Background
chemotherapy-, diabetes, cardiovascular diseases, gingivitis, HNC, pain, dehydration, intestinal microbial dysbiosis, head and neck cancer
ORAL MUCOSITIS, ORAL MUCOSITIS, MALNUTRITION, RECURRENT APHTHOUS STOMATITIS, INFLAMMATION, DISEASE, DISEASES, GINGIVITIS, PERIODONTAL DISEASES, DEHYDRATION, PATHOGENESIS, HEAD AND NECK CANCER, ULCERATION, MUCOSAL INFLAMMATION, ULCERATIONS, SECONDARY INFECTION, COMPLICATIONS
Oral mucositis (OM) is considered one of the most common debilitating complications that develops in head and neck cancer (HNC) patients receiving radiotherapy [Radiation-induced oral mucositis (RIOM) is described as an injury to normal tissues occurring in the form of oral mucosal inflammation and/or ulceration, encountered in more than 80% of head and neck cancer patients undergoing radiation therapy [OM- related complaints frequently include mild to severe pain as well as oral erosions and ulcerations that are prone to secondary infections, which interfere with the oral intake of solid food and liquids and may subsequently result in dehydration and/or malnutrition. It can also lead to a reduction in the treatment dose or breaking the treatment course, prolonging hospitalization and consequently affecting patients’ quality of life (QoL) and overall survival [The major steps in OM development and resolution are generally characterized by five continuous overlapping phases [Along with the current cascade involved in the pathogenesis of OM, recent studies have discussed an emerging role for oral microbial community alterations in OM development and progression. This is possibly explained by an alteration in oral microbial diversity or an increase in pathogenic bacterial abundance during radiation, which is known as “dysbiosis”[To date, standard treatment for OM usually focuses on pain control and rehydration [Omega-3 (ω-3) polyunsaturated fatty acids (PUFAs) are classified as essential fatty acids that have long been recognized in normal growth, health, and disease risk reduction [Supported by both animal and human studies, mounting evidence has shown that ω-3 PUFAs, mainly EPA and DHA, have beneficial therapeutic roles in various human diseases such as diabetes, cardiovascular diseases and autoimmune conditions [Several hypotheses have been postulated to explain the anti-inflammatory effect of Omega-3. It majorly focused on their capability in inhibiting nuclear factor kappa B (NF-κB) protein expression [Moreover, recent studies suggest the potential role of ω-3 in managing chemotherapy- or radiotherapy-related intestinal microbial dysbiosis, by upregulating beneficial bacteria with anti-inflammatory impact, that in turn modulates systemic inflammatory and immune responses of the host. In addition to its ability to decrease proportions of pathogenic microorganisms, which may collectively influence OM in terms of development, severity or healing [Compared to systemic supplements, animal studies have demonstrated a better effect of locally delivered ω-3 PUFAs in terms of decreasing inflammation, enhancing re-epithelialization and wound healing [Both human and animal studies demonstrated the effect of ω-3 PUFAs on different oral diseases such as gingivitis, periodontal diseases and recurrent aphthous stomatitis (RAS) [