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Oral anaerobes generate volatile sulfur compounds (VSCs) such as hydrogen sulfide and methanethiol, which may modulate inflammatory signaling and epithelial integrity within the respiratory mucosa 195 , while organic acids and tryptophan-derived metabolites produced by oral commensals may further alter microbial colonisation patterns and host immune responses in the airways 196

Unlike acute wounds, which follow a well-defined healing cascade of re-epithelialization, fibroblast proliferation, and angiogenesis, chronic wounds remain trapped in a prolonged inflammatory phase characterized by microbial persistence and dysregulated immune responses [4,5,6]

TNF- plays an important roles in many processes, such as cell survival, apoptosis, necrosis, and intercellular communication 27

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