Discussion
oral mucositis, head and neck cancer, mucositis, dysbiosis, head and neck tumours
ORAL MUCOSITIS, MOUTH SORES, HEAD AND NECK CANCER, MUCOSITIS, DISEASES, COMPLICATIONS
RIOM is one of the most frequently encountered complications in HNC [Our results are aligned with Hashemipour et al. [Although clinician-reported instruments such as the WHO grading system can provide an adequate estimate of the severity of oral mucositis and its associated symptoms, patient reported outcome tools have been increasingly used to measure symptom burden and QoL [Our study demonstrated a significant difference in MDASI-HN scores in the head and neck subscale between groups at three and six weeks, while the total scores differed significantly only after three weeks. Patients receiving topical omega-3 nanoemulgel experienced clinically meaningful reduction in mouth sores and reported easier food chewing and swallowing, together with an overall improvement in their daily functioning and QoL compared to the control group. These results are consistent with Barker et al [In addition to the known mechanisms of RIOM development and progression, recently, there have been a surge of interest in microbiome dysbiosis and its possible association with oral mucositis [The study has several strengths, to the best of our knowledge, this is the first clinical trial to test the efficacy of topical Omega-3 nanoemulgel in preventing RIOM. We depended on clinical examination to assess the oral mucositis severity and complemented our assessment by measuring patient-reported outcomes to comprehensively capture the efficacy of topical omega-3 in prevention of RIOM and its associated symptoms. We also collected oral swabs to assess the role of Omega-3 in regulation of oral microbial dysbiosis. Our study, thus, fills a knowledge gap by providing evidence about the effect of topical Omega-3 nanoemulgel in prevention of RIOM.However, the study had some limitations including the short-term follow up, so further clinical trials with larger sample size and longer follow-ups that can assess OM after several radiation therapy-cycles are still needed. Also, the current study included a heterogenous group of head and neck tumours that required different radiation doses for treatment, thus, more clinical trials are needed with standardization of the type of head and neck cancer to ensure a more homogenous sample of patients. Also, trials comparing the efficacy of topical and systemic Omega-3 supplements on mucositis prevention are needed to further study the role of Omega-3 on modulation of oral microbiota, including more phyla and species. More studies are encouraged to determine and adjust the exact dosage of Omega-3 nanoemulgel in different oral diseases.