Efficacy of Zinc L-Carnosine Mouthwash in the Management of Radio-Chemotherapy-Induced Oral Mucositis: A Prospective Pilot Study

Introduction
Oral mucositis (OM) is one of the most frequent and debilitating toxicities associated with concurrent radiotherapy and chemotherapy, causing pain, dysphagia, nutritional impairment, and possible interruption of cancer treatment. Zinc L-carnosine (ZnL) exhibits cytoprotective, antioxidant, and anti-inflammatory properties that may enhance mucosal repair and reduce epithelial damage. The aim of this prospective study was to evaluate the clinical effectiveness of a zinc L-carnosine mouthwash in preventing and reducing the severity of radio-chemotherapy-induced oral mucositis.

Materials and Methods
A prospective pilot study was conducted at the Department of Dentistry, University of Bari. Four patients undergoing concurrent radio-chemotherapy were prospectively enrolled. Patients were instructed to rinse with 10 mL of zinc L-carnosine mouthwash containing 37.5 mg of ZnL three times daily after meals and to swallow the solution after rinsing throughout the oncological treatment. Oral mucositis severity and pain intensity were assessed weekly using validated clinical grading systems and the Visual Analog Scale (VAS).

Results
All four patients completed the planned oncological treatment without interruption due to oral mucositis. The onset of mucosal lesions was delayed, and disease severity remained clinically manageable throughout treatment. Pain scores remained low, allowing maintenance of oral feeding. No adverse events related to zinc L-carnosine administration or ingestion were observed. Clinical outcomes were consistent with the protective effects previously reported in the literature.

Conclusions
Within the limitations of this prospective study, zinc L-carnosine mouthwash followed by ingestion appears to be a safe and effective supportive strategy for patients receiving concurrent radio-chemotherapy. This protocol appears to reduce the severity of oral mucositis, improve symptom control, and facilitate completion of oncological treatment. Larger randomized controlled studies are required to confirm these preliminary findings.