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Estornut C, Rinaldi G, Carceller MC, Estornut S, Pérez-Leal M. Systemic and local effect of oxidative stress on recurrent aphthous stomatitis: systematic review. J Mol Med (Berl) 2024; 102:453-463. [PMID: 38376817 DOI: 10.1007/s00109-024-02434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
Recurrent aphthous stomatitis (RAS) is a chronic and recurrent inflammatory disease of the mouth. It is characterised by the appearance of painful ulcers in the oral mucosa. RAS is believed to be a multifactorial disease with genetic predisposition, environmental factors and alterations in the immune system. Oxidative stress, caused by an imbalance between free radicals and the antioxidant system, also appears to be involved in the pathogenesis of RAS. Several risk factors, such as smoking, iron and vitamin deficiency and anxiety, may contribute to the development of the disease. Understanding the underlying mechanisms may help in the prevention and treatment of RAS. We searched PubMed, Scopus and Web of Science databases for articles on oxidative stress in patients with RAS from 2000 to 2023. Studies analysing oxidant and antioxidant levels in the blood and saliva of RAS patients and healthy controls were selected. Of 170 potentially eligible articles, 24 met the inclusion criteria: 11 studies on blood samples, 6 on salivary samples and 7 on both blood and salivary samples. Multiple oxidative and antioxidant markers were assessed in blood and saliva samples. Overall, statistically significant differences were found between RAS patients and healthy controls for most markers. In addition, increased oxidative DNA damage was observed in patients with RAS. Patients with RAS show elevated levels of oxidative stress compared to healthy controls, with a significant increase in oxidative markers and a significant decrease in antioxidant defences in saliva and blood samples.
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Affiliation(s)
- Cristina Estornut
- Faculty of Health Sciences, Department of Dentistry, Universidad Europea de Valencia, Valencia, Spain.
| | - Giulia Rinaldi
- Faculty of Health Sciences, Department of Dentistry, Universidad Europea de Valencia, Valencia, Spain
| | - María Carmen Carceller
- Faculty of Health Sciences, Department of Dentistry, Universidad Europea de Valencia, Valencia, Spain
- Department of Pharmacy, Pharmaceutical Technology and Parasitology, Faculty of Pharmacy and Food Sciences, University of Valencia, Av. Vicent Andrés Estellés s/n, Burjassot, Valencia, 46100, Spain
- Interuniversity Research Institute for Molecular Recognition and Technological Development (IDM), University of Valencia, Polytechnic University of Valencia, Av. Vicent A. Estellés s/n, Burjassot, Valencia, 46100, Spain
| | | | - Martín Pérez-Leal
- Faculty of Health Sciences, Department of Dentistry, Universidad Europea de Valencia, Valencia, Spain
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2
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Cofré-Leiva C, Camargo-Ayala PA, Vergara-Pérez A, Hernández-Olivos R, Sanhueza S, Nova-Lamperti E, Zúñiga-Hernández J, Rivera C. Salivary proteins offer insights into keratinocyte death during aphthous stomatitis. A case-crossover study. BMC Oral Health 2023; 23:279. [PMID: 37170213 PMCID: PMC10176878 DOI: 10.1186/s12903-023-02955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/09/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The death of oral keratinocytes is a crucial step in the emergence of recurrent aphthous stomatitis (RAS, also known as aphthae or aphthous ulcers). Since there are no experimental models available to research aphthous ulcers, little is understood about this process. We hypothesize that saliva can be a data bank of information that offers insights on epithelial damage. METHODS In this case-crossover study, we assessed the salivary proteome of patients with RAS (n = 36) in the presence and absence of ulcers using discovery proteomics and bioinformatics. Additionally, we contrasted these patterns with those of healthy individuals (n = 31) who had no prior aphthous ulceration. RESULTS Salivary proteome showed that during the ulcerative phase, controlled cell death was downregulated. Due to its ability to distinguish between individuals with and without ulcers, the ATF6B protein raises the possibility that endoplasmic reticulum (ER) stress is responsible for the damage that leads to the death of oral keratinocytes. The high abundance of TRAP1 and ERN1 matches with this biological discovery. The type of death is immunogenic, according to the functional data found in a cell death database. CONCLUSION We identified a cellular process that can lead to the death of oral keratinocytes in the etiopathogenesis process of RAS. Future studies should be conducted to identify what is responsible for the increase in ER stress signaling that would lead to an anti-cell death response.
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Affiliation(s)
- Camila Cofré-Leiva
- Departamento de Ciencias Básicas Biomédicas, Facultad de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - Paola Andrea Camargo-Ayala
- Departamento de Ciencias Básicas Biomédicas, Facultad de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - Angela Vergara-Pérez
- Laboratorio de Histopatología Oral y Maxilofacial, Departamento de Estomatología, Facultad de Odontología, Universidad de Talca, Avenida Lircay S/N, Campus Norte Universidad de Talca, Talca, Oficina, N°4, Chile
| | - Romina Hernández-Olivos
- Laboratorio de Histopatología Oral y Maxilofacial, Departamento de Estomatología, Facultad de Odontología, Universidad de Talca, Avenida Lircay S/N, Campus Norte Universidad de Talca, Talca, Oficina, N°4, Chile
| | - Sergio Sanhueza
- Laboratorio de Inmunología Translacional, Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Estefanía Nova-Lamperti
- Laboratorio de Inmunología Translacional, Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Jessica Zúñiga-Hernández
- Departamento de Ciencias Básicas Biomédicas, Facultad de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - César Rivera
- Laboratorio de Histopatología Oral y Maxilofacial, Departamento de Estomatología, Facultad de Odontología, Universidad de Talca, Avenida Lircay S/N, Campus Norte Universidad de Talca, Talca, Oficina, N°4, Chile.
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Soto AP, Meyer SL. Oral Implications of Polypharmacy in Older Adults. Clin Geriatr Med 2023; 39:273-293. [PMID: 37045533 DOI: 10.1016/j.cger.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Over the next several decades, rates of aged populations will increase rapidly. These populations are susceptible to multimorbidities and polypharmacy (concurrently, prescribed 5 or more medications). Many medications have side effects that manifest orally. Therefore, it essential to possess current pharmacologic knowledge to diagnose and treat oral implications of commonly prescribed medications. This article details common medication-induced oral lesions and patient assessment of risk factors for polypharmacy and provides a template to integrate medication reconciliation into dental clinical practice.
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Affiliation(s)
- Annetty P Soto
- Division of General Dentistry, Department of Restorative Dental Sciences, University of Florida College of Dentistry, 1395 Center Drive, PO Box 100415, Gainesville, FL 32610-0415, USA.
| | - Sarah L Meyer
- University of Florida Health Science Center Libraries, 1600 Southwest Archer Road, PO Box 100206, Gainesville, FL 32610, USA
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Balazic E, Axler E, Konisky H, Khanna U, Kobets K. Pentoxifylline in dermatology. J Cosmet Dermatol 2023; 22:410-417. [PMID: 36208009 DOI: 10.1111/jocd.15445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pentoxifylline was initially marketed for use in patients with intermittent claudication due to chronic occlusive arterial disease of the extremities but has since been shown to have several off-label uses in dermatology. AIMS The aim of this review is to increase awareness of the several applications of pentoxifylline in the field of dermatology. METHODS A comprehensive PubMed search was conducted in May 2022 using the following phrases "dermatology" AND "pentoxifylline." Our search period spanned 34 years from 1988 to 2022. All available literature was reviewed. Reference lists of identified articles were included. Studies were excluded if they were not in English and if the study was out of scope. Eighty-one articles were included in this review. RESULTS Pentoxifylline has been used to treat various dermatological conditions including peripheral vascular disease, vasculitis and vasculopathies, chilblains, pigmented purpuric dermatosis, granuloma annulare, necrobiosis, keloids, lichen sclerosis et atrophicus, scars, radiation-induced fibrosis, vitiligo, alopecia areata, leishmaniasis, and leprosy. CONCLUSIONS Pentoxifylline's use in dermatology is growing. However, there are limited larger studies and randomized control trials on the use of pentoxifylline in dermatology and more investigation is needed to evaluate its use for many dermatologic conditions. Pentoxifylline's unique mechanism of action as well as its good tolerability, cost-effectiveness, and minimal drug interactions make it a convenient primary or adjunctive option in many dermatological conditions.
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Affiliation(s)
- Eliza Balazic
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Eden Axler
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Hailey Konisky
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Urmi Khanna
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Kseniya Kobets
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Molania T, Malekzadeh Shafaroudi A, Saeedi M, Moosazadeh M, Valipour F, Rostamkalaei SS, Salehabadi N, Salehi M. Evaluation of cinnamaldehyde mucoadhesive patches on minor recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled clinical trial. BMC Oral Health 2022; 22:235. [PMID: 35701773 PMCID: PMC9199160 DOI: 10.1186/s12903-022-02248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background & objective The use of herbal medicines to treat common oral diseases increases rapidly. Recurrent aphthous stomatitis is one of the most common oral mucosal diseases, which has an unclear etiology and could lead to severe pain and dysfunction. Cinnamaldehyde is a major component of cinnamon bark oil. Biological properties of cinnamaldehyde, such as antioxidant, antitumor, antifungal, cytotoxic, and anti-mutational characteristics, have been identified. Considering the prevalence of recurrent aphthous stomatitis and the importance of using herbal resources for treatment, the present study aimed to evaluate the effect of mucosal adhesive patches containing Cinnamaldehyde on minor recurrent aphthous stomatitis lesions.
Material & methods In this randomized, double-blind clinical trial, patients were divided into two groups. The intervention group received three daily mucosal adhesive patches to be used in the morning, afternoon, and night. The control group also did the same with a placebo. To evaluate the healing and determine the diameter of the lesions, patients were clinically examined on days zero, 3, 5, and 7. The VAS scale evaluated pain at baseline and after each meal for seven days. The Fisher's exact test, t-test, Shapiro Wilk test, Friedman test, and the Mann–Whitney test were used to analyze the data using the SPSS 20 software.
Results There was no statistically significant difference in the mean diameter of the inflammatory lesion and pain intensity in the two groups in the baseline (p > 0.05). However, the ulcer size was significantly reduced in the cinnamaldehyde group on the third, fifth, and seventh days of the study. Except for baseline, the mean pain intensity significantly decreased in the cinnamaldehyde group compared to the placebo group (p < 0.05). Conclusion Cinnamaldehyde mucoadhesive patches effectively reduced and improved aphthous lesions and pain intensity in patients and can be considered a treatment for RAS. Registration number: IRCT20180312039060N2—First registration date: 20/07/2018. The present study was registered as a retrospective study.
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Affiliation(s)
- Tahere Molania
- Department of Oral Medicine, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran.,Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Malekzadeh Shafaroudi
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastroinstitional Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Seyyed Sohrab Rostamkalaei
- Department of Pharmaceutics, Faculty of Pharmacy, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran.,Medicinal Plant Research Center, Faculty of Pharmacy, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran
| | - Negareh Salehabadi
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maede Salehi
- Department of Oral Medicine, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran. .,Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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Krapf JM, Casey RK, Goldstein AT. Reactive non-sexually related acute genital ulcers associated with COVID-19. BMJ Case Rep 2021; 14:14/5/e242653. [PMID: 33952571 PMCID: PMC8103359 DOI: 10.1136/bcr-2021-242653] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Acute genital ulcers (AGU), known as Lipschütz ulcers, are painful vulvar ulcers typically affecting non-sexually active girls and women. AGU have been associated with viral infections, namely, Epstein-Barr virus (EBV). Here, we describe a case of AGU in the setting of SARS-CoV-2 in a non-sexually active adolescent girl hospitalised for pain control and urinary retention, who failed a course of oral corticosteroids and then improved with colchicine. Testing for herpes simplex virus, EBV and Behcet's syndrome were all negative. Testing for SARS-CoV-2 was positive. COVID-19 increases cytokines such as tumour necrosis factor alpha, which has been shown to affect endothelial cell adhesion and neutrophil chemotaxis, leading to aphthosis.
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Affiliation(s)
- Jill M Krapf
- Gynecology, Center for Vulvovaginal Disorders, Washington, DC, USA .,Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rachel K Casey
- Pediatric Specialists of Virginia, Inova Fairfax Medical Campus, Department of Obstetrics and Gynecology, Fairfax, Virginia, USA
| | - Andrew T Goldstein
- Gynecology, Center for Vulvovaginal Disorders, Washington, DC, USA.,Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Abstract
Over the next several decades, rates of aged populations will increase rapidly. These populations are susceptible to multimorbidities and polypharmacy (concurrently, prescribed 5 or more medications). Many medications have side effects that manifest orally. Therefore, it essential to possess current pharmacologic knowledge to diagnose and treat oral implications of commonly prescribed medications. This article details common medication-induced oral lesions and patient assessment of risk factors for polypharmacy and provides a template to integrate medication reconciliation into dental clinical practice.
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8
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Toader MP, Esanu IM, Taranu T, Mocanu M, Toader S. Colchicine in the treatment of refractory aphthous ulcerations: Review of the literature and two case reports. Exp Ther Med 2021; 21:281. [PMID: 33603888 DOI: 10.3892/etm.2021.9712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/16/2020] [Indexed: 11/06/2022] Open
Abstract
Colchicine has been known and used for over a millennium for its anti-inflammatory properties, being the treatment of choice for gout and familial Mediterranean fever. A tricyclic alkaloid extracted from the herbaceous plant, Colchicum autumnale, colchicine blocks multiple inflammatory pathways, and has antimitotic and antifibrotic action. Although there are insufficient data on the beneficial mechanism of action, colchicine is a widely used treatment in dermatology, one of the morbid conditions with more evidence of efficacy being recurrent aphthous stomatitis (RAS), a disorder with incompletely known etiopathogenesis and, consequently, with poorly defined treatment. Colchicine is considered as the first therapeutic line in complex or severe aphthoses, significantly relieving pain, decreasing the number of lesions, increasing the free interval between eruptive episodes, without inducing noticeable side effects. We examined the treatment efficacy of colchicine in two cases of chronic, severe RAS, evolving in different morbid contexts, who did not respond to other therapeutic measures. The two cases presented with recurrent aphthous stomatitis with herpetiform aphthae; one patient with Turner syndrome and one patient with major Sutton ulcers.
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Affiliation(s)
- Mihaela Paula Toader
- Department of Oral Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 70015 Iasi, Romania
| | - Irina Mihaela Esanu
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 70015 Iasi, Romania
| | - Tatiana Taranu
- Department of Oral Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 70015 Iasi, Romania
| | - Madalina Mocanu
- Department of Oral Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 70015 Iasi, Romania
| | - Stefan Toader
- Department of Pathophysiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 70015 Iasi, Romania
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9
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The efficacy of probiotics in management of recurrent aphthous stomatitis: a systematic review and meta-analysis. Sci Rep 2020; 10:21181. [PMID: 33273680 PMCID: PMC7713296 DOI: 10.1038/s41598-020-78281-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023] Open
Abstract
There is currently a lack of effective drugs to cure recurrent aphthous stomatitis. This study aimed to evaluate the efficacy of probiotics alone or as an adjunct in recurrent aphthous stomatitis (RAS) patients. Seven randomized controlled trials (RCTs) were included, of which three were included in quantitative analysis. Of five studies evaluating the efficacy of probiotics alone compared with placebo or Oracure gel, two reported no significant difference in relieving oral pain, while probiotics exhibited a higher capacity for decreasing oral pain in the other three. A significant decrease in ulcer severity was found in one, while no significant difference was found in the other four. The remaining two studies demonstrated that probiotics, as an adjunct to steroids or anaesthetic antiseptic gel, significantly reduced the ulcer severity and oral pain. The meta-analysis showed a significant decrease in oral pain (- 1.72, P = 0.0001) with probiotics compared with placebo. In conclusion, probiotics alone were capable of relieving oral pain but not effective in reducing ulcer severity. A combination of probiotics and steroids or anaesthetic antiseptic gel was more effective than steroids or anaesthetic antiseptic gel alone in RAS patients. Probiotics are promising for the treatment of recurrent aphthous stomatitis.
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10
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Zhang F, Zhou H, Ding S, Zhang D, Lian D, Chen X, Wang C. Efficacy and safety of acupuncture for recurrent aphthous stomatitis: a systematic review protocol. BMJ Open 2020; 10:e037603. [PMID: 33033019 PMCID: PMC7542930 DOI: 10.1136/bmjopen-2020-037603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Recurrent aphthous stomatitis (RAS) is a distressing symptom. There are many ways to treat RAS, such as pudilan anti-inflammatory oral liquid and doxycycline and laser therapy, but these take a long time to produce positive effects and compliance is low. Previous reviews of acupuncture treatment for RAS has been growing, but a systematic review is not available. To assess the efficacy and safety of acupuncture for the management of RAS. METHODS AND ANALYSIS The following databases will be searched from their inception to 1 February 2020: PubMed, Embase, Cochrane Library, CINAHL, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure and Wanfang. The randomised controlled trials in English or Chinese associated with acupuncture for patients with RAS will be included. Eligible study conference abstracts and reference lists of manuscripts will also be searched. Two reviewers will select the studies, extract data independently. The Cochrane risk of bias tool will be used to assess the risk of bias for the studies. According to heterogeneity testing, data will be synthesised using a random-effects model. A meta-analysis will be performed using Rev Man V.5.3.5 statistical software for each outcome. Subgroup analysis and sensitivity analysis are planned according to clinical evidence. Mean difference or standardised mean difference for continuous data and risk ratio for dichotomous data will be calculated. ETHICS AND DISSEMINATION No ethical approval is required. This protocol will not involve individual patient information and endangering participant rights. The results will be reported in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/QASUY.
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Affiliation(s)
- Feng Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hao Zhou
- Sub-Health Center, Sichuan Integrative Medicine Hospital, Chengdu, China
| | - Songyi Ding
- Sub-Health Center, Sichuan Integrative Medicine Hospital, Chengdu, China
| | - Da Zhang
- Sub-Health Center, Sichuan Integrative Medicine Hospital, Chengdu, China
| | - Daoshi Lian
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xingliang Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chao Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Sub-Health Center, Sichuan Integrative Medicine Hospital, Chengdu, China
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11
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Low-level laser therapy in the treatment of recurrent aphthous stomatitis and oral lichen planus: a literature review. Postepy Dermatol Alergol 2020; 37:475-481. [PMID: 32994766 PMCID: PMC7507163 DOI: 10.5114/ada.2020.98258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/17/2018] [Indexed: 12/17/2022] Open
Abstract
Recurrent aphthous stomatitis (RAS) and oral lichen planus (OLP) present inflammatory, recurrent diseases of the oral mucosa with not fully understood aetiology. Despite numerous attempts to discover an effective treatment for RAS and OLP, the current main treatment strategies are largely confined to the reduction of symptoms. Low-level laser therapy (LLLT) is of interest as a novel treatment modality. The aim of the paper was to discuss the mechanism of action and the biological effects of LLLT and to critically review and summarize recent clinical reports on the management of RAS and OLP. Most of the studies demonstrated the beneficial effect of LLLT in accelerating the healing process and pain reduction. However, the results should be interpreted with caution due to the limited number of studies available and empirical design using various irradiation parameters.
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12
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Ghorbani A, Akbari J, Boorboor M, Nekoukar Z, Eslami G. Evaluation of zinc sulfate mucoadhesive formulation on recurrent aphthous stomatitis: a randomized double-blind, placebo-controlled clinical trial. BMC Oral Health 2020; 20:212. [PMID: 32723352 PMCID: PMC7385976 DOI: 10.1186/s12903-020-01194-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recurrent aphthous stomatitis (RAS) is a common lesion that affects the oral mucosa. There are several methods to treat RAS, including systemic and topical formulations. This study was conducted to evaluate the anti-inflammatory effect of topical zinc sulfate and its efficacy in the treatment of RAS. METHODS A double-blind randomized clinical trial was conducted on 46 patients with RAS. They were randomly assigned into two groups to receive a zinc sulfate mucoadhesive tablet or placebo for 7 days. The pain severity was measured at baseline and daily while the diameter of the lesion was measured at baseline and on days 3, 5, and 7. The obtained data were analyzed in SPSS V.16. RESULTS There was no significant difference in the mean diameter of lesions and pain at baseline between the two groups (P = 0.643 and P = 0.842, respectively). However, on the third, fifth, and seventh days of the study, the diameter of the lesion significantly reduced in the intervention group (P = 0.001) and the pain intensity became significantly different between groups from the fourth day of the study (P = 0.001). CONCLUSION Zinc sulfate mucoadhesive tablet was effective in recovery and reducing the pain and diameter of the aphthous lesion and could be considered for the treatment of RAS. TRIAL REGISTRATION Evaluation of the effectiveness of zinc sulfate mucoadhesive tablet in the improvement of recurrent aphthous stomatitis (RAS), IRCT20151109024975N9. Registered August 1, 2018, https://en.irct.ir/trial/32423 . This project was registered by the Iranian Registry of Clinical Trials ( http://www.irct.ir ). The IRCT ID was IRCT20151109024975N9.
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Affiliation(s)
- Anahita Ghorbani
- Department of Oral and Maxillofacial Diseases, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jafar Akbari
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Boorboor
- Department of Oral and Maxillofacial Diseases, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Nekoukar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Gohar Eslami
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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13
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Senusi A, Kang A, Buchanan JAG, Adesanya A, Aloraini G, Stanford M, Fortune F. New mouthwash: an efficacious intervention for oral ulceration associated with Behçet's disease. Br J Oral Maxillofac Surg 2020; 58:1034-1039. [PMID: 32819746 DOI: 10.1016/j.bjoms.2020.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
Topical interventions to treat oral ulcers in Behçet's disease (BD) are crucial to control disease activity and improve patients' quality of life. Our aim was to evaluate the effectiveness of a new BD mouthwash (BD MW) for oral ulceration. A retrospective cross-sectional study was carried out on 261 BD patients (141 women, mean (SD) age 39.9 (11.8) years, and 120 men, mean (SD) age 41.141(3.7) years). All were assessed using the oral ulcer severity score (OUSS), oral health quality of life (OHQoL), and the Behçet's disease current activity form (BDCAF). Patients were divided into three groups: one group used the BD MW, one group used a betamethasone mouthwash, and the other used no therapeutic mouthwash. Patients were assessed at three and six months. The OUSS in those using the BD MW was nine times lower than it was in those using betamethasone mouthwash (p=0.001), and 12 times lower than it was in the no mouthwash group (p=0.001). Compared with the baseline data, use of the BD MW during the first three months significantly reduced the OUSS, the BDCAF score, and intraoral scarring, and also improved OHQoL (p=0.001, 0.019, 0.012, and 0.001, respectively). Ongoing use of the BD MW after six months significantly improved the OUSS, OHQoL, and intraoral scars, and kept oral and systemic disease activity under control. A total of 20/31 patients reported high levels of satisfaction with its use, and a patients' satisfaction score showed a preference for it. This study confirms the efficacy of the BD MW in patients with recurrent oral ulceration (ROU). It is more efficacious than betamethasone mouthwash used alone.
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Affiliation(s)
- Amal Senusi
- Centre for Oral Immunobiology and Regenerative Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Centre for Teaching and Innovation, Institute of Dentistry Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.
| | - Angray Kang
- Centre for Oral Immunobiology and Regenerative Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.
| | - John A G Buchanan
- Centre for Teaching and Innovation, Institute of Dentistry Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Oral Medicine Unit, Institute of Dentistry, Dental Hospital, Royal London Hospital, Barts Health NHS Trust, UK.
| | - Adebowale Adesanya
- Centre for Oral Immunobiology and Regenerative Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Behçet's Centre of Excellence, Royal London Hospital, Barts Health NHS Trust, UK.
| | - Ghfren Aloraini
- Centre for Oral Immunobiology and Regenerative Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.
| | - Miles Stanford
- Behçet's Centre of Excellence, Royal London Hospital, Barts Health NHS Trust, UK.
| | - Farida Fortune
- Centre for Oral Immunobiology and Regenerative Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Oral Medicine Unit, Institute of Dentistry, Dental Hospital, Royal London Hospital, Barts Health NHS Trust, UK; Behçet's Centre of Excellence, Royal London Hospital, Barts Health NHS Trust, UK.
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15
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Mauskar MM, Marathe K, Venkatesan A, Schlosser BJ, Edwards L. Vulvar diseases. J Am Acad Dermatol 2020; 82:1287-1298. [DOI: 10.1016/j.jaad.2019.10.077] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/26/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022]
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Sánchez-Bernal J, Conejero C, Conejero R. Recurrent Aphthous Stomatitis. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:471-480. [PMID: 32451064 DOI: 10.1016/j.ad.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/17/2019] [Accepted: 09/25/2019] [Indexed: 12/21/2022] Open
Abstract
Recurrent aphthous stomatitis is a chronic inflammatory disease of the oral mucosa. It is characterized by painful mouth ulcers that cannot be explained by an underlying disease. Recurrent oral mucosal ulcers require a proper differential diagnosis to rule out other possible causes before recurrent aphthous stomatitis is diagnosed. The condition is common, with prevalence rates ranging from 5 to 60% in different series. Its pathogenesis is unknown, but multiple factors are considered to play a part. There are no standardized treatments for this condition and none of the treatments are curative. The goal of any treatment should be to alleviate pain, reduce the duration of ulcers, and prevent recurrence.
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Affiliation(s)
- J Sánchez-Bernal
- Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - C Conejero
- Unidad de Dermatología, Centro Médico Millenium, Zaragoza, España
| | - R Conejero
- Departamento de Dermatología, Hospital Royo Villanova, Zaragoza, España.
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Soliman HA, Mostafaa D. Clinical Evaluation of 660 nm Diode Laser Therapy on the Pain, Size and Functional Disorders of Recurrent Aphthous Stomatitis. Open Access Maced J Med Sci 2019; 7:1516-1522. [PMID: 31198466 PMCID: PMC6542398 DOI: 10.3889/oamjms.2019.268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND: Minor recurrent aphthous stomatitis (MiRAS) is one of the most common, recurrent, and painful mucosal pathological condition. It is characterised by round or shallow oval ulcers, less than 10 mm in diameter, surrounded by a thin erythematous halo. It involves non-keratinized mucosa such as the labial and buccal mucosa, the ventral surface or borders of the tongue and the floor of the mouth, but it is uncommon to occur on the keratinised mucosa. It heals spontaneously within 10-14 days without scarring. There is no curative remedy to prevent its recurrence; also, available modalities only reduce the symptoms and severity of the lesion. AIM: Since these lesions may be extremely painful, we decided to estimate the pain-relieving and healing properties of low energy level laser therapy using diode laser 660 nm on MiRAS. MATERIAL AND METHODS: Twenty healthy patients suffering from minor aphthous ulcers were randomly selected from the Out-Patient Clinic of Oral Medicine Department, Faculty of Dentistry, Alexandria University. They were equally divided into two groups, study group who received 660 nm diode laser irradiation while the control group received placebo (sodium bicarbonate rinse). The visual analogue scale, size reduction, effectiveness indices and functional disorders were compared between the groups. RESULTS: Both groups presented a statistically significant difference from baseline to follow up periods. But, diode laser 660 nm treatment showed more remarkable improvements in reduction of healing time, pain and lesion size. CONCLUSION: We concluded that diode laser 660 nm should be further considered as an effective alternative therapeutic regimen to patients who suffer from recurrent aphthous stomatitis.
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Affiliation(s)
| | - Diana Mostafaa
- Faculty of Dentistry, Alexandria University, Alexandria, Egypt.,Department of Preventive Dental Sciences, Al Farabi Colleges, Riyadh, Saudi Arabia
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Zhang Y, Ng KH, Kuo CY, Wu DJ. Chinese herbal medicine for recurrent aphthous stomatitis: a protocol for systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13681. [PMID: 30558077 PMCID: PMC6320145 DOI: 10.1097/md.0000000000013681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 11/22/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Recurrent aphthous stomatitis (RAS) is the most frequent form of oral ulceration, characterized by recurrent oral mucosal ulceration in an otherwise healthy individual. This study was designed to evaluate the efficacy and safety of Chinese herbal medicine for recurrent aphthous stomatitis. METHODS Five databases will be searched from inception to date, including PubMed, Cochrane Library, EMBASE,CNKI, and CBM. The researchers will comprehensively screen clinical randomized trials of Chinese herbal medicine for recurrent aphthous stomatitis. The review will be conducted by 2 independent authors without time and language limitation. The risk of bias will be assessed by the Cochrane risk of bias tool. RESULTS Ethical approval is not required because this study is based on published papers. After peer-review, the study will be disseminated in scientific journals and conferences. CONCLUSION This systematic review will provide evidence for the efficacy and safety of Chinese medicine for recurrent aphthous stomatitis. PROSPERO REGISTRATION CRD42018111955.
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Affiliation(s)
- Ying Zhang
- Department of Geriatrics, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Kwan-him Ng
- School of Chinese Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chih-yu Kuo
- LONGHUA Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Dong-jie Wu
- Graduate School, Zhejiang Chinese Medical University, Hangzhou
- Clinical Research Unit, Longevity All Clinic, Quzhou, Zhejiang, China
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Sharma R, Pallagatti S, Aggarwal A, Sheikh S, Singh R, Gupta D. A Randomized, Double-Blind, Placebo-Controlled Trial on Clinical Efficacy of Topical Agents in Reducing Pain and Frequency of Recurrent Aphthous Ulcers. Open Dent J 2018; 12:700-713. [PMID: 30369980 PMCID: PMC6183024 DOI: 10.2174/1745017901814010700] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/13/2018] [Accepted: 09/04/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction Recurrent Aphthous Ulcers (RAU) is one of the most common oral ulcerative Disease of the oral mucosa with high recurrence rate. Standard topical treatment options provide symptomatic relief with few have been found to be effective in treating or relieving the symptoms. Aim The study aimed to evaluate the clinical efficacy of various topical agents in order to find the better treatment modality so as to decrease the number, size, exudate level and discomfort associated with pain with RAU. Materials and methods The patients diagnosed with minor recurrent aphthous ulcers fulfilling the inclusion and exclusion criteria were enrolled. All the baseline parameters were measured by the principal investigator. The treatment modality was assigned by generating a randomization list by computer software, double-blinded in consecutively numbered sealed envelopes. The topical treatment modalities that were included: 5% Amlexanox, 0.1% Triamcinolone Acetonide, 20% Benzocaine gel, 100 mg Doxycycline hyclatemixed with denture adhesive and normal saline (20:2:1); The study was placebo controlled in which placebo gel 10 gm was used. The size, no of ulcers, pain, erythema and exudate level were measured by the principal investigator at days 1, 4, 8 and 10. All quantitative variables were estimated using measures of central tendency (mean, median) and measures of dispersion (standard deviation). Qualitative or categorical variables were described as frequencies or proportions. Proportions were compared using Post Hoc Test and N Par Tests. Effectiveness was checked using p-value (< 0.005). Results It was observed that 0.1% Triamcinolone Acetonide and 5% Amlexanox proven to be more efficacious in the reduction of size, Number, Pain, Erythema and Exudate Levels at day 8, (p = .000*) and at day 10 (p =. 000*) as compared to single application of 100 mg Doxycycline Hyclate, 20% Benzocaine gel and the placebo, which was statistically significant. VAS scale was significant for 100 mg Doxycycline Hyclate and 20% Benzocaine gel. Conclusion The selected topical treatment modality can deliver cheap, effective and safe drug therapy which benefits the patient in refining their regular activities and everyday events of life.
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Affiliation(s)
- Renu Sharma
- Department of Oral Medicine and Radiology, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, Punjab- 147301, India
| | - Shambulingappa Pallagatti
- Department of Oral Medicine and Radiology, Maharishi Markandeshwar College of Dental Science and Research, Mullana, Ambala, India
| | - Amit Aggarwal
- Department of Oral Medicine and Radiology, Maharishi Markandeshwar College of Dental Science and Research, Mullana, Ambala, India
| | - Soheyl Sheikh
- Department of Oral Medicine and Radiology, Maharishi Markandeshwar College of Dental Science and Research, Mullana, Ambala, India
| | - Ravinder Singh
- Department of Oral Medicine and Radiology, Maharishi Markandeshwar College of Dental Science and Research, Mullana, Ambala, India
| | - Deepak Gupta
- Department of Oral Medicine and Radiology, Maharishi Markandeshwar College of Dental Science and Research, Mullana, Ambala, India
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Khozeimeh F, Saberi Z, Tavangar A, Badi FF. Effect of Herbal Echinacea on Recurrent Minor Oral Aphthous Ulcer. Open Dent J 2018; 12:567-571. [PMID: 30258501 PMCID: PMC6131317 DOI: 10.2174/1874210601812010567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/28/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
Abstract
Background The oral aphthous is a common oral ulcer with intense pain and there is no treatment for it, yet. Echinacea is an herbal medicine that moderated the immune system. Objective The aim of this study was to investigate the effects of Echinacea on the treatment of aphthous ulcer. Methods 50 patients with minor aphthous participated in our study. 25 patients take 3 tablets in a day for five weeks (case group) and 25 patients didn't take any tablets (control group). The patients were monitored for one month before taking the tablets for six months. During this period, the number of lesions, complete improvement of ulcers, recurrence rate and intensity of pain were considered in each month. Finally, the Friedman and ANOVA tests used to analyze the obtained data. Result Our study showed a significant difference between a number of lesions during six-month in case and control groups (p>0.001). In this way, we observed that the number of lesions was decreased significantly after six months in the case group. Hence, ANOVA analysis showed a significant decrease between each month for the intensity of pain (p=0.025), complete improvement (p<0.001) and recurrence rate (p=0.026). Conclusion In conclusion, we showed that Echinacea tablets as an herbal medicine have positive effects on a number of lesions, intensity of pain, complete improvement and recurrence rate in patients with recurrent minor aphthous ulcers.
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Affiliation(s)
- Faezeh Khozeimeh
- Dental Research Center, Department of Oral and Maxillofacial Medicine, School of Dentistry, University Of Medical Sciences, Isfahan, Iran
| | - Zahra Saberi
- Dental Research Center, Department of Oral and Maxillofacial Medicine, School of Dentistry, University Of Medical Sciences, Isfahan, Iran
| | - Atefeh Tavangar
- Dental Material Research Center, Department of Oral and Maxillofacial Medicine, School of Dentistry, Isfahan University Of Medical Sciences, Isfahan, Iran
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Akerzoul N, Chbicheb S. Low laser therapy as an effective treatment of recurrent aphtous ulcers: a clinical case reporting two locations. Pan Afr Med J 2018; 30:205. [PMID: 30574224 PMCID: PMC6294968 DOI: 10.11604/pamj.2018.30.205.15779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/22/2018] [Indexed: 11/11/2022] Open
Abstract
Apthous ulcers, commonly referred to as canker sores, are the most common ulcerative lesions of the oral mucosa. These are usually painful and are associated with redness and occasional bleeding from the affected area(s). Low Level Laser Therapy (LLLT) has shown excellent results in relieving the pain and complete remission of the oral ulcers. Through a clinical case, we report two locations of oral ulcers treated successfully with diode laser.
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Affiliation(s)
- Narjiss Akerzoul
- Department of Oral Surgery, Faculty of Dentistry, Mohamed V University, Rabat, Morocco
| | - Saliha Chbicheb
- Department of Oral Surgery, Faculty of Dentistry, Mohamed V University, Rabat, Morocco
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Kim J, Song MJ, Jeong HJ, Cho SK, Sung YK. A Case of Refractory Oral Aphthous Ulcer Successfully Treated with Adalimumab. JOURNAL OF RHEUMATIC DISEASES 2017. [DOI: 10.4078/jrd.2017.24.3.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jinyeong Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Myung-jin Song
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hye-Jin Jeong
- Department of Rheumatology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Soo-Kyung Cho
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
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Ranganath SP, Pai A. Is Optimal Management of Recurrent Aphthous Stomatitis Possible? A Reality Check. J Clin Diagn Res 2016; 10:ZE08-ZE13. [PMID: 27891490 DOI: 10.7860/jcdr/2016/19519.8643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 06/17/2016] [Indexed: 12/31/2022]
Abstract
Recurrent Aphthous Stomatitis (RAS) is a condition in which aphthous ulcers repeatedly occur in the oral cavity. It is prevalent in developed countries, occurring in all ages, geographic regions and races and about 80% of people have one episode of oral aphthous ulcers before the age of 30 years. With no laboratory procedures to confirm the diagnosis, treatment is mainly empirical in nature and focuses on short-term symptomatic management. Although numerous treatment modalities have been recommended, only a few are evidence based and can be considered for the optimal management of RAS. Biologic agents are a new category of drugs which acts by blocking specific pathways associated with the pathophysiology of neoplastic or immune-mediated diseases. These agents have targeted immunosuppressive or anti-inflammatory actions. In patients of RAS who were not responding to standard therapy, etanercept, adalimumab, infliximab and Interferon-Alpha (INF-α) were found to be useful. The objective of this review was to propose and review a treatment protocol to be followed for the optimal management of RAS. We reviewed several evidence-based studies and through this review we recommend topical interventions as the first-line of therapy since they are associated with low risk of systemic side effects. Due to limitations in the number of evidence-based trials and the insufficient data to support or refute the efficacy of the therapies prescribed, larger evidence-based clinical studies and literature reviews are needed to further improvise the optimal methodology for the effective management of RAS.
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Affiliation(s)
- Shesha Prasad Ranganath
- Senior Lecturer, Department of Oral Medicine and Radiology, The Oxford Dental College , Bengaluru, Karnataka, India
| | - Anuradha Pai
- Professor and Head of Department, Department of Oral Medicine and Radiology, The Oxford Dental College , Bengaluru, Karnataka, India
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24
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Robertson JJ. Managing Pharyngeal and Oral Mucosal Pain. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0101-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Vaillant L, Samimi M. [Aphthous ulcers and oral ulcerations]. Presse Med 2016; 45:215-26. [PMID: 26880080 DOI: 10.1016/j.lpm.2016.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/06/2016] [Indexed: 02/07/2023] Open
Abstract
Aphthous ulcers are painful ulcerations located on the mucous membrane, generally in the mouth, less often in the genital area. Three clinical forms of aphthous ulcers have been described: minor aphthous ulcers, herpetiform aphthous ulcers and major aphthous ulcers. Many other conditions presenting with oral bullous or vesiculous lesions orulcerations and erosions can be mistaken for aphthous ulcers. Currently, treatment of aphthous ulcers is palliative and symptomatic. Topical treatments (topical anesthetics, topical steroids and sucralfate) are the first line therapy. Recurrent aphthous stomatitis (RAS) is defined by the recurrence of oral aphthous ulcers at least 4 times per year. RAS is often idiopathic but can be associated with gastro-intestinal diseases (i.e. celiac disease, inflammatory bowel diseases), nutritional deficiencies (iron, folates...), immune disorders (HIV infection, neutropenia) and rare syndromes. Behçet's disease is a chronic, inflammatory, disease whose main clinical feature is recurrent bipolar aphthosis. Colchicine associated with topical treatments constitutes a suitable treatment of most RAS. Thalidomide is the most effective treatment of RAS but its use is limited by frequent adverse effects. Oral ulcers can be related to a wide range of conditions that constitute the differential diagnoses of aphthous ulcers. Oral ulcers are classified into three main groups: acute ulcers with abrupt onset and short duration, recurrent ulcers (mainly due to postherpetic erythema multiforme) and chronic ulcers (with slow onset and insidious progression). Acute oral ulcers are due to trauma, bacterial infections (including acute necrotizing ulcerative gingivitis), deep fungal infection, gastro-intestinal (namely inflammatory bowel disease) or systemic diseases. Chronic oral ulcers may be drug-induced, or due to benign or malignant tumors. Every oral solitary chronic ulcer should be biopsied to rule out squamous cell carcinoma. A solitary palatal ulcer can be related with necrotizing sialometaplasia.
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Affiliation(s)
- Loïc Vaillant
- CHRU de Tours, université François-Rabelais de Tours, hôpital Trousseau, Inserm U 930, service de dermatologie, 37044 Tours cedex 01, France.
| | - Mahtab Samimi
- CHRU de Tours, université François-Rabelais de Tours, hôpital Trousseau, Inra, service de dermatologie, 37044 Tours cedex 01, France
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Management of recurrent aphthous ulcers using low-level lasers: A systematic review. Medicina (B Aires) 2016; 52:263-268. [DOI: 10.1016/j.medici.2016.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 07/05/2016] [Accepted: 07/21/2016] [Indexed: 11/17/2022] Open
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Hijazi K, Lowe T, Meharg C, Berry SH, Foley J, Hold GL. Mucosal microbiome in patients with recurrent aphthous stomatitis. J Dent Res 2014; 94:87S-94S. [PMID: 25540188 DOI: 10.1177/0022034514565458] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Recurrent aphthous stomatitis (RAS) is the most common disease affecting oral mucosae. Etiology is unknown, but several factors have been implicated, all of which influence the composition of microbiota residing on oral mucosae, which in turn modulates immunity and thereby affects disease progression. Although no individual pathogens have been conclusively shown to be causative agents of RAS, imbalanced composition of the oral microbiota may play a key role. In this study, we sought to determine composition profiles of bacterial microbiota in the oral mucosa associated with RAS. Using high-throughput 16S rRNA gene sequencing, we characterized the most abundant bacterial populations residing on healthy and ulcerated mucosae in patients with RAS (recruited using highly stringent criteria) and no associated medical conditions; we also compared these to the bacterial microbiota of healthy controls (HCs). Phylum-level diversity comparisons revealed decreased Firmicutes and increased Proteobacteria in ulcerated sites, as compared with healthy sites in RAS patients, and no differences between RAS patients with healthy sites and HCs. Genus-level analysis demonstrated higher abundance of total Bacteroidales in RAS patients with healthy sites over HCs. Porphyromonadaceae comprising species associated with periodontal disease and Veillonellaceae predominated in ulcerated sites over HCs, while no quantitative differences of these families were observed between healthy sites in RAS patients and HCs. Streptococcaceae comprising species associated with oral health predominated in HCs over ulcerated sites but not in HCs over healthy sites in RAS patients. This study demonstrates that mucosal microbiome changes in patients with idiopathic RAS--namely, increased Bacteroidales species in mucosae of RAS patients not affected by active ulceration. While these changes suggest a microbial role in initiation of RAS, this study does not provide data on causality. Within this limitation, the study contributes to the understanding of the potential role of mucosal microbiome changes in oral mucosal disease.
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Affiliation(s)
- K Hijazi
- School of Medicine and Dentistry, Division of Medical and Dental Education, University of Aberdeen, Aberdeen, UK
| | - T Lowe
- Maxillofacial Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | - C Meharg
- School of Biological Sciences, Institute for Global Food Security, Queen's University Belfast, Belfast, UK
| | - S H Berry
- School of Medicine and Dentistry, Division of Applied Medicine, University of Aberdeen, Aberdeen, UK
| | - J Foley
- School of Medicine and Dentistry, Division of Medical and Dental Education, University of Aberdeen, Aberdeen, UK Edinburgh Dental Institute, Edinburgh, UK
| | - G L Hold
- School of Medicine and Dentistry, Division of Applied Medicine, University of Aberdeen, Aberdeen, UK
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Hullah EA, Blaker PA, Marinaki AM, Escudier MP, Sanderson JD. A practical guide to the use of thiopurines in oral medicine. J Oral Pathol Med 2014; 44:761-8. [PMID: 25529219 DOI: 10.1111/jop.12274] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 12/11/2022]
Abstract
Thiopurines are widely used as first-line immunosuppressive therapies in the management of chronic inflammatory oral disease. However, despite over half a century of clinical experience, the evidence base for their use is limited. The aims of this paper were to review the evidence for the use of thiopurines in oral medicine and provide a contemporary model of thiopurine metabolism and mechanism of action and a rationale for clinical use and safe practice.
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Affiliation(s)
- E A Hullah
- Oral Medicine, King's College London Dental Institute, London, UK
| | - P A Blaker
- Gastroenterology, Guy's & St Thomas' Hospitals NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, UK
| | - A M Marinaki
- Purine Research Laboratory, Viapath, Guy's & St Thomas' Hospitals NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, UK
| | - M P Escudier
- Oral Medicine, King's College London Dental Institute, London, UK
| | - J D Sanderson
- Gastroenterology, Guy's & St Thomas' Hospitals NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London, UK
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M K PD, D N S V R, Koppal S, Byatnal AR, Rukmangada T, Byatnal AA. Efficacy of rebamipide and levamisole in the treatment of patients with recurrent aphthous ulcer - a comparative study. J Clin Diagn Res 2014; 8:ZC119-22. [PMID: 25584301 DOI: 10.7860/jcdr/2014/10295.5202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/27/2014] [Indexed: 11/24/2022]
Abstract
UNLABELLED Context (Background): Recurrent aphthous stomatitis is an inflammatory condition of unknown aetiology characterized by painful recurrent, single or multiple ulcerations of the oral mucosa. AIMS To compare the efficacy of rebamipide, a gastro-protective agent and levamisole, an immunomodulating agent in the treatment of recurrent aphthous stomatitis. MATERIALS AND METHODS Hundred patients diagnosed with recurrent aphthous stomatitis were enrolled in the study. Fifty patients were assigned randomly to each of the two treatment groups. After the clinical diagnosis and ulcer measurement, a subjective evaluation of symptoms was done for each subject. Both the drugs were given orally at specified intervals. Ulcer measurements and subjective evaluations were made at day one. STATISTICAL ANALYSIS Analysis was done using various test like Mann Whitney and t-test. RESULTS AND CONCLUSION The overall results showed mean number of episodes whose values were not statistically significant (p=0.43), neither were the mean number of ulcers (p=0.75), or values for mean size of ulcers (p=0.91). However, the overall results suggested that efficacy of rebamipide is almost same as that of the efficacy of previously proved drug levamisole. The current study with a three months follow up, including patients with high scores of pain, aphthae count, ulcer size and frequency of occurrence showed better results in both the study groups. However, rebamipide is suggested to be well tolerated and may therefore be useful in the treatment and prevention of frequently recurrent aphthous ulcers not restricted to Behcet's disease.
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Affiliation(s)
- Parvathi Devi M K
- Reader, Department of Oral Medicine and Radiology, AMES Dental College and Hospital , Raichur, Karnataka, India
| | - Ramesh D N S V
- Professor, Department of Oral Medicine and Radiology, Pulla Reddy Dental College and Hospital , Kurnool, Andhrapradesh, India
| | - Shrinivas Koppal
- Professor, Department of Oral Medicine and Radiology, AMES Dental College and Hospital , Raichur, Karnataka, India
| | - Amit R Byatnal
- Assistant Professor, Department of Oral Medicine and Radiology, AMES Dental College and Hospital , Raichur, Karnataka, India
| | - Thriveni Rukmangada
- Professor and Head, Department of Oral Medicine and Radiology, AMES Dental College and Hospital , Raichur, Karnataka, India
| | - Aditi A Byatnal
- Private Consultant, Department of Oral and Maxillofacial Pathology, Hubli, Karnataka, India
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Altenburg A, El-Haj N, Micheli C, Puttkammer M, Abdel-Naser MB, Zouboulis CC. The treatment of chronic recurrent oral aphthous ulcers. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:665-73. [PMID: 25346356 PMCID: PMC4215084 DOI: 10.3238/arztebl.2014.0665] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 06/18/2014] [Accepted: 06/18/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic recurrent oral aphthous ulcers are the most common type of inflammatory efflorescence of the oral mucosa, with a prevalence of 2% to 10% in Caucasian populations. To treat them properly, physicians should know their clinical appearance and course, conditioning factors, underlying causes, and differential diagnosis. METHOD This review is based on pertinent articles that were retrieved by a selective search in PubMed and in the Cochrane Central Register of Controlled Trials. RESULTS Hard, acidic, and salty foods and toothpastes containing sodium lauryl sulfate should be avoided, along with alcohol and carbonated drinks. In Germany, the only drugs that have been approved to treat oral aphthous ulcers are corticosteroids, topical antiseptic/anti-inflammatory agents such as triclosan and diclofenac, and local anesthetics such as lidocaine. Antiseptic agents and local anesthetics should be tried first; if these are ineffective, topical cortico steroids should be used. In severe cases, local measures can be combined with systemic drugs, e.g., colchicine, pentoxifylline, or prednisolone. The efficacy of systemic treatment is debated. Other immunosuppressive agents should be given systemically only for refractory or particularly severe oral aphthous ulcers due to Adamantiades-Behçet disease. CONCLUSION The treatment of chronic recurrent oral aphthous ulcers is symptomatic, mainly with topically applied agents. It is tailored to the severity of the problem in the individual case, i.e., the frequency of ulcers, the intensity of pain, and the responsiveness of the lesions to treatment. Effective treatment relieves pain, lessens functional impairment, and lowers the frequency and severity of recurrences.
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Affiliation(s)
- Andreas Altenburg
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center
| | - Nadine El-Haj
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center
| | - Christiana Micheli
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center
| | | | - Mohammed Badawy Abdel-Naser
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center
- Department of Dermatology and Andrology, Faculty of Medicine, Ain Shams University, Cairo (Egypt)
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center
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Siupsinskiene N, Žekonienė J, Padervinskis E, Žekonis G, Vaitkus S. Efficacy of sucralfate for the treatment of post-tonsillectomy symptoms. Eur Arch Otorhinolaryngol 2014; 272:271-8. [PMID: 24691853 DOI: 10.1007/s00405-014-3023-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 03/20/2014] [Indexed: 12/20/2022]
Abstract
Pain after tonsillectomy remains the main issue of postoperative morbidity and the search for an effective post-tonsillectomy analgesic is of increasing relevance. The aim of this study was to evaluate the effectiveness of topical sucralfate during an early post-tonsillectomy period. Fifty patients of both genders from 6 to 58 years submitted to tonsillectomy or adenotonsillectomy were randomly included into either a sucralfate treatment group (N = 25) or into a control group (N = 25). Patients of the sucralfate group received topical sucralfate four times a day for 7 days. No topical treatment was applied to patients of the control group. A systemic analgesic was standardized. Post-tonsillectomy symptoms, including throat pain, odynophagia and otalgia, were evaluated during the period of seven postoperative days. Secondary outcomes were analgesic use, well being in general, return to regular daily activities, secondary hemorrhage and side effects of sucralfate. This study revealed that during the period of the second to seventh postoperative days average throat pain scores of the sucralfate using patients were significantly lower than those of the control group patients (p < 0.05); the same could be applied to odynophagia scores during the period of all seven postoperative days (p < 0.01) and otalgia scores from the 4th postoperative day (p < 0.05). The sucralfate group patients also had a significantly smaller need for analgesics, better scores of well being in general and early return to regular daily activities with no side effects of the treatment. Topical sucralfate could be recommended for the everyday clinical practice as a safe, adjuvant medicine of treatment during the period of the first post-tonsillectomy week.
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Affiliation(s)
- Nora Siupsinskiene
- Department of Otorhinolaryngology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania,
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Hopper SM, McCarthy M, Tancharoen C, Lee KJ, Davidson A, Babl FE. Topical Lidocaine to Improve Oral Intake in Children With Painful Infectious Mouth Ulcers: A Blinded, Randomized, Placebo-Controlled Trial. Ann Emerg Med 2014; 63:292-9. [DOI: 10.1016/j.annemergmed.2013.08.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 08/18/2013] [Accepted: 08/23/2013] [Indexed: 02/06/2023]
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Abstract
Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease affecting the oral mucosa. RAS occurs mostly in healthy individuals and has an atypical clinical presentation in immunocompromised individuals. The etiology of RAS is still unknown, but several local, systemic, immunologic, genetic, allergic, nutritional, and microbial factors, as well as immunosuppressive drugs, have been proposed as causative agents. Clinical management of RAS using topical and systemic therapies is based on severity of symptoms and the frequency, size, and number of lesions. The goals of therapy are to decrease pain and ulcer size, promote healing, and decrease the frequency of recurrence.
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Affiliation(s)
- Sunday O Akintoye
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Martin S Greenberg
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA 19104, USA
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Mansour G, Ouda S, Shaker A, Abdallah HM. Clinical efficacy of new aloe vera- and myrrh-based oral mucoadhesive gels in the management of minor recurrent aphthous stomatitis: a randomized, double-blind, vehicle-controlled study. J Oral Pathol Med 2013; 43:405-9. [PMID: 24164309 DOI: 10.1111/jop.12130] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the clinical efficacy, and safety of newly customized natural oral mucoadhesive gels, containing either aloe vera or myrrh as active ingredients, in the management of minor recurrent aphthous stomatitis (MiRAS). SUBJECTS AND METHODS Ninety subjects with MiRAS were recruited from Oral Medicine Clinic, at Faculty of Dentistry, King Abdulaziz University, Saudi Arabia, for this randomized, double-blind, placebo-controlled study. Two new natural gels, containing aloe vera and myrrh, were prepared in a concentration of (0.5% w/w), in addition to a plain mucoadhesive gel used as a placebo. Patients with fresh ulcers (<48-h duration) were instructed to apply either one of the three gels four times a day for a period of 5 days. Clinical efficacy was investigated in the form of changes in ulcer size, pain intensity, erythema, and exudation at days 4 and 6 of study entry. Participants were interviewed for the emergence of any side effects. RESULTS 76.6% of patients using aloe gel showed complete ulcer healing, 86.7%, and 80% of them revealed subsidence of erythema and exudation, respectively, especially at day 6 visit, whereas 76.7% of myrrh-treated patients revealed almost absence of pain at day 6. No side effects were encountered with the use of any of the three gels. CONCLUSION The new formulated aloe- and myrrh-based gels proved to be effective in topical management of MiRAS. Aloe was superior in decreasing ulcer size, erythema, and exudation; whereas myrrh resulted in more pain reduction.
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Affiliation(s)
- Ghada Mansour
- Department of Oral Basic and Clinical Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Oral Medicine, Periodontology, Oral Diagnosis and Oral Radiology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Gibson AM, Sommerkamp SK. Evaluation and management of oral lesions in the emergency department. Emerg Med Clin North Am 2013; 31:455-63. [PMID: 23601482 DOI: 10.1016/j.emc.2013.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article reviews the emergency diagnosis and treatment of oral lesions. It presents a framework for developing a differential diagnosis based on the color of the lesions, describes emergency department interventions, and identifies pitfalls for the emergency physician.
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Affiliation(s)
- Alisa M Gibson
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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Abstract
Recurrent aphthous ulcers are the most common inflammatory lesions of the oral mucosa, occurring in up to 10% of the population and even more common in children. The history, morphological characteristics, predilection sides and typical stages of aphthae help to distinguish them from other diseases that may exhibit aphthous-like lesions. Underlying diseases should be excluded. The main goals of therapy are to minimize pain and functional disabilities as well as decrease frequency and severity of recurrences. Topical symptomatic relief is the standard of care for simple cases of recurrent aphthosis. In cases of major aphthosis or systemic involvement, topical therapies are still useful but should be combined with systemic therapy, such as colchicine, pentoxifylline or prednisolone. In case of Adamantiades-Behçet disease, systemic immunomodulatory drugs can inhibit the development of new lesions. This overview summarizes morphological and presentation forms of aphthae, differential diagnoses and evidence-based therapeutic possibilities.
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Repurposing of yunnan baiyao as an alternative therapy for minor recurrent aphthous stomatitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:284620. [PMID: 23258985 PMCID: PMC3521495 DOI: 10.1155/2012/284620] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/22/2012] [Indexed: 11/24/2022]
Abstract
The study was designed to evaluate the efficacy and safety of an herbal extract of Yunnan Baiyao formulated in toothpaste as an alternative therapy for minor RAS. A randomized, double-blind, placebo-controlled clinical trial (from March 2010 to March 2011) was conducted on a cohort of 227 minor RAS patients. The toothpaste containing Yunnan Baiyao was used twice daily as part of the patient's routine oral hygiene for 5 days. An assessment of ulcerative size and pain was recorded on day 0 (baseline), day 3, and day 5. Any noted adverse reactions were recorded. All data were analyzed using the SAS software 8.0. As a result, the toothpaste containing Yunnan Baiyao began to present noticeable effectiveness on ulcer healing (ulcer size) by day 3 (27.5% versus 15.8%, P < 0.05), which further improved by day 5 when compared to the placebo (66.4% versus 50.0%, P = 0.01). A significant difference in alleviating pain was noted on day 5 for those who used the toothpaste containing Yunnan Baiyao (66.4% versus 51.8%, P < 0.05). No side effects were noted as a result of the Yunnan Baiyao. Therefore, Yunnan Baiyao may provide an alternative therapy for minor ulcers by promoting healing.
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Hopper SM, Babl FE, McCarthy M, Tancharoen C, Lee KJ, Oakley E. A double blind, randomised placebo controlled trial of topical 2% viscous lidocaine in improving oral intake in children with painful infectious mouth conditions. BMC Pediatr 2011; 11:106. [PMID: 22104033 PMCID: PMC3251034 DOI: 10.1186/1471-2431-11-106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 11/21/2011] [Indexed: 12/26/2022] Open
Abstract
Background Painful infectious mouth conditions are a common presentation to emergency departments. Although self limiting, painful ulcerative lesions and inflamed mucosa can decrease oral intake and can lead to dehydration. Oral analgesia is of limited efficacy and is often refused by the patient. Despite widespread use of oral 2% viscous lidocaine for many years, there is little evidence for its efficacy as an analgesic and in aiding oral intake in children with painful infectious mouth conditions. This study aims to establish the effectiveness of 2% viscous lidocaine in increasing oral intake in these children by comparing it with placebo. Methods/Design This study is a randomised double-blind placebo controlled trial of children between 6 months and 8 years of age with painful infectious mouth conditions defined as gingivostomatitis (herpetic or non herpetic), ulcerative pharyngitis, herpangina and hand foot and mouth disease as assessed by the treating clinician in association with a history of poor oral fluid intake. It will be conducted at a single tertiary paediatric emergency department in Melbourne Australia. 20 patients have already been randomised to receive 2% lidocaine or placebo in a pilot study to determine the sample size in a preplanned adaptive design. A further 80 patients will be randomised to receive either 2% lidocaine or placebo. The placebo agent is identical to lidocaine in terms of appearance, flavour and smell. All clinical and research staff involved, patients and their parents will be blinded to treatment allocation. The primary endpoint is the amount of fluid ingested by each child, expressed in ml/kg, within 60 minutes from the time of administration of the study mixture. Secondary endpoints are the proportion of patients ingesting 5 ml/kg and 10 ml/kg at 30 and 60 minutes after drug administration and the incidence of adverse events. Longer term outcomes will include the proportion of patients requiring hospital admission and length of emergency department stay. Discussion This trial will define the role of 2% lidocaine in the treatment of painful infectious mouth conditions Trial registration The trial is registered with the Australian and New Zealand Clinical Trials Registry - ACTRN12609000566235.
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Affiliation(s)
- Sandy M Hopper
- Department of Emergency Medicine, Royal Children's Hospital, and Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Flemington Rd, Parkville, Victoria 3052, Australia.
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Topical use of systemic drugs in dermatology: A comprehensive review. J Am Acad Dermatol 2011; 65:1048.e1-22. [DOI: 10.1016/j.jaad.2010.08.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 07/28/2010] [Accepted: 08/06/2010] [Indexed: 11/24/2022]
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La aftosis oral recurrente en Reumatología. ACTA ACUST UNITED AC 2011; 7:323-8. [DOI: 10.1016/j.reuma.2011.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/13/2011] [Accepted: 05/17/2011] [Indexed: 12/20/2022]
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García-Sabina A, Rabuñal Rey R, Martínez-Pacheco R. Revisión sobre el uso de medicamentos en condiciones no incluidas en su ficha técnica. FARMACIA HOSPITALARIA 2011; 35:264-77. [PMID: 21570887 DOI: 10.1016/j.farma.2010.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 06/16/2010] [Accepted: 06/23/2010] [Indexed: 12/18/2022] Open
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Use of Lozenges Containing Lactobacillus brevis CD2 in Recurrent Aphthous Stomatitis: A Double-Blind Placebo-Controlled Trial. ACTA ACUST UNITED AC 2011. [DOI: 10.1155/2011/439425] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recurrent aphthous stomatitis is a common disorder of the oral cavity, affecting mainly young people. It is characterized by small ulcers which can be very painful and generally heal spontaneously within 7–14 days. There is currently no therapy that can provide rapid healing.
This study evaluated the efficacy and rapidity of response of a lozenge containing Lactobacillus brevis CD2. 30 patients were randomized to take 4 lozenges a day of active product or placebo for 7 days. Signs and symptoms as well as laboratory parameters in the saliva were assessed at the start of the study and after 7 days of treatment.
The study demonstrated the efficacy and the rapidity of response of the Lactobacillus brevis CD2 lozenges in resolving the clinical signs and symptoms of aphthous stomatitis, with a significantly rapid improvement of pain. This is the first study confirming the efficacy of a probiotic product in this pathology.
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Saint-Jean M, Tessier MH, Barbarot S, Billet J, Stalder JF. [Oral disease in children]. Ann Dermatol Venereol 2010; 137:823-37. [PMID: 21134589 DOI: 10.1016/j.annder.2010.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2010] [Indexed: 02/08/2023]
Affiliation(s)
- M Saint-Jean
- Clinique Dermatologique, CHU Hôtel-Dieu, Place A.-Ricordeau, 44093 Nantes Cedex, France
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Management of bisphosphonate-associated osteonecrosis: pentoxifylline and tocopherol in addition to antimicrobial therapy. An initial case series. ACTA ACUST UNITED AC 2010; 110:593-6. [DOI: 10.1016/j.tripleo.2010.05.067] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 05/27/2010] [Accepted: 05/28/2010] [Indexed: 11/22/2022]
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Hapa A, Aksoy B, Polat M, Aslan U, Atakan N. Does recurrent aphthous stomatitis affect quality of life? A prospective study with 128 patients evaluating different treatment modalities. J DERMATOL TREAT 2010; 22:215-20. [PMID: 20804437 DOI: 10.3109/09546631003675450] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Quality of life measures are increasingly being used in the evaluation of oral disease outcome. To date, there has been less focus on oral health-related quality of life (OHR-QoL) measures for oral diseases in dermatologic literature. OBJECTIVE To test whether patients with recurrent aphthous stomatitis (RAS) report a lower OHR-QoL than the general population and to evaluate therapeutic regimens for RAS by using OHR-QoL measures. METHOD A total of 128 patients and 40 controls were enrolled. A questionnaire entitled the 14-item oral health impact profile (OHIP-14) was completed. Forty-three (33%) of the patients were followed-up and completed the OHIP-14 following treatment. RESULTS The median total score of patients on colchicine before treatment was 21. Following use of colchicine, the total score was 10. There was a significant difference concerning the impact of oral health following use of oral colchicine. However, no reduction of OHIP-14 scores was observed in the topical treatment group. CONCLUSION When the influence of one of the most common oral diseases such as RAS on OHR-QoL was taken into consideration, OHR-QoL provides an additional dimension that may help to improve the impact of a disease on an individual's life. In relation to this, colchicine seems to be one of the most effective management strategies used in RAS.
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Affiliation(s)
- Asli Hapa
- Dermatology Clinic, Bolu Izzet Baysal State Hospital, Bolu, Turkey.
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Babaee N, Mansourian A, Momen-Heravi F, Moghadamnia A, Momen-Beitollahi J. The efficacy of a paste containing Myrtus communis (Myrtle) in the management of recurrent aphthous stomatitis: a randomized controlled trial. Clin Oral Investig 2009; 14:65-70. [PMID: 19306024 DOI: 10.1007/s00784-009-0267-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 03/05/2009] [Accepted: 03/09/2009] [Indexed: 12/22/2022]
Abstract
Recurrent aphthous stomatitis (RAS) is a common, painful, and ulcerative disorder of the oral cavity with unknown etiology. Treatment is a highly controversial topic. The aim of this study was to evaluate the clinical efficacy of a novel paste containing Myrtus communis (Myrtle) in the treatment of recurrent aphthous stomatitis. Myrtle is a particular herb used in some cultures as treatment for mouth ulcers. The study was a randomized, double-blind, controlled before-after clinical trial. Forty-five patients with RAS randomly participated in this study. The subjects were treated with placebo paste and myrtle oral paste in two consecutive episodes. The paste was applied by subjects themselves four times a day for 6 days. Five parameters (size change, pain scale, erythema and exudation level, oral health impact profile, and patient overall assessment of their treatment) were recorded both before (baseline) and during each episodes of treatment (on the morning of days 2, 4, and 6). There were no statistically significant differences between baseline parameters (p > 0.05). The data indicated a statistically significant reduction of ulcer size (p < 0.001), pain severity (p < 0.05), and erythema and exudation level (p < 0.001). Oral Health Impact Profile improved significantly in the treatment group (p < 0.001). Patient overall assessment of their treatment improved after applying paste containing myrtle (p < 0.05). No side effects were reported. This study has shown myrtle to be effective in decreasing the size of ulcers, pain severity and the level of erythema and exudation, and improving the quality of life in patients who suffer from RAS.
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Affiliation(s)
- Neda Babaee
- Department of Oral Medicine, Faculty of Dentistry, Babol University of Medical Sciences, Babol, Iran
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Altenburg A, Krahl D, Zouboulis CC. Non-infectious ulcerating oral mucous membrane diseases. J Dtsch Dermatol Ges 2009; 7:242-57. [DOI: 10.1111/j.1610-0387.2008.06962.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Daneshpazhooh M, Chams-Davatchi C, Ramezani A, Moinedin F, Rezaei Hemami M. Abortive aphthous-like oral lesions: an underreported initial presentation of pemphigus vulgaris. J Eur Acad Dermatol Venereol 2009; 23:157-9. [DOI: 10.1111/j.1468-3083.2008.03007.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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