Background: Oral Mucositis(OM) is an acute debilitating dose limiting toxicity of Radiotherapy/ Radiochemotherapy(RT/RCT) in management of Head and Neck Cancer (HNC). Curcumin/Turmeric may reduce OM in patients. Aim: Efficacy of Curcumin/Turmeric for preventing and ameliorating the onset and severity of RT/RCT induced OM was analysed in this review. Methods: A systematic literature search with meta-analysis were performed using Mesh terms in PubMed, Google scholar, Science Direct, Cochrane library and manual searching, articles published from 2010 to April 2021 were included. Clinical trials that studied the efficacy/effects of turmeric / curcumin in management of RT/RCT induced OM in HNC patients were included. Statistical Analysis were done to calculate the pooled Risk ratio at 95%confidence interval with significance at p <0.05. Results: Nine studies with overall 582 patients with HNC undergoing RT/RCT were included qualitatively. From evidence, orally 1,500-2,000 mg/day of Curcumin/Turmeric, (80mg/day/0.1%mouthwash) of nanocurcumin, topically gel/mouthwash used with increase in frequency prior and the entire course of RT/RCT with long follow ups are beneficial with no serious adverse effects. Meta-analysis of 5 prophylactic trials favoured curcumin/turmeric in reducing the severity of OM (RR 0.48 at 95% CI=0.23,0.99,P=0.05), did not prevent the overall incidence of OM (RR 0.99 at 95%CI=0.95,1.03,P=0.67) but delayed the onset of OM (RR 0.38 at 95% CI=0.18,0.80, P=0.01) during RT/RCT compared to control. Mean mucositis grade (Grade 3) was reduced in curcumin/turmeric with a mean difference of (-0.85 at 95%CI=-1.02,0.67, P<0.00001) over control. Pooling of 2 therapeutic trials favoured Curcumin/Turmeric with significant reduction of pain score at a mean difference of -2.17 at 95%CI =-2.77, -1.58,P<0.00001 over chlorhexidine. Conclusion: Curcumin/Turmeric are safe, efficacious, well tolerated in preventing the delay in onset and severity of OM, therapeutically ameliorated pain in patients with cancer therapy induced OM. We recommend novel curcumin formulations, high quality randomised controlled trials to further improve its therapeutic effects.

Objective: To determine the antimicrobial efficacy of silver, titanium dioxide and zinc oxide nanoparticles against Streptococcus mutans. Material and Methods: Serial dilution method was employed for preparing 1%, 0.5%, 0.25% concentrations of the three test compounds. ATCC 25175 strain of streptococcus mutans was used to assess the antimicrobial activity of test compounds. Equal quantity of BHI broth was dispensed in test tubes containing sectioned tooth and to this the prepared bacterial inoculum was added. Prepared concentrations of test compounds were added accordingly and incubated for 24hrs at 37 0 C. Then, the sectioned tooth was removed and the adherent bacteria were transferred into saline solution by vortexing. These suspensions were transferred onto sterile blood agar plate to make lawn culture and were further incubated at 37 0 C for 24hrs to determine viable bacterial count. The number of colonies were counted manually from each plate and recorded for further analysis. Decrease in number of colonies represents the effective concentration of the test compound against the inhibition of biofilm formation. Results: A significant difference in the colony forming units among all three concentrations of silver (Ag), titanium dioxide (TiO2) and zinc (ZnO) nanoparticles was noted and the antimicrobial effect of nanoparticles was concentration dependent. Inter group comparison of colony forming units with 1%, 0.5% and 0.25% of the test compound revealed that the colony forming units on the ZnO nanoparticles demonstrated highest value followed by TiO2 and the least were with that of the Ag nano particles. Conclusion: Silver, Zinc oxide and Titanium dioxide showed significant antimicrobial effects and the antimicrobial effect of nanoparticles was concentration dependent.

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