Reduction of salivary tumor necrosis factor alpha levels in response to magic mouthwash with curcuma xanthorriza in cancer patients undergoing chemotherapy

Abstract

Tumor necrosis factor-alpha (TNF-α) is pro-inflammatory cytokine that play a key role in initiating and accelerating the development of oral mucositis in cancer patients undergoing chemotherapy. Mixed medication mouthwash called magic mouthwash has been widely used to prevent and treat oral mucositis. Curcuma xanthorriza is a traditional herbal medicine, which has shown anti-inflammatory, antibacterial, and antifungal effects. The aim of this study was to evaluate the effect of magic mouthwash with Curcuma xanthorriza on salivary TNF-α levels in cancer patients undergoing chemotherapy. The magic mouthwash formulation used in this study contains diphenhydramine, hydrocortisone, nystatin and dry curcuma extract. This study involved 60 cancer patients undergoing 5-Fluorouracil (5-FU)-based chemotherapy who were assigned into two groups, each group consisted of 30 patients. Group 1 instructed for rinsing with magic mouthwash with Curcuma xanthorriza and group 2 rinsed with NaCl 0.9% as control group. Unstimulated whole saliva was collected before and after oral rinsing with mouthwashes. Salivary TNF-α levels were measured with enzyme linked immunosorbent assay (ELISA). Data were analyzed statistically with Wilcoxon and Chi square test. The result of this study showed a significant decrease in salivary TNF-α levels on both groups (p<0.05). In the study group, more patients were found with salivary TNF-α levels decreased (74.2%) compared to control group (53.5%) and showed significant difference statistically (p<0.05). The study concludes that magic mouthwash with Curcuma xanthorriza can reduce Salivary TNF-α levels and can be used as an alternative therapy for oral mucositis-induced chemotherapy.