ArticlePublisher preview available

Results of a randomized controlled phase III trial: efficacy of polyphenol-containing cystus® tea mouthwash solution for the reduction of mucositis in head and neck cancer patients undergoing external beam radiotherapy

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract and Figures

Purpose: To determine the effect of Cystus® tea (Naturprodukte Dr. Pandalis GmbH & Co. KG) as mouthwash compared to sage tea on oral mucositis in patients undergoing radio(chemo)therapy for head and neck cancer. Methods: In this randomized, prospective phase III study, 60 head and neck cancer patients with primary or postoperative radio(chemo)therapy were included between 04/2012 and 06/2014. They received either sage or Cystus® tea for daily mouthwash under therapy. Mucositis was scored twice a week following the Radiation Therapy Oncology Group and the European Organization for Research and Treatment Cancer (RTOG/EORTC) scoring system. Dental parameters were also recorded. Statistical evaluation of the primary endpoint was performed using t‑test and log rank test. Results: Data from 57 patients could be evaluated. Patient characteristics showed no significant difference between the two groups (n = 27 sage; n = 30 Cystus®). A total of 55 patients received the prescribed dose (60-66 Gy postoperative; 70-76.8 Gy primary). Mucositis grade 3 was observed in 23 patients (n = 11 sage; n = 12 Cystus®) and occurred between day 16 and 50 after start of therapy. There was no significant difference between the two groups in latency (p = 0.75) and frequency (p = 0.85) of the occurrence of mucositis grade 3. The self-assessment of the oral mucosa and the tolerability of the tea also showed no significant differences. Occurrence of dental pathologies appeared to increase over time after radiotherapy. Conclusion: Cystus® and sage tea have a similar effect on the occurrence of radiation-induced mucositis regarding latency and incidence. Cystus® tea mouthwash solution is tolerated well and can be applied in addition to intensive oral care and hygiene along with the application of fluorides.
This content is subject to copyright. Terms and conditions apply.
ORIGINAL ARTICLE
https://doi.org/10.1007/s00066-020-01684-y
Strahlenther Onkol (2021) 197:63–73
Results of a randomized controlled phase III trial: efficacy of
polyphenol-containing cystus®tea mouthwash solution for the
reduction of mucositis in head and neck cancer patients undergoing
external beam radiotherapy
Nadja Ebert1,2,3,4,5 · Anna Kensche6·SteenLöck
2,3,4,5 · Wahyu Wijaya Hadiwikarta1· Anna Hänsch6·
Wolfgang Dörr · Mechthild Krause1,2,3,4,5,7,8,9 · Christian Hannig6·MichaelBaumann
1,2,3,5,10
Received: 24 April 2020 / Accepted: 24 August 2020 / Published online: 24 September 2020
© Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract
Purpose To determine the effect of Cystus®tea (Naturprodukte Dr. Pandalis GmbH & Co. KG) as mouthwash compared
to sage tea on oral mucositis in patients undergoing radio(chemo)therapy for head and neck cancer.
Methods In this randomized, prospective phase III study, 60 head and neck cancer patients with primary or postoperative
radio(chemo)therapy were included between 04/2012 and 06/2014. They received either sage or Cystus®tea for daily
mouthwash under therapy. Mucositis was scored twice a week following the Radiation Therapy Oncology Group and the
European Organization for Research and Treatment Cancer (RTOG/EORTC) scoring system. Dental parameters were also
recorded. Statistical evaluation of the primary endpoint was performed using t-test and log rank test.
Results Data from 57 patients could be evaluated. Patient characteristics showed no significant difference between the
two groups (n= 27 sage; n=30 Cystus
®). A total of 55 patients received the prescribed dose (60–66Gy postoperative;
70–76.8 Gy primary). Mucositis grade 3 was observed in 23 patients (n= 11 sage; n=12 Cystus
®) and occurred between
day 16 and 50 after start of therapy. There was no significant difference between the two groups in latency (p= 0.75) and
frequency (p= 0.85) of the occurrence of mucositis grade 3. The self-assessment of the oral mucosa and the tolerability
of the tea also showed no significant differences. Occurrence of dental pathologies appeared to increase over time after
radiotherapy.
C. Hannig und M. Baumann share last co-authorship.
Availability of data and material Data were stored at the
Department of Radiation Oncology, except for the dental
parameters that were stored at the Clinic of Operative Dentistry at
the University Medical Center Carl Gustav Carus in Dresden. The
data are not deposited in a repository.
Code availability Statistical analysis and graph creations were
performed using R version 3.5.0 (2018-04-23).
Dr. med. Nadja Ebert
nadja.ebert@uniklinikum-dresden.de
1German Cancer Research Center (DKFZ), Heidelberg,
Germany
2Department of Radiotherapy and Radiation Oncology,
Faculty of Medicine and University Hospital Carl Gustav
Carus, Technische Universität, Dresden, Germany
3OncoRay—National Center for Radiation Research in
Oncology, Faculty of Medicine and University Hospital Carl
Gustav Carus, Technische Universität, Dresden, Germany
4German Cancer Consortium (DKTK), Partner Site Dresden,
and German Cancer Research Center (DKFZ), Heidelberg,
Germany
5Faculty of Medicine and University Hospital Carl Gustav
Carus, Technische Universität Dresden, Dresden, Germany
6Clinic of Operative and Pediatric Dentistry, Faculty of
Medicine and University Hospital Carl Gustav Carus,
Technische Universität, Dresden, Germany
7Helmholtz-Zentrum Dresden Rossendorf, Institute of
Radiooncology OncoRay, Dresden, Germany
8National Center for Tumor Diseases (NCT), Partner Site
Dresden, Dresden, Germany
9Helmholtz Association/Helmholtz-Zentrum
Dresden—Rossendorf (HZDR), Dresden—Rossendorf,
Germany
10 Ruprecht-Karls-University, Heidelberg, Germany
K
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Of the included studies, 7 studies reported Curcuma longa [18][19][20][21][22][23][24], 6 studies reported honey [16,[25][26][27][28][29] (including pure honey from tea plant Camellia sinensis [16], pure honey from Thymus and Astragale [25], pure honey (Dabur honey) [26], pure honey from the clover plant Trifoliumalexandrenum [27], manuka honey [28], and thyme honey [29]), 3 studies reported aloe vera [30][31][32], 2 studies reported black mulberry molasses [33,34], and 2 studies reported FITOPROT [18,24] (an adhesive herbal remedy that contains glycerinated extract of Bidens pilosa L. and curcuminoids from Curcuma longa L. [18]), 2 studies reported Silymarin [35,36], and 1 study reported essential oils of manuka and kanuka [37]. Seven studies reported on propolis [38], Zataria [39], green tea [17], Cystus1 tea [40], Indigowood root [41], Plantago major L [42], and Kangfuxin solution [43]. The remaining studies reported herbal medicines in treating oral mucositis: Mucotrol™ [44] (a herbal remedy made up of centella asiatica, ...
... Assessment of oral mucositis was performed using scales for assessing the degree of mucositis. The scales used for assessment included the World Health Organization (WHO) scale [17, 21, 23, 26-28, 32, 35, 42, 44, 45, 50, 51], the Common Terminology Criteria scale (NCI-CTC) [16, 21-23, 33-36, 38, 41, 43, 47-49], the Radiation Therapy Oncology Group (RTOG) [16,28,29,31,33,37,40,44,50,52] scale (used for the Cooperative Group Common Toxicity Criteria), the Oral Mucositis Assessment Scale (OMAS) [34,45,48] and the Oral Assessment Guide (OAG) [25,28,39,45]. ...
... Natural products in the treatment and prevention of radiotherapy-induced oral mucositis: A systematic review Cycus tea [40], QingReliyanb decoction [50], and Kangfuxin solution [43]) revealed a possible reduction in the incidence of mucositis during radiotherapy. Thirteen studies, including those involving Aloe vera (30,32), Curcuma longa [19-21], Honey (Dabur honey) [26], Glycyrrhiza glabra (Yashtimadhu) [52], SAMITAL1 [45], essential oils [37], silymarin [35], Shuaghuabaihe tablets [48], Cycus tea [40], and Kangfuxin [43], reported that using the natural products postponed the beginning of oral mucositis, regarding which the Cycus tea and SMITAL studies found no discernible differences. ...
Article
Full-text available
The aim of this systematic review was to describe the efficacy and acceptability of natural products in the management of oral mucositis caused by radiation. From the day it started to August 7, 2023, a thorough search for randomized controlled trials (RCTs) was carried out among seven databases: the Web of Science, PubMed, Embase, OVID, Scopus, the Cochrane Library and the CINAHL database. Only English-language articles were identified during the search. Using the revised Cochrane risk-of-bias tool, version 2, two researchers screened the articles, collected information on study characteristics, and appraised risks of bias. The data were analyzed and descriptively presented with a narrative synthesis methodology involving the Synthesis Without Meta-Analysis (SWiM) reporting element applied in detail. The PROSPERO registration number of this study is CRD42023476932. Thirty-six clinical trials were included in the study; the included studies included a variety of 20 types of natural products. Honey and Curcuma longa were the most commonly assessed natural products. A total of 2,400 participants reported taking part in therapy with natural products for oral mucositis. Natural products demonstrated substantial efficacy in terms of influencing intensity, incidence, pain score, quality of life, and symptoms such as xerostomia and dysphagia. Except for manuka honey, most natural products were well accepted. Regarding the clinical trials’ risk of bias, 2 clinical trials (5.56%) had a high risk of bias, 17 studies (47.2%) had a low risk of bias, and 17 studies (47.2%) were rated with “some concern.” Natural remedies work well as alternate treatments for managing oral mucositis caused by radiation therapy. However, additional clinical trials are still needed. The safety of these conventional medications as well as their effectiveness and safety when used in combination with other conventional or naturopathic therapies should be fully examined.
... 19,[27][28][29][30][44][45][46][47] The most definitive evidence is from a phase III sham-controlled RCT conducted among 226 patients with moderate to severe AI-related joint pain. 19 After 6 weeks, true acupuncture reduced pain significantly more than sham acupuncture and standard of care (waitlist Oral mucositis [188][189][190] Omega-3 fatty acids RCTs 4 AI-related joint pain [191][192][193] Teas RCTs 2 Oral mucositis 195,196 Mouthwash RCTs 6 ...
... Multiple trials tested a variety of botanical and natural products to prevent and/or treat mucositis in a range of different cancer types receiving different chemotherapy and/or radiation therapy treatments. [167][168][169][170][171][172][173][174]188,189,[195][196][197][198][199][200][201][202][211][212][213][214][215][216][217][218][219][220][221][222][223][224][225][226][227][228][229] Interventions included chamomile, 167,168 propolis, [169][170][171] glutamine, 172-185 curcumin, 188-190 botanical teas, 195,196 mouthwashes, 197-202 and other natural products (Data Supplement). [211][212][213][214][215][216][217][218][219][220][221][222][223][224][225][226][227][228][229] No two trials used the same formulation. ...
Article
Purpose: The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer. Methods: The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. Results: The literature search identified 227 relevant studies to inform the evidence base for this guideline. Recommendations: Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.
... Another ph2 clinical trial using a novel liquid containing eugenol, camphor, parachlorophenol and hydrogen peroxide, showed a lower incidence and shorter duration of severe OM induced by RT in HNC patients, although the results were not statistically significant [98]. In a ph3 study, cistus tea and sage tea were compared for their preventive effects on RT-induced OM, with no significant difference observed between the two herbal products [99]. A study by Liao et al. evaluated green tea mouthwash, showing improved oral hygiene status, but its effect on OM was not clear [100]. ...
Article
Introduction: The introduction of targeted therapy and immunotherapy has tremendously changed the clinical outcomes and prognosis of cancer patients. Despite innovative pharmacological therapies and improved radiotherapy (RT) techniques, patients continue to suffer from side effects, of which oral mucositis (OM) is still the most impactful, especially for quality of life. Areas covered: We provide an overview of current advances in cancer pharmacotherapy and RT, in relation to their potential to cause OM, and of the less explored and more recent literature reports related to the best management of OM. We have analyzed natural/antioxidant agents, probiotics, mucosal protectants and healing coadjuvants, pharmacotherapies, immunomodulatory and anticancer agents, photobiomodulation and the impact of technology. Expert opinion: The discovery of more precise pathophysiologic mechanisms of CT and RT-induced OM has outlined that OM has a multifactorial origin, including direct effects, oxidative damage, upregulation of immunologic factors, and effects on oral flora. A persistent upregulated immune response, associated with factors related to patients' characteristics, may contribute to more severe and long-lasting OM. The goal is strategies to conjugate individual patient, disease, and therapy-related factors to guide OM prevention or treatment. Despite further high-quality research is warranted, the issue of prevention is paramount in future strategies.
... Studies have also compared the effectiveness of plant extract and natural substance-based mouthwashes with saline, baking soda-based, or placebo mouthwashes. The effectiveness of these mouthwashes is often comparable to bicarbonate-based saline solution rinses [64][65][66]. Granulocyte-macrophage colonystimulating factor mouthwashes are the most studied for the prevention of mucositis [67]. Antiseptic mouthwashes alone can help improve oral hygiene and prevent overinfections [68]. ...
Article
Full-text available
Head and neck cancers (HNCs) are malignant tumors mainly from squamous cells in the head and neck tissues. Treatment involves a multidisciplinary approach with surgery, radiotherapy, and chemotherapy. However, the long-term prognosis for patients with advanced-stage tumors is guarded, with a median survival time of approximately 24 months. HNC patients have very high rates of depression and anxiety and the highest suicide rate among all cancers due to the intense and challenging nature of the treatment, underscoring the importance of our collective efforts. Rehabilitation success depends on various factors, including tumor, patient, and treatment-related factors. Patients may require post-treatment oral rehabilitation measures, including implants, obturators, and flexible dentures. These measures are crucial, but they often need to be more utilized. Patients may face challenges in maintaining oral hygiene and managing mucositis. Additionally, it is essential to address other intricacies such as trismus, xerostomia, gustatory dysfunctions, neuropathy, speech impairments, and psychological disturbances. Unfortunately, there is little literature on post-treatment rehabilitative measures. Despite its crucial role in improving patients' quality of life, rehabilitation often receives inadequate attention compared to treatment. Our narrative review, which covers various factors that affect rehabilitation, including oral rehabilitation measures and post-treatment complications, is anticipated to deliver practical insights to professionals and inspire positive changes in their regular practice.
... 35 Çeşitli bitkilerin, oral mukozitin semptomlarını geciktirebildiği, farklı formülasyonlarının profilaksi olarak kullanılabileceği söylenmiş ancak önleyici etkisinde anlamlı bir fark bulunmamıştır. 36,37 Melatonin içeren oral jelin daha düşük insidans sağladığı, şiddetli oral mukozitin süresini kısalttığı gösterilmiştir. 38 Ağız mukozasını korumak için, farmakolojik olmayan bir tedavi seçeneği olarak yeşil çay gargarasının basit, doğal, etkili ve güvenli bir seçenek olabileceği, 39 kurkuminin, mukozitin gecikmesinde etkili olduğu fakat önlemediği ve şiddetini azaltmadığı 40 gösterilmiştir. ...
... Cystus® reduces radiation-induced mucositis in terms of grade, latency, and incidence. Cystus® tea mouthwash can be applied in addition to intensive oral care and hygiene, along with the application of fluorides within the accepted range (24). ...
Article
Full-text available
Herbal teas are very common around the world. It has a good therapeutic effect. But due to adulteration, we face an obstacle to using them. The author has collected some clinical trials on commercial herbal tea formulations on the market that have proven their efficacy and safety. So, the future is for herbal medicine owing to people's psychology, minimum adverse reactions, and lower cost. The pharmaceutical manufacturing of herbal tea formulations should be encouraged to use them as add-on therapy or healthy daily beverages at least.
... Generally, oral mucositis manifests in the first week after starting the therapy and increases in the following weeks until RT is completed. The mucosal reactions may persist for several weeks after the end of treatment [3,6,7]. The manifestation of oral mucositis includes complaints of pain, ulceration, erythema, soreness, dryness, and white patches. ...
Article
Full-text available
Radiation-induced oral mucositis (RIOM) is one of the common toxic reactions from ionizing radiation and normal tissue injuries as a complication of radiation therapy and chemotherapy. Radiation therapy is an option for the treatment of head and neck cancer (HNC). The use of natural products is an alternative therapy for RIOM. This review aimed to describe the effectiveness of natural-based products (NBPs) in reducing the severity, pain score, incidence, oral lesion size, and other symptoms such as dysphagia, dysarthria, and odynophagia. This systematic review follows the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Pubmed, ScienceDirect, and Ebscohost-CINAHL Plus databases were used for article searches. The inclusion criteria were studies published from 2012 to 2022 with full text available, in English, a study in humans, and a Randomized Clinical Trial (RCT) that evaluate the effect of NBPs therapy in RIOM patients diagnosed with HNC. This study's population was HNC patients who had oral mucositis after receiving radiation or chemical therapy. The NBPs were manuka honey, thyme honey, aloe vera, calendula, zataria multiflora, Plantago major L., and turmeric. Eight of the twelve included articles showed significant effectiveness against RIOM in various parameters, such as a decrease in severity, incidence rate, pain score, oral lesion size, and the other symptoms of oral mucositis such as dysphagia and burning mouth syndrome. This review concludes that NBPs therapy is effective for RIOM in HNC patients.
... In contrast, payayor and fingerroot mouthwashes analyzed by Kongwattanakul et al. [11], Cystus tea mouthwash used by Ebert et al. [15], green tea mouthwash used by Liao et al. [16], propolis mouthwash by Hamzah et al. [18], and curcumin mouthwash studied by Shah et al. [21] have been shown to be equally effective compared to placebo mouthwash, especially when assisted with cryotherapy and laser or light therapy [16]. The multicenter study by De Sanctis et al. [17] also found no differences in the onset and severity of radioinduced mucositis with Lactobacillus brevis CD2 supplementation. ...
Article
Full-text available
Background: In the literature, among oral health prevention programs dedicated to cancer patients, a wide heterogeneity is evident. The purpose of this work is to analyze the available scientific evidence for the treatment of head and neck cancer (HNC) patients undergoing resective surgery and radiotherapy and to draw up a diversified oral hygiene protocol during oncological therapy. Methods: PubMed was used as database. Studies published from 2017 to September 2022 were analyzed. Studies investigating the effectiveness of the preventive procedures carried out by the dental professionals in HNC patients undergoing postoperative adjuvant therapy have been taken into account. Results: The application of the search string on PubMed allowed the selection of 7184 articles. The systematic selection of articles led to the inclusion of 26 articles in this review, including 22 RCTs, 3 observational studies, and 1 controlled clinical study. Articles were divided according to the debated topic: the management of radiation-induced mucositis, xerostomia, the efficacy of an oral infection prevention protocol, and the prevention of radiation-induced caries. Conclusions: Dental hygienists are fundamental figures in the management of patients undergoing oncological surgery of the maxillofacial district. They help the patient prevent and manage the sequelae of oncological therapy, obtaining a clear improvement in the quality of life.
Article
Exercise has been demonstrated to induce an elevated production of free radicals, leading to the onset of oxidative stress. Numerous studies highlight the positive impacts of aerobic exercise, primarily attributed to the increase in overall antioxidant capacity. The evidence suggests that engaging in aerobic exercise contributes to a reduction in the likelihood of advanced cancer and mortality. Oxidative stress occurs when there is an imbalance between the generation of free radicals and the collective antioxidant defense system, encompassing both enzymatic and nonenzymatic antioxidants. Typically, oxidative stress triggers the formation of reactive oxygen or nitrogen species, instigating or advancing various issues in cancers and other diseases. The pro‐oxidant‐antioxidant balance serves as a direct measure of this imbalance in oxidative stress. Polyphenols contain a variety of bioactive compounds, including flavonoids, flavanols, and phenolic acids, conferring antioxidant properties. Previous research highlights the potential of polyphenols as antioxidants, with documented effects on reducing cancer risk by influencing processes such as proliferation, angiogenesis, and metastasis. This is primarily attributed to their recognized antioxidant capabilities. Considering the extensive array of signaling pathways associated with exercise and polyphenols, this overview will specifically focus on oxidative stress, the antioxidant efficacy of polyphenols and exercise, and their intricate interplay in cancer treatment.
Article
Die Strahlentherapie ist eine wichtige Behandlungssäule in der Krebstherapie, jedoch auch mit Nebenwirkungen und Spätfolgen verbunden. Ergänzende Maßnahmen können diese effektiv vorbeugen und lindern. Dabei werden verschiedene pflanzliche Präparate, Vitamine, Spurenelemente oder weitere Nahrungsergänzungsmittel zur Behandlung der radiogenen Dermatitis (Aloe vera, Calendula), Mukositis (Honig, Sanddornfruchtfleischöl), Proktitis (Vitamin D, Probiotika, Selen) oder des Hirnödems (Boswelliaserrata) eingesetzt. Maßnahmen wie Sport und regelmäßige Entspannungsübungen können die allgemeine Leistungsfähigkeit und Befindlichkeit verbessern. Des Weiteren sind mögliche Wechselwirkungen zwischen komplementären Verfahren und der Strahlentherapie zu berücksichtigen.
Article
Full-text available
The main aim of this study was to detect and identify antibacterial components of fraction I derived from eleven commercial C. incanus herbal teas. Fraction I obtained by a well-established phytochemical protocol of a multi-step extraction was expected to contain flavonoid aglycons alone. Antibacterial profile of fraction I was demonstrated by means of thin-layer chromatography - direct bioautography (TLC-DB) using a Gram positive B. subtilis and a Gram negative A. fischeri strain. Six chromatographic zones of fraction I exhibited a well pronounced antibacterial potential. In qualitative terms, a good agreement was observed among chromatographic fingerprints and the corresponding bioautograms of the eleven samples. The compounds isolated from the six zones were analyzed by HPLC- diode array detector (DAD)-electrospray ionization (ESI)-MS. High numerical m/z values valid for certain constituents of these isolates suggested that some selected antibacterial components are, unexpectedly, flavonoid glycosides. In order to confirm this suggestion, three independent HPTLC methods (multi-development on amino phase and two two-dimensional developments on silica gel phase) were devised to in situ hydrolyze flavonoid glycosides and then separate and visualize the liberated glucose and some other building blocks of the zones' components. Additionally, the sensitivity of glucose detection with p-aminobenzoic acid reagent was enhanced by paraffin. In that way, the presence of the kaempferol glycosides (and not only the aglycones alone) in fraction I was confirmed. Beside kaempferol, p-coumaric acid as a building block unit was shown by HPLC-DAD-MS analysis of the hydrolyzed isolates. Results proved apigenin, kaempferide and acylated kaempferol glycosides (cis- and trans-tiliroside and their conjugates with p-coumaric acid) to be antibacterial components of fraction I. Because isomers of the coumaric acid conjugated tiliroside were detected only in fraction I and not in the crude C. incanus extract, they are regarded as artifacts produced through fractionation.
Article
Full-text available
Introduction Oral mucositis is most severe complication of cancer therapy characterized by ulcerative lesions of oral mucosa causing negative impact on patient's quality of life. Wide variety of therapeutic agents are available to reduce the lesions of mucositis. Currently, natural herbal remedies have become popular in treating this condition due to fewer side effects than synthetic drugs. Aim The aim of this systematic review is to compile evidence based studies to evaluate the effectiveness of natural agents in the management of oral mucositis induced by chemotherapy or radiotherapy in cancer patients. Materials and method Computerized literature searches were performed to identify all published articles in the subject. The following databases were used: PUBMED [MEDLINE], SCOPUS, COCHRANE DATABASE, EMBASE and SCIENCE DIRECT using specific keywords. The search was for limited articles published in English which were read in full by two authors. Results Twenty six randomized controlled trials satisfied our inclusion criteria. Most studies showed statistically significant result demonstrating the efficacy of natural agents with minimal side effects except manuka honey which was not tolerated by few patients. Conclusion Natural agents proved to be promising in healing cancer induced oral mucositis but future demands further randomized controlled clinical trials on these agents which should also be focused on drug interactions of the natural remedies.
Article
Full-text available
Treatment of head and neck cancers (HNCs) involves radiotherapy. Patients undergoing radiotherapy for HNCs are prone to dental complications. Radiotherapy to the head and neck region causes xerostomia and salivary gland dysfunction which dramatically increases the risk of dental caries and its sequelae. Radiation therapy (RT) also affects the dental hard tissues increasing their susceptibility to demineralization following RT. Postradiation caries is a rapidly progressing and highly destructive type of dental caries. Radiation‑related caries and other dental hard tissue changes can appear within the first 3 months following RT. Hence, every effort should be focused on prevention to manage patients with severe caries. This can be accomplished through good preoperative dental treatment, frequent dental evaluation and treatment after RT (with the exception of extractions), and consistent home care that includes self‑applied fluoride. Restorative management of radiation caries can be challenging. The restorative dentist must consider the altered dental substrate and a hostile oral environment when selecting restorative materials. Radiation‑induced changes in enamel and dentine may compromise bonding of adhesive materials. Consequently, glass ionomer cements have proved to be a better alternative to composite resins in irradiated patients. Counseling of patients before and after radiotherapy can be done to make them aware of the complications of radiotherapy and thus can help in preventing them.
Article
Full-text available
Background and objective: The aim of the study was to evaluate the clinical effects of a mouthwash containing Sage (Salvia officinalis) extracts on Streptococcus mutans (SM) causing dental plaque in school-aged children. Material and methods: A double blind clinical trial study was conducted in a dormitory on 70 girls aged 11-14 years having the same socioeconomic and oral hygiene conditions. These students were randomly divided into 2 groups; the first group (N=35) using Sage mouthwash, and the second group (N=35) using placebo mouthwash without active any ingredients. At the baseline, plaque samples obtained from the buccal surfaces of teeth were sent to laboratory to achieve SM colony count. These tests were reevaluated after 21 days of using the mouthwashes. Statistical data analysis was performed using t-student tests with p<0.05 as the level of significance. Results: Sage mouthwash significantly reduced the colony count (P=0.001). Average number of colonies in test group was 3900 per plaque sample at the baseline, and 300 after mouthwash application. In the control group, pre-test colony count was 4400 that was reduced to 4000; although this reduction wasn't significant. Conclusion: The Sage mouthwash effectively reduced the number of Streptococcus mutans in dental plaque.
Article
Full-text available
Oral mucositis (OM) is a major limiting acute side effect of radiotherapy for head and neck cancer. The spectrum of problems associated with mucositis includes oral pain, odynophagia, reduced oral intake, and secondary infections. Incidence of mucositis is increased with addition of concurrent chemotherapy as well as altered fractionation schedules. This leads to treatment interruption and suboptimal disease control. Hence, prevention as well as timely management of OM is necessary for optimum tumor control. We reviewed the English literature with key words "Radiation induced mucositis, Mucositis, Oral Mucositis" to find relevant articles describing incidence, pathophysiology, prophylaxis, and treatment of oral mucositis. Prevention and treatment of OM is an active area of research. Maintenance of oral hygiene is an important part in prevention of OM. A battery of agents including normal saline and alkali (soda bicarbonate) mouth washes, low level laser therapy, and benzydamine (non-steroidal analgesic and anti-inflammatory) have effectiveness in the prevention and treatment of radiation induced oral mucositis. Chlorhexidine mouth gargles are recommended for prevention of chemotherapy induced oral mucositis but is not recommended for radiotherapy associated mucositis. Treatment of co-existing infection is also important and both topical (povidone iodine) and systemic anti fungals should be used judiciously. Radiation induced oral mucositis is a common problem limiting the efficacy of radiation by increasing treatment breaks. Adequate prophylaxis and treatment may limit the severity of radiation mucositis and improve compliance to radiation which may translate in better disease control and survival.
Article
This review assesses the development of oral health habits and status in European adults (35-44 years old) and senior citizens (65-74 years old) over the period of 1996-2016. There seem to be good opportunities for improving oral health habits by brushing twice daily with fluoride toothpaste among adults, as only 33-85% reported doing so. Caries experience was extensive among adults (≥92%). In adults of 23 countries, the mean DMFT score ranged from 6.6 to 17.6 (median 12.1). In senior citizens of 21 countries, the mean DMFT score varied from 14.7 to 25.5 (median 22.0). Repeated cross-sectional studies on caries trends in adults revealed a reduction of the DMFT value by 20%, referring to country-wide data. Among senior citizens, the corresponding reduction was 13%, with a shift in the DMFT components, i.e., with lower MT and higher FT scores. Edentulousness in the age group of 35- to 44-year-olds started disappearing in Europe from the year 2000, and had been markedly reduced in some countries during the last decade. However, the eradication of edentulousness among 65- to 74-year-olds has not yet been reported. Further epidemiological surveys should apply caries diagnostic criteria that, besides representing our contemporary understanding of oral health care, allow comparisons with previous surveys using the WHO criteria. In conclusion, in the last two decades, a decline in caries was observed among European adults, and to a lesser extent among senior citizens. It is expected that the decline in caries will contribute to better oral health of individuals.
Article
Parts of Salvia species such as its flowers and leaves are currently used as a culinary herb and for some medicinal applications. To distinguish the different sage extracts it is necessary to analyze their individual chemical compositions. Their characteristic compounds might be established as markers to differentiate between sage flowers and leaf extracts or to determine the manufacturing technology and storage conditions. Tri-p-coumaroylspermidine can be detected only in flowers and has been described here for Salvia and Lavandula species for the first time. Markers for oxidation processes are the novel compounds salviquinone A and B, which were generated from carnosol by contact with oxygen. Caffeic acid ethyl ester was established as an indirect marker for the usage of ethanol as extraction solvent. The compounds were identified by LC-QTOF-HRESIMS, LC-MS, NMR, IR, and single-crystal X-ray diffraction after isolation by semipreparative HPLC. Furthermore, sage flower resin showed interesting antibacterial in vitro activities against Gram-positive and Gram-negative bacteria.
Article
Treatment of head and neck cancer (HNC) is accompanied by a high rate of morbidity, and complications can have a lifelong, profound impact on both patients and caregivers. Radiation-related injury to the hard and soft tissue of the head and neck can significantly decrease patients’ quality of life. The purpose of this study is to provide patent-specific guidelines for managing the oral health and related side effects of HNC patients treated with radiation therapy. Based on reviewed articles retrieved on the PubMed database, guidelines for management of the oral health of this patient population were organized into three separate categories: cancer, patient, and dentition. The location, type, and staging of the cancer, along with the radiation used to treat the cancer significantly impact dental treatment. Several unique patient characteristics such as motivation, presence of support system, socioeconomic status, nutrition, and race have all been found to affect outcomes. Dental disease and available supportive dental management was found to significantly impact treatment and quality of life in this patient population. By comprehensively assessing unique cancer, patient, and dental-related factors, this review provides individualized evidence-based guidelines on the proper management of this complex and vulnerable patient population.
Article
Background: Caries prevention is paramount in safeguarding the life quality of head and neck cancer patients and is dependent on patient compliance with caries preventive protocols. The purpose of this study was to examine this compliance. Methods: All records of patients referred to one public oral medicine clinic servicing a head and neck oncology unit of one major Western Australian hospital, between January 2005 and December 2011 were examined. Data extracted included patient and cancer characteristics and compliance with dietary advice, dental care, oral hygiene instruction and fluoride use over a follow-up period of at least 12 months. Compliance was assessed against various oral health outcomes and patient characteristics. Results: Of the 116 participants, 75.9% complied with all caries preventive measures over a mean follow-up period of 45 months. Non-compliance with regular dental attendance (p=0.004), oral hygiene instruction (p=0.009), dietary advice (p=0.034) and daily fluoride use (p=0.018) were associated with the development of dental caries post-treatment. The presence of dental caries at the time of cancer diagnosis was predictive of poorer compliance. Conclusion: High compliance with caries preventive measures is attainable in the head and neck cancer patient group. Factors other than fluoride use seem important in caries prevention. This article is protected by copyright. All rights reserved.
Article
The Mediterranean plant Cistus incanus is rich in polyphenols and has shown several pharmacological activities, mainly antibacterial effects. Furthermore, in situ studies revealed that a C. incanus infusion reduces the initial bacterial adhesion in the oral cavity due to the polyphenols, an indication that C. incanus might reduce the risk of caries disease. In the present study, the polyphenols from four different commercial C. incanus herbal teas were extracted by standardized accelerated solvent extraction for in vitro tests and by an infusion for in situ tests. Both extracts were characterized qualitatively and quantitatively by high-performance liquid chromatography and only the polyphenol content differed slightly. By means of diode array detection and mass spectrometry, 29 polyphenols, including ellagitannins, flavanols, and glycosylated flavonols, were identified. Thereby, only quantitative but no qualitative differences between the four samples were detected. Furthermore, the in vitro antibacterial activity of the C. incanus accelerated solvent extracts against Streptococcus mutans, one of the primary cariogenic bacterial species, was examined using a live/dead assay (BacLight®). With this approach, C. incanus yielded antibacterial properties. Additional in situ experiments indicated that rinses with a C. incanus infusion reduced the initial bacterial colonization of enamel samples exposed to oral fluids for over eight hours. Furthermore, it was shown by transmission electron microscopy that the application of a C. incanus infusion modifies the ultrastructure of the acquired enamel pellicle, yielding a more electron-dense morphology. It can be assumed that the polyphenols are responsible for the observed effects. Georg Thieme Verlag KG Stuttgart · New York.