitis” AND “Treatment of Mucositis” OR “Treatment of Oral Mucositis” OR “Treatment of Oral Stomatitis” AND “Prevention of Mucositis” OR “Prevention of Oral Mucositis” OR “Prevention of Oral Stomatitis“) in prominent journals pertaining to Oncology and Dentistry (CA: A Cancer Journal for Clinicians, Cancer, Frontiers in Oncology, Journal of Clinical Oncology, and Oral Oncology). It is basically sequelae of CT, RT, and radiochemotherapy in patients suffering from malignant diseases as well as those who require hematopoietic stem cell transplants. In addition to its negative effects on the oral cavity and consequently on the overall quality of life, OM may lead to delay in cancer treatment which incriminates in a poor prognosis of the disease.

In Vitro Antifungal Activity of a Medicinal Plant Extract Mixture Against Candida Species Isolated from Patients with Oral Stomatitis

Background: Ankaferd Blood Stopper® (ABS) is a hemostatic product comprising a standardized mixture of Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum, and Urtica dioica. It is used to control bleeding after extracorporeal injuries, traumatic cuts, dental operations, and surgical intervention. ABS was reported to exhibit antibacterial and germicidal activities. Objectives: This in vitro study aimed to determine the antifungal activity of ABS. Methods: In total, 114 Candida strains; 65 Candida albicans and 49 non-albicans isolated from the oral cavity of patients with oral stomatitis, as well as three reference strains of C. albicans ATCC 90028, C.parapsilosis ATCC 22019, and C.krusei ATCC 6258, were tested by agar well diffusion, disk diffusion, and time-kill curve methods in this study. The results obtained for ABS were compared with those obtained for amphotericin B (AMB). Results: ABS and AMB exhibited inhibitory zones with mean diameters of 18.2 ± 1.4 (12-20) mm, 20.6 ± 1.2 (18 - 23) mm by disk diffusion and 18.3 ± 1.3 (15 - 20) mm, 19.9 ± 2.6 (18 - 22) mm, respectively, by agar well diffusion methods for C. albicans. On the other hand, ABS and AMB showed inhibition zones with mean diameters of 19.4 ± 1.5 (18 - 24) mm, 19.1 ± 2.8 (13 - 30) mm by disk diffusion and 19.8 ± 2.1 (18 - 25) mm, 18.7 ± 2.3 (13 - 23) mm by agar well diffusion methods for non-albicans Candida isolates. ABS exhibited higher activity against non-albicans Candida species compared to C. albicans (P < 0.001). By the time kill-curve method, ABS achieved a 4 log10 cfu/mL decrease in C. albicans ATCC 90028, C. parapsilosis ATCC 22019, and C. krusei ATCC 6258, as well as seven different Candida spp. isolates of C. albicans, C. glabrata, C. tropicalis, C. guilliermondii, C. kefyr, C. krusei, and C. parapsilosis, respectively. Conclusions: ABS can be an alternative for treating superficial infections.