Interaction between properties of commercial Australian honey and saliva: in vitro exploratory study of a potential mechanism in the treatment of oral mucositis

Objectives Oral mucositis is a debilitating oncology treatment side effect, with honey identified as a viable management option due to established wound-healing abilities. However, effects of saliva on properties attributed to honey’s wound-healing abilities is unknown. Therefore, this study aimed to identify interactions between saliva, and antioxidant characteristics and pH of honey. Methods Saliva was collected from 15 healthy participants (Females n=9; mean age=34.1 ± 11.2 years). Centrifuged salivary supernatant, whole saliva, and water were independently used to dilute commercial Australian honeys (n=42). Antioxidant characteristics (DPPH and FRAP) and pH of diluted honeys were analysed, and differences between dilution conditions were determined. Results Honey and saliva dilutions increased antioxidant characteristics compared to water, and addition of honey to saliva reduced pH compared with saliva alone. There were significant differences between dilutions for FRAP and pH, and water and salivary conditions for DPPH (p<0.001). No difference was observed between salivary conditions for DPPH (p=0.931), suggesting smaller cells remaining in the supernatant possess antioxidant abilities. However, differences observed for FRAP suggest precipitable molecules, including epithelial and food debris, could provide additional antioxidant power. Conclusions The addition of saliva to honey may support properties attributed to honey’s wound-healing abilities and should be considered in the context of oral mucositis management.

Oral mucositis: the hidden side of cancer therapy

Inflammation response of epithelial mucosa to chemo- radiotherapy cytotoxic effects leads to mucositis, a painful side effect of antineoplastic treatments. About 40% of the patients treated with chemotherapy develop mucositis; this percentage rises to about 90% for head and neck cancer patients (HNC) treated with both chemo- and radiotherapy. 19% of the latter will be hospitalized and will experience a delay in antineoplastic treatment for high-grade mucositis management, resulting in a reduction of the quality of life, a worse prognosis and an increase in patient management costs. Currently, several interventions and prevention guidelines are available, but their effectiveness is uncertain. This review comprehensively describes mucositis, debating the impact of standard chemo-radiotherapy and targeted therapy on mucositis development and pointing out the limits and the benefits of current mucositis treatment strategies and assessment guidelines. Moreover, the review critically examines the feasibility of the existing biomarkers to predict patient risk of developing oral mucositis and their role in early diagnosis. Despite the expression levels of some proteins involved in the inflammation response, such as TNF-α or IL-1β, partially correlate with mucositis process, their presence does not exclude others mucositis-independent inflammation events. This strongly suggests the need to discover biomarkers that specifically feature mucositis process development. Non-coding RNAs might hold this potential.

Chemotherapy-induced oral mucositis management: A retrospective analysis of MuGard, Caphosol, and standard supportive care measures

Background Oral mucositis, a common complication of several different anticancer therapies, causes significant morbidity in cancer patients. It is characterized by the destruction of the mucosa throughout the gastrointestinal tract including the oral cavity. Limited data exist regarding the treatment of established oral mucositis with oral mucoadhesive hydrogel (MuGard) or supersaturated calcium phosphate oral rise (Caphosol) compared to standard topical therapies. Objectives To evaluate the effects of MuGard and Caphosol compared to standard topical therapy in the treatment of established oral mucositis. Methods A retrospective chart review was performed including adults receiving MuGard, Caphosol, and/or standard topical therapy for the treatment of established oral mucositis while admitted to a community teaching hospital. A post hoc propensity score was used to match patients receiving newer agents (Mugard/Caphosol) to those receiving standard topical therapy (ST). Results One hundred and forty-seven patients were included for analysis (125 ST, 15 MuGard, 7 Caphosol). From this population, 14 patients in each group were matched. The primary endpoint of median change in average daily pain score at days 3 and 7, compared to baseline, demonstrated no difference between matched groups at day 3 (ST 0, MuGard/Caphosol 0.18, p = 0.830) or day 7 (ST 0, MuGard/Caphosol 0.8, p = 0.494). No differences were noted between groups in opioid usage, oral mucositis symptom duration or progression, or incidence of documented infection. Conclusion MuGard and Caphosol did not demonstrate any benefits compared to standard topical therapy at reducing pain scores or increasing mucosal recovery in the treatment of oral mucositis.