Efficacy of Phytotherapy in Oral Mucosites Induced by Chemotherapy and Radiotherapy Phytotherapy in OM really work?

The clinical manifestations most commonly associated with cancer therapy in the oral cavity are OM, osteorradionecrosis, xerostomia, radiation caries, trismus, opportunistic infections, dysphagia, among others [3]. Because of the associated complications, patients with OM go through decreasing doses or until the suspension of chemotherapy treatment or radiotherapy of head and neck until the improvement of the clinical picture, with that, exposing them the progression of the tumor. Current treatments produce limited results and are based on using ice oral cryotherapy, laser exposure power and low systemic administration of keratinocyte growth factor (Palifermin).The use of medicinal plants and herbal medicine in the treatment of OM is still little used, but with a tendency to expansion and acceptance of the pharmaceutical market.


Introduction
Oral mucositis (OM) is a complication that results from cancer therapy, with a prevalence of 75%-99% [1]. Complications due to antineoplastic treatment are associated with factors such as number of chemotherapy fractions, total dose of radiotherapy, interval between sessions, and total time of treatment and also factors related to patients such as age, smoking, oral hygiene index and alcohol [2].
The clinical manifestations most commonly associated with cancer therapy in the oral cavity are OM, osteorradionecrosis, xerostomia, radiation caries, trismus, opportunistic infections, dysphagia, among others [3]. Because of the associated complications, patients with OM go through decreasing doses or until the suspension of chemotherapy treatment or radiotherapy of head and neck until the improvement of the clinical picture, with that, exposing them the progression of the tumor. Current treatments produce limited results and are based on using ice oral cryotherapy, laser exposure power and low systemic administration of keratinocyte growth factor (Palifermin).The use of medicinal plants and herbal medicine in the treatment of OM is still little used, but with a tendency to expansion and acceptance of the pharmaceutical market.
Some herbal medicines have been used in treatment, such as Aloe Vera gel. Some patients often use Aloe vera L. topical gel to prevent radiation contact dermatitis and to control esophagitis and OM [4]. Although the mechanism of action is not well established, it is hypothesized that the gel inhibits cyclooxygenase because it has anti-inflammatory properties. The Extract of Hypericum perforatum L. contains in its phytocomplex the borneol and have shown anti-inflammatory and cicatricial activities in OM in animal models [5,6]. Borneol has an antioxidant effect, promoting cellular protection and decreasing iNOS and NO expression [7]. Chamomile (Matricaria chamomilla L.) has been used in the treatment of OM with promising results, reducing tissue levels of IL-1β and TNF-α, presenting antiinflammatory activity [8,9].
Honey has been used in the treatment of OM in reducing the frequency of mucositis and associated bacterial infection, but with conflicting results in some studies [10]. Honey in another study showed no statistical significance compared to placebo [11]. The leaves of Camellia sinensis L. are used in an exaggeration, BaxidilOnco®, with antioxidant action and success in reducing the incidence, severity and duration of OM [12]. Acacia catechu has been used in mouthwash for its antiinflammatory and cicatricial actions, with promising results [13]. Calendula officinalis has been used in the treatment of OM with a significant reduction in lesion intensity [14].

Conclusion
We can conclude that phytotherapy is an expanding market and that, although efficient, needs more research and better acceptance of oncologists and other health professionals. Also some mechanisms of action are still not well understood, therefore, studies are needed that evaluate the long-term effects, in addition to standardized clinical protocols that prove efficacy. OM, because it is a frequent complication, requires research that seeks to improve patients' quality of life, reducing pain and the appearance of lesions. An efficient natural product in the treatment of OM should have an anti-inflammatory, bactericidal, antioxidant and healing effect on oral mucosa. In this sense, the search for multi-herbal products can be promising, since the plants together can have superior synergistic effects to the isolated species. However, there are few products in the current market with this profile.