The oral mucosa is an extremely sensitive part of our bodies, especially when the immune system is compromised during long treatments like chemotherapy. There is evidence that this tissue might change completely in as short as every 3 days. Since most of the current chemo-therapies act on the cells that are dividing, the risk of mucositis has been found to be as high as 40% to even 70 % in patients undergoing cancer treatments. The common medical practices to prevent this side effect have been limited to the use of ice to decrease perfusion during the actual chemotherapy infusion. However, this practice is limited by patient’s tolerance to the extreme cold temperatures such as in patients being treated with oxaliplatin that will give them a cold induced neuropathic sensation.
Once the mucositis develops our conventional medical arsenal has been very limited to aid with symptomatic relief. Concoctions like the so called magic mouth wash (a mixture of viscous lidocaine and other medications such as aluminum hydroxide), have marginal medical evidence of benefit.
That is the reason why most health care professionals have turned their attention to more natural alternatives that present better evidence. However, the risk of using these therapies in an indiscriminate way might end up being more problematic. Mostly since one of the best natural substances that come to mind to treat this bothersome side effect is goldenseal as a byproduct of berberine. Even though it is a great antibacterial in the mucosa, it is also extremely active in the liver producing an inhibition of important enzymes involved also in the metabolism of many other medication including chemotherapy. This could potentially create the risk of even more toxicity.
With that in mind it is pivotal that when deciding what to use for the treatment of mucositis one must not only take into consideration the topical effect but if there could also be systemic effect and to try to avoid it, since it would not make any sense to treat a side effect with a compound that can generate a new side effect.
The main issues when considering therapy of oral ulcers is the combination of demulcents, defined as substances that relief irritation of the mucous membranes in the mouth by forming a protective film, and other constituents that could provide antibiotic effect with the intention of decreasing super infection of the unprotected tissues and decrease bacterial overgrowth.
One of the best demulcents is Slippery Elm because it contains mucilage, a substance that becomes a slick gel when mixed with water. It coats and soothes the mouth, throat, stomach, and intestines. It also contains antioxidants that help relieve inflammation in a topical fashion with minimal absorption. Other compounds on this category include propolis derived from the bee hives, found to be very high on flavonoids and reported extensively in the literature to have topical antifungal and bacterial effect. However, in regards to antibiotic effect it is very likely that one of the most extensively studied substances has been xylitol that upon review of the literature has been widely found to be active against many of the typical oral bacteria and even against candida species. Combining all the previously mentioned ingredients, yields a wider body of evidence in the treatment of this bothersome side effect over the standard use of traditional medical interventions. Moreover, the lack of herb-drug interactions and minimal absorption would allow patients to have the possibility of frequent dosing contributing to better symptomatic control when is mostly needed at the time of dietary intake.
Dr. Mike Cusnir