1
|
Roy S, Chhaparwal Y, Kumar M, Acharya S, Chhaparwal S, Solomon MC. Evaluation of the Effectiveness of Amlexanox in the Treatment of Erosive Oral Lichen Planus: A Clinical Experience from a Tertiary Care Center. J Int Soc Prev Community Dent 2024; 14:61-68. [PMID: 38559643 PMCID: PMC10980302 DOI: 10.4103/jispcd.jispcd_113_23] [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: 07/24/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 04/04/2024] Open
Abstract
Aim This comparative study evaluated the effectiveness and safety profile of topical amlexanox and triamcinolone for the management of erosive oral lichen planus (EOLP). Materials and Methods This prospective, observational study included 21 patients diagnosed clinically and histopathologically with EOLP and categorized into two groups. Subjects in the two groups were prescribed topical amlexanox and triamcinolone, respectively, for 4 weeks. The area of the erosive lesion and burning sensation was measured at baseline, at the end of the first, 2second, and fourth week. These outcome measures were documented and statistically analyzed. The statistical analyses were performed using the IBM SPSS Statistics version 22. Analysis for age distribution was done by independent sample t test. Analysis of sex distribution was done by chi-square test. Variations within a single group for both the outcome parameters were calculated by Wilcoxon signed rank test. (P < 0.05 statistically significant). Results A total of 30 erosive sites were evaluated in 21 patients over a 4-week duration. The most common site was the buccal mucosa in both groups (23 of 30; 76.67% of total lesions assessed), followed by the tongue (5 of 30; 16.67% of total lesions assessed), the palate (1 of 30; 3.33% of total sites assessed), and the maxillary attached gingiva (1 of 30; 3.33% of total sites assessed). Group 1 (amlexanox) was comprised of 11 subjects, whereas Group 2 (triamcinolone) was comprised of 10 subjects. Pre and posttreatment comparison revealed no statistically significant difference (P = 0.756; 0.512, respectively), for the area of the erosion and burning sensation. Intragroup analysis showed that in Groups 1 and 2, there was a statistically significant reduction in the measures posttreatment (P < 0.05). Conclusions Amlexanox provides an earlier onset of pain relief in the treatment of EOLP, whereas providing a comparable reduction in the erosive area compared with triamcinolone. Topical amlexanox appears to be as effective as triamcinolone and is a promising alternative in the management of the erosive lichen planus with minimal adverse effects.
Collapse
Affiliation(s)
- Saurabh Roy
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Yogesh Chhaparwal
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mathangi Kumar
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shruthi Acharya
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shubha Chhaparwal
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Monica C Solomon
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
2
|
Amlexanox-loaded nanoliposomes showing enhanced anti-inflammatory activity in cultured macrophages: A potential formulation for treatment of oral aphthous stomatitis. J Drug Deliv Sci Technol 2023. [DOI: 10.1016/j.jddst.2022.104052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
3
|
Jiao S, Guan J, Chen M, Wang W, Li C, Wang Y, Cheng Y, Zhou Z. Targeting IRF3 as a YAP agonist therapy against gastric cancer. J Exp Med 2018; 215:699-718. [PMID: 29339449 PMCID: PMC5789414 DOI: 10.1084/jem.20171116] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/07/2017] [Accepted: 12/12/2017] [Indexed: 11/25/2022] Open
Abstract
Jiao et al. show that the key player of antiviral immunity IRF3 binds to and promotes the transactivation of the YAP–TEAD4 complex to coregulate transcription of Hippo pathway target genes and that therapeutic targeting of IRF3 suppresses YAP-driven gastric cancer. The Hippo pathway plays a vital role in tissue homeostasis and tumorigenesis. The transcription factor IRF3 is essential for innate antiviral immunity. In this study, we discovered IRF3 as an agonist of Yes-associated protein (YAP). The expression of IRF3 is positively correlated with that of YAP and its target genes in gastric cancer; the expression of both IRF3 and YAP is up-regulated and prognosticates patient survival. IRF3 interacts with both YAP and TEAD4 in the nucleus to enhance their interaction, promoting nuclear translocation and activation of YAP. IRF3 and YAP–TEAD4 are associated genome-wide to cobind and coregulate many target genes of the Hippo pathway. Overexpression of active IRF3 increased, but depletion of IRF3 reduced, the occupancy of YAP on the target genes. Knockdown or pharmacological targeting of IRF3 by Amlexanox, a drug used clinically for antiinflammatory treatment, inhibits gastric tumor growth in a YAP-dependent manner. Collectively, our study identifies IRF3 as a positive regulator for YAP, highlighting a new therapeutic target against YAP-driven cancers.
Collapse
Affiliation(s)
- Shi Jiao
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Jingmin Guan
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Min Chen
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Wenjia Wang
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Chuanchuan Li
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yugong Wang
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yunfeng Cheng
- Department of Hematology and Institute of Clinical Science, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhaocai Zhou
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China.,State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China .,University of Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
4
|
Han M, Fang H, Li QL, Cao Y, Xia R, Zhang ZH. Effectiveness of Laser Therapy in the Management of Recurrent Aphthous Stomatitis: A Systematic Review. SCIENTIFICA 2016; 2016:9062430. [PMID: 28078164 PMCID: PMC5203897 DOI: 10.1155/2016/9062430] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 11/15/2016] [Indexed: 06/06/2023]
Abstract
Objectives. Laser therapy is a promising new treatment for patients with recurrent aphthous stomatitis (RAS). However, the clinical effect and security issue of laser therapy remain controversial. This systematic review was conducted to evaluate the clinical effectiveness and security of laser treatment in RAS patients. Methods. Five electronic databases were searched (MEDLINE (PubMed), EMBASE, ScienceDirect, the Cochrane Library, and Web of Science) to identify all studies that were about randomized controlled clinical trials, involving the effect of laser therapy in RAS patients. Conclusion. Twenty-three studies were retained for full-text analysis after screening the titles and abstracts of potential articles, but only 10 studies satisfied the inclusion criteria after the full texts were reviewed. The included studies reported a comparison of the effectiveness between the laser treatment and placebo laser therapy (or conventional drug therapy) when managing the RAS patients. It can be concluded that laser therapy has the superiority in relieving ulcer pain and shortening healing time when compared with placebo group or medical treatment group. Although laser therapy is a promising effective treatment for RAS, high-quality clinical studies with large sample size must be further performed to confirm the effectiveness of this therapy.
Collapse
Affiliation(s)
- Min Han
- College & Hospital of Stomatology, Key Lab of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei 230032, China
| | - Hui Fang
- College & Hospital of Stomatology, Key Lab of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei 230032, China
| | - Quan-Li Li
- College & Hospital of Stomatology, Key Lab of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei 230032, China
| | - Ying Cao
- College & Hospital of Stomatology, Key Lab of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei 230032, China
| | - Rong Xia
- The 2nd Hospital Affiliated to Anhui Medical University, Hefei 230601, China
| | | |
Collapse
|
5
|
Abbasi F, Raoof M, Khatami R, Shadman N, Borjian-Boroojeni F, Nazari F. Effectiveness of Amlexanox and Adcortyl for the treatment of recurrent aphthous ulcers. J Clin Exp Dent 2016; 8:e368-e372. [PMID: 27703603 PMCID: PMC5045682 DOI: 10.4317/jced.52540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/05/2015] [Indexed: 11/28/2022] Open
Abstract
Background Recurrent aphthous stomatitis (RAS) is a common condition that affects approximately 20% of the general population. The ulcers can interfere with speech and eating and cause significant pain and discomfort. This study aimed to evaluate the efficacy of Amlexanox and Adcortyl in the treatment of aphthous ulcers. Material and Methods In this randomized double blind clinical trial with sequential patient entry, a total of 40 patients who presented with aphthous ulcers were included. Patients were received Amlexanox or Adcortyl four times daily for 7 days. Patients were evaluated for pain, lesion size, and tingling at one day, three days, five days and seven days follow-ups. The treatment effects were then evaluated using the Wilcoxon–Mann–Whitney (WMW) test. Values of p<0.05 were considered significant. Results No significant differences in pain score, tingling and lesion size were observed on similar days between Amlexanox and Adcortyl groups. In both groups, reduction in the assessed variables was significant between days 1-3, 3-5, and 5-7 (p < 0.001). Conclusions This study indicated that Amlexanox as well as Adcortyl was effective in relieving pain and reducing the lesion size during the treatment of aphthous ulcers. Key words:Recurrent aphthous stomatitis, Amlexanox, Adcortyl, pain relief.
Collapse
Affiliation(s)
- Farid Abbasi
- Associate Professor. Department of Oral Medicine, School of Dentistry, Shahed University of Medical Sciences, Tehran, Iran
| | - Maryam Raoof
- Assistant Professor. Laboratory of Molecular Neuroscience, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Roya Khatami
- Postgraduate Student of Oral Medicine. School of Dentistry, Shahed University, Tehran, Iran
| | - Niloofar Shadman
- Assistant Professor. Department of Operative Dentistry, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Farahnaz Nazari
- Postgraduate Student of Endodontics. School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
6
|
Sakly A, De Wever B, Jutla B, Satia M, Bogaert JP. The safety and efficacy of AphtoFix® mouth ulcer cream in the management of recurrent aphthous stomatitis. BMC Oral Health 2016; 16:17. [PMID: 26868504 PMCID: PMC4750241 DOI: 10.1186/s12903-016-0177-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/05/2016] [Indexed: 11/25/2022] Open
Abstract
Background Recurrent Aphthous stomatitis (RAS) is a prevalent ulcerative and painful disorder of the oral cavity with unknown etiology and for which no efficient treatment is currently available. The present study aimed to evaluate the safety and the efficacy of AphtoFix®, a new mouth ulcer cream that was developed to help treat RAS. Prior to launching the product on the market, two initial safety assessment studies were performed. Subjects and methods In a first study, the in vitro biocompatibility of AphtoFix® was evaluated on reconstructed human gingival tissue models according to ISO guidelines 10993. In a second study, the tolerability of AphtoFix® was evaluated in 20 subjects during a 4-weeks daily application in the mouth. The third study investigated both the safety and efficacy of AphtoFix® treatment on 19 patients suffering from RAS. This study was done in compliance with the Helsinki Declaration. Results The results of in vitro biocompatibility study showed that AphtoFix® mouth ulcer cream did not induce any detectable cytotoxicity and irritation. These observations were confirmed in the 4 weeks tolerability study where no undesired of adverse reactions were noticed. The results of the post-market clinical efficacy study demonstrated a clear reduction in ulcer size from baseline after 3 days treatment (p < 0.05). Pain intensity reduction was also observed in all subjects. Conclusion The application of AphtoFix® did not induce any undesired skin or mucosa reactions. These initial findings demonstrate that AphtoFix® is safe and efficient in reducing ulcer size and decreasing the pain intensity induced by ulcers. Trial registration Clinical trial Registry India Nr. CTRI201408004918, Date of registration: 22/08/2014 Electronic supplementary material The online version of this article (doi:10.1186/s12903-016-0177-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Amina Sakly
- MSI (Medical Sanitizing Innovations) Laboratories AG, Vaduz, Liechtenstein. .,Bonyf AG, Heiligkreuz 16, FL-9490, Vaduz, Liechtenstein.
| | - Bart De Wever
- MSI (Medical Sanitizing Innovations) Laboratories AG, Vaduz, Liechtenstein.
| | - Balraj Jutla
- MSI (Medical Sanitizing Innovations) Laboratories AG, Vaduz, Liechtenstein. .,Bonyf AG, Heiligkreuz 16, FL-9490, Vaduz, Liechtenstein.
| | - Milan Satia
- Ethicare Clinical Trial Services; Satellite, Ahmedabad, 380015, Gujarat, India.
| | - Jean Pierre Bogaert
- MSI (Medical Sanitizing Innovations) Laboratories AG, Vaduz, Liechtenstein. .,Bonyf AG, Heiligkreuz 16, FL-9490, Vaduz, Liechtenstein.
| |
Collapse
|
7
|
Mays JW, Sarmadi M, Moutsopoulos NM. Oral manifestations of systemic autoimmune and inflammatory diseases: diagnosis and clinical management. J Evid Based Dent Pract 2013; 12:265-82. [PMID: 23040353 DOI: 10.1016/s1532-3382(12)70051-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT Systemic autoimmune and inflammatory diseases often manifest oral lesions in their earliest stages, and early diagnosis, which may be spurred by a dental examination, is key for improved outcomes. After systemic diagnosis, oral lesions benefit from specialized care by dentists in collaboration with the medical team. This review aims to educate dental clinicians about the most relevant systemic autoimmune and inflammatory conditions with accompanying oral lesions, their implications for health, and management strategies supported by the biomedical literature and clinical experience. Ulcerative conditions including Behcet and Crohn diseases are discussed, along with rheumatic conditions including Sjögren syndrome, lupus erythematosus, and rheumatoid arthritis. EVIDENCE ACQUISITION Evidence was accumulated through PubMed searches using pertinent keywords for each subsection. References were reviewed and original publications examined to verify the accuracy of the information. We focused on evidence included in current reviews and randomized trials. Recommendations were supported by multiple studies and consensus expert opinion. EVIDENCE SYNTHESIS Disease phenotypes described and clinical recommendations were synthesized from best-quality evidence available for each disease. Efforts were made to describe evidence selection within each disease section. CONCLUSIONS Dentists play an important role in the early detection and multidisciplinary medical management of complex autoimmune diseases. It is important to recognize prevalent medical and dental issues and special needs of patients with autoimmune conditions. The management of many inflammatory conditions is similar, and often begins with the use of topical steroids, analgesics, and antimicrobial treatments, in addition to careful attention to oral hygiene and appropriate fluoride usage. In this brief review, we aim to discuss the presentation/prevalence, diagnosis, and treatment of oral manifestations encountered in autoimmune, autoinflammatory and systemic chronic inflammatory diseases. Systemic autoimmune conditions are estimated to affect 5% to 8% of Americans.(1) Oral manifestations are encountered with high frequency, and are often the first clinical signs or symptoms of the general disease. Optimal management of complex autoimmune diseases requires a multidisciplinary medical team including dentists to care for lesions of the oral cavity. The dental practitioner may be asked to play a primary role in the diagnosis of such conditions and to participate with other health professionals working together to achieve effective clinical management. To aid in this process, we discuss in this article the current general knowledge of systemic autoimmune conditions that present with prevalent oral manifestations. The focus is on the diagnosis and management of the oral component of each disease. Importantly, whereas the etiology and pathogenesis and systemic clinical presentation may vary, presentation in the oral cavity is often similar and many conditions involve oral ulcerations. For this reason, we discuss the differential diagnosis and management of the most common oral ulcerations in a general section and subsequently address individual conditions that present with oral ulcerations. Similarly, treatment of various autoimmune/inflammatory oral conditions is often common and involves modulation or suppression of the immune response locally and/or systemically and will be therefore addressed in a common section as well as individually for each disease when unique treatment regimens are recommended. We present here our general treatment recommendations based on clinical experience and literature review; however, it is critical that good clinical judgment and specifics of an individual case should determine the appropriate dental/oral medicine intervention for a specific patient.
Collapse
Affiliation(s)
- Jacqueline W Mays
- Clinical Research Core, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA
| | | | | |
Collapse
|
8
|
Cavalcante GM, Sousa de Paula RJ, Souza LPD, Sousa FB, Mota MRL, Alves APNN. Experimental model of traumatic ulcer in the cheek mucosa of rats. Acta Cir Bras 2012; 26:227-34. [PMID: 21537526 DOI: 10.1590/s0102-86502011000300012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 02/14/2011] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To establish an experimental model of traumatic ulcer in rat cheek mucosa for utilization in future alternative therapy studies. METHODS A total of 60 adult male rats (250 - 300g) were used. Ulceration of the left cheek mucosa was provoked by abrasion using a nº 15 scalpel blade. The animals were observed for 10 days, during which they were weighed and their ulcers were measured. The histological characteristics were analyzed and scored according to the ulcer phase. In the statistical analysis, a value of p<0.01 was considered a statistically significant response in all cases. RESULTS During the five first days, the animals lost weight (Student t test, p<0.01). The ulcerated area receded linearly over time and was almost completely cicatrized after 10 days (ANOVA, Tendency posttest, p<0.0001). Groups on days 1, 2 and 3 days displayed similar results, but a decrease in scores were observed after the 4th day. CONCLUSION The proposed cheek mucosa ulcer model in rats can be considered an efficient, low-cost, reliable, and reproducible method.
Collapse
|
9
|
Mini-implants in the anchorage armamentarium: new paradigms in the orthodontics. Int J Biomater 2012; 2012:394121. [PMID: 22719763 PMCID: PMC3374939 DOI: 10.1155/2012/394121] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 04/06/2012] [Indexed: 11/17/2022] Open
Abstract
Paradigms have started to shift in the orthodontic world since the introduction of mini-implants in the anchorage armamentarium. Various forms of skeletal anchorage, including miniscrews and miniplates, have been reported in the literature. Recently, great emphasis has been placed on the miniscrew type of temporary anchorage device (TAD). These devices are small, are implanted with a relatively simple surgical procedure, and increase the potential for better orthodontic results. Therefore, miniscrews not only free orthodontists from anchorage-demanding cases, but they also enable clinicians to have good control over tooth movement in 3 dimensions. The miniplate type also produces significant improvements in treatment outcomes and has widened the spectrum of orthodontics. The purpose of this paper is to update clinicians on the current concepts and versatile uses and clinical applications of skeletal anchorage in orthodontics.
Collapse
|
10
|
Abstract
Oral mucosal lesions are commonly encountered in clinical practice. One study reported that they occurred in approximately 27.9% of patients aged 17 years and older and in 10.3% of children aged 2 to 17 years. The diagnosis and treatment of mucosal diseases should be an integral part of the general practitioner's practice. According to an American Dental Association survey conducted in 2007, 44% of biopsies were performed by a general practictioner. Understanding of the fundamentals of diagnosing mucocutaneous lesions requires a sound knowledge of their origin and clinical course, and of biopsy methods using contemporary diagnostic tools and techniques.
Collapse
Affiliation(s)
- Michael H Chan
- Oral & Maxillofacial Surgery/Dental Service, Department of Veterans Affairs, New York Harbor Healthcare Systems (Brooklyn Campus), 800 Poly Place (Bk-160), Brooklyn, NY 11209, USA.
| | | |
Collapse
|
11
|
Baccaglini L, Lalla RV, Bruce AJ, Sartori-Valinotti JC, Latortue MC, Carrozzo M, Rogers RS. Urban legends: recurrent aphthous stomatitis. Oral Dis 2011; 17:755-70. [PMID: 21812866 DOI: 10.1111/j.1601-0825.2011.01840.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Recurrent aphthous stomatitis (RAS) is the most common idiopathic intraoral ulcerative disease in the USA. Aphthae typically occur in apparently healthy individuals, although an association with certain systemic diseases has been reported. Despite the unclear etiopathogenesis, new drug trials are continuously conducted in an attempt to reduce pain and dysfunction. We investigated four controversial topics: (1) Is complex aphthosis a mild form of Behçet's disease (BD)? (2) Is periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome a distinct medical entity? (3) Is RAS associated with other systemic diseases [e.g., celiac disease (CD) and B12 deficiency]? (4) Are there any new RAS treatments? Results from extensive literature searches, including a systematic review of RAS trials, suggested the following: (1) Complex aphthosis is not a mild form of BD in North America or Western Europe; (2) Diagnostic criteria for PFAPA have low specificity and the characteristics of the oral ulcers warrant further studies; (3) Oral ulcers may be associated with CD; however, these ulcers may not be RAS; RAS is rarely associated with B12 deficiency; nevertheless, B12 treatment may be beneficial, via mechanisms that warrant further study; (4) Thirty-three controlled trials published in the past 6 years reported some effectiveness, although potential for bias was high.
Collapse
Affiliation(s)
- L Baccaglini
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL 32610-3628, USA.
| | | | | | | | | | | | | |
Collapse
|
12
|
Baccaglini L, Lalla RV, Bruce AJ, Sartori-Valinotti JC, Latortue MC, Carrozzo M, Rogers RS. Urban legends: recurrent aphthous stomatitis. Oral Dis 2011. [PMID: 21812866 DOI: 10.1111/j.601-0825.2011.01840.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Recurrent aphthous stomatitis (RAS) is the most common idiopathic intraoral ulcerative disease in the USA. Aphthae typically occur in apparently healthy individuals, although an association with certain systemic diseases has been reported. Despite the unclear etiopathogenesis, new drug trials are continuously conducted in an attempt to reduce pain and dysfunction. We investigated four controversial topics: (1) Is complex aphthosis a mild form of Behçet's disease (BD)? (2) Is periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome a distinct medical entity? (3) Is RAS associated with other systemic diseases [e.g., celiac disease (CD) and B12 deficiency]? (4) Are there any new RAS treatments? Results from extensive literature searches, including a systematic review of RAS trials, suggested the following: (1) Complex aphthosis is not a mild form of BD in North America or Western Europe; (2) Diagnostic criteria for PFAPA have low specificity and the characteristics of the oral ulcers warrant further studies; (3) Oral ulcers may be associated with CD; however, these ulcers may not be RAS; RAS is rarely associated with B12 deficiency; nevertheless, B12 treatment may be beneficial, via mechanisms that warrant further study; (4) Thirty-three controlled trials published in the past 6 years reported some effectiveness, although potential for bias was high.
Collapse
Affiliation(s)
- L Baccaglini
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL 32610-3628, USA.
| | | | | | | | | | | | | |
Collapse
|
13
|
Sankar V, Hearnden V, Hull K, Juras DV, Greenberg MS, Kerr AR, Lockhart PB, Patton LL, Porter S, Thornhill M. Local drug delivery for oral mucosal diseases: challenges and opportunities. Oral Dis 2011; 17 Suppl 1:73-84. [PMID: 21382140 DOI: 10.1111/j.1601-0825.2011.01793.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There are few topical formulations used for oral medicine applications most of which have been developed for the management of dermatological conditions. As such, numerous obstacles are faced when utilizing these preparations in the oral cavity, namely enzymatic degradation, taste, limited surface area, poor tissue penetration and accidental swallowing. In this review, we discuss common mucosal diseases such as oral cancer, mucositis, vesiculo-erosive conditions, infections, neuropathic pain and salivary dysfunction, which could benefit from topical delivery systems designed specifically for the oral mucosa, which are capable of sustained release. Each condition requires distinct penetration and drug retention profiles in order to optimize treatment and minimize side effects. Local drug delivery may provide a more targeted and efficient drug-delivery option than systemic delivery for diseases of the oral mucosa. We identify those mucosal diseases currently being treated, the challenges that must be overcome and the potential of novel therapies. Novel biological therapies such as macromolecular biological drugs, peptides and gene therapy may be of value in the treatment of many chronic oral conditions and thus in oral medicine if their delivery can be optimized.
Collapse
Affiliation(s)
- V Sankar
- Department of Comprehensive Dentistry, The University of Texas Health Science Center at San Antonio, TX, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Elad S, Epstein JB, von Bültzingslöwen I, Drucker S, Tzach R, Yarom N. Topical immunomodulators for management of oral mucosal conditions, a systematic review; part II: miscellaneous agents. Expert Opin Emerg Drugs 2011; 16:183-202. [DOI: 10.1517/14728214.2011.528390] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
15
|
Abstract
The diagnosis and management of the following non-infectious vulvar ulcers are reviewed: vulvar aphthae in adult and pediatric patients, aphthae associated with Behçet's disease, vulvar ulcers resulting from Crohn's disease, and vulvar ulcers associated with human immunodeficiency virus infection. There are many resources providing excellent reviews of infectious ulcers; therefore this topic will not be covered here.
Collapse
|
16
|
Pilot study on recurrent aphthous stomatitis (RAS): a randomized placebo-controlled trial for the comparative therapeutic effects of systemic prednisone and systemic montelukast in subjects unresponsive to topical therapy. ACTA ACUST UNITED AC 2010; 109:402-7. [DOI: 10.1016/j.tripleo.2009.10.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 10/03/2009] [Accepted: 10/11/2009] [Indexed: 01/16/2023]
|
17
|
Han RP, Hwu YJ, Peng NH, Tseng KY, Pai LW, Chiu SC. Effectiveness of Vitamin B12 on Recurrent Aphthous Stomatitis in long term care: a Systematic Review. JBI LIBRARY OF SYSTEMATIC REVIEWS 2010; 8:1-15. [PMID: 27820363 DOI: 10.11124/01938924-201008341-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Ruo-Ping Han
- 1. Central Taiwan University of Science and Technology. 2. A Collaborating Centre of the Joanna Briggs Institute, National Yang-Ming University, Taipei, Taiwan 3. Feng-Yuan Hospital Department of Health
| | | | | | | | | | | |
Collapse
|
18
|
Meng W, Dong Y, Liu J, Wang Z, Zhong X, Chen R, Zhou H, Lin M, Jiang L, Gao F, Xu T, Chen Q, Zeng X. A clinical evaluation of amlexanox oral adhesive pellicles in the treatment of recurrent aphthous stomatitis and comparison with amlexanox oral tablets: a randomized, placebo controlled, blinded, multicenter clinical trial. Trials 2009; 10:30. [PMID: 19419555 PMCID: PMC2690593 DOI: 10.1186/1745-6215-10-30] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 05/06/2009] [Indexed: 12/04/2022] Open
Abstract
Background Amlexanox has been developed as a 5 percent topical oral paste for the treatment of patients with recurrent aphthous stomatitis (RAS) in most European countries. However, it is not yet available in China and has not been generally accepted in clinical treatment. The aim of this study was to explore the effectiveness of amlexanox oral adhesive pellicles in the treatment of minor recurrent aphthous ulcers, and compare the results with those of amlexanox oral adhesive tablets in order to analyse the difference between the two dosage forms of amlexanox. Methods We performed a randomized, blinded, placebo-controlled, parallel, multicenter clinical study. A total of 216 patients with minor recurrent aphthous ulcers (MiRAU) were recruited and randomized to amlexanox pellicles or placebo pellicles. Pellicles were consecutively applied four times per day, for five days. The size and pain level of ulcers were measured and recorded on treatment days 0, 4 and 6. Finally, the results were compared with those of our previous 104 cases treated with amlexanox tablets. Results Amlexanox oral adhesive pellicles significantly reduced ulcer size (P= 0.017 for day 4, P=0.038 for day 6) and alleviated ulcer pain (P=0.021 for day 4, P=0.036 for day 6). No significant difference was observed in the treatment effectiveness between the pellicle and tablet form of amlexanox. Conclusions Amlexanox oral adhesive pellicles are as effective and safe as amlexanox oral adhesive tablets in the treatment of MiRAU for this Chinese cohort. However, pellicles seem to be more comfortable to use when compared with the dosage form of tablets. Therefore, in clinical practice, amlexanox oral adhesive pellicles may be a better choice for RAS patients. Trials registration Nederlands Trial Register NTR1727.
Collapse
Affiliation(s)
- Wenxia Meng
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Sichuan, PR China.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
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.
Collapse
Affiliation(s)
- Neda Babaee
- Department of Oral Medicine, Faculty of Dentistry, Babol University of Medical Sciences, Babol, Iran
| | | | | | | | | |
Collapse
|
20
|
Abstract
There are many types of diseases associated with the oral cavity. As an adjunct to professional oral dental care, various drug delivery systems have been developed to improve the treatment or prevention of these diseases. In this manuscript, the current status of drug delivery strategies for these common orofacial diseases is reviewed. Biomineral-binding drug delivery and on-demand drug release are suggested to be considered in the future design of drug delivery systems for orofacial diseases. Apparently, this research field deserves much more attention from both pharmaceutical scientists and dental health professionals.
Collapse
Affiliation(s)
- Xin-Ming Liu
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198-6025, USA
| | | | | |
Collapse
|
21
|
Scully C, Porter S. Oral mucosal disease: Recurrent aphthous stomatitis. Br J Oral Maxillofac Surg 2008; 46:198-206. [PMID: 17850936 DOI: 10.1016/j.bjoms.2007.07.201] [Citation(s) in RCA: 221] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2007] [Indexed: 11/28/2022]
Abstract
Recurrent aphthous stomatitis (RAS; aphthae; canker sores) is common worldwide. Characterised by multiple, recurrent, small, round, or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or grey floors, it usually presents first in childhood or adolescence. Its aetiology and pathogenesis is not entirely clear, but there is genetic predisposition, with strong associations with interleukin genotypes, and sometimes a family history. Diagnosis is on clinical grounds alone, and must be differentiated from other causes of recurrent ulceration, particularly Behçet disease - a systemic disorder in which aphthous-like ulcers are associated with genital ulceration, and eye disease (particularly posterior uveitis). Management remains unsatisfactory, as topical corticosteroids and most other treatments only reduce the severity of the ulceration, but do not stop recurrence.
Collapse
Affiliation(s)
- Crispian Scully
- University College London, Eastman Dental Institute, London, UK.
| | - Stephen Porter
- University College London, Eastman Dental Institute, London, UK
| |
Collapse
|
22
|
Femiano F, Lanza A, Buonaiuto C, Gombos F, Nunziata M, Piccolo S, Cirillo N. Guidelines for diagnosis and management of aphthous stomatitis. Pediatr Infect Dis J 2007; 26:728-32. [PMID: 17848886 DOI: 10.1097/inf.0b013e31806215f9] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aphthous ulcers are the most common oral mucosal lesions in the general population. These often are recurrent and periodic lesions that cause clinically significant morbidity. Many suggestions have been proposed but the etiology of recurrent aphthous stomatitis (RAS) is unknown. Several precipitating factors for aphthous ulcers appear to operate in subjects with genetic predisposition. An autoimmune or hypersensitivity mechanism is widely considered possible. Sometimes aphthous ulcers can be the sign of systemic diseases, so it is essential to establish a correct diagnosis to determine suitable therapy. Before initiating medications for aphthous lesions, clinicians should determine whether well-recognized causes are contributing to the disease and these factors should be corrected. Various treatment modalities are used, but no therapy is definitive. Topical medications, such as antimicrobial mouth-washes and topical corticosteroids (dexamethasone, triamcinolone, fluocinonide, or clobetasol), can achieve the primary goal to reduce pain and to improve healing time but do not improve recurrence or remission rates. Systemic medications can be tried if topical therapy is ineffective.
Collapse
Affiliation(s)
- Felice Femiano
- Stomatology Department, II University of Medicines and Surgery, Naples, Italy.
| | | | | | | | | | | | | |
Collapse
|
23
|
Kravitz ND, Kusnoto B. Risks and complications of orthodontic miniscrews. Am J Orthod Dentofacial Orthop 2007; 131:S43-51. [PMID: 17448385 DOI: 10.1016/j.ajodo.2006.04.027] [Citation(s) in RCA: 214] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 04/01/2006] [Accepted: 04/01/2006] [Indexed: 11/15/2022]
Abstract
The risks associated with miniscrew placement should be clearly understood by both the clinician and the patient. Complications can arise during miniscrew placement and after orthodontic loading that affect stability and patient safety. A thorough understanding of proper placement technique, bone density and landscape, peri-implant soft-tissue, regional anatomic structures, and patient home care are imperative for optimal patient safety and miniscrew success. The purpose of this article was to review the potential risks and complications of orthodontic miniscrews in regard to insertion, orthodontic loading, peri-implant soft-tissue health, and removal.
Collapse
Affiliation(s)
- Neal D Kravitz
- Department or Orthodontics, University of Illinois, Chicago, Ill 60612, USA.
| | | |
Collapse
|
24
|
Nolan A, Baillie C, Badminton J, Rudralingham M, Seymour RA. The efficacy of topical hyaluronic acid in the management of recurrent aphthous ulceration. J Oral Pathol Med 2006; 35:461-5. [PMID: 16918596 DOI: 10.1111/j.1600-0714.2006.00433.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy of a topical hyaluronic acid (HA) preparation (0.2%) in the management of recurrent aphthous ulceration (RAU). METHODS One hundred and twenty patients with RAU participated in a randomized, placebo controlled, double-blind trial to evaluate the efficacy of the topical HA and preparation. Outcome measures include soreness relief on immediate application (recorded over 60 min). Thereafter, patients completed a log diary recording soreness from the ulcers, occurrence of new ulcers and ulcer duration. RESULTS Both topical HA and placebo resulted in a significant reduction in ulcer soreness following immediate application (P = 0.0004). Throughout the rest of the investigation period, there was no significant differences (P > 0.05) between the treatments for reducing soreness. Patients treated with topical HA recorded few ulcers on day 5 of the investigation than those treated with placebo (P < 0.001). Likewise, the occurrence of new ulcers was lower in the HA treated group on day 4 when compared with placebo (P = 0.047). CONCLUSION Topical HA (0.2%) may be of benefit in the management of RAU. Immediate reduction of symptoms appears to be a barrier effect.
Collapse
Affiliation(s)
- A Nolan
- School of Dental Sciences, University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne, UK.
| | | | | | | | | |
Collapse
|
25
|
Affiliation(s)
- Crispian Scully
- Eastman Dental Institute, University College London, London, United Kingdom.
| |
Collapse
|
26
|
Murray B, Biagioni PA, Lamey PJ. The efficacy of amlexanox OraDisc on the prevention of recurrent minor aphthous ulceration. J Oral Pathol Med 2006; 35:117-22. [PMID: 16430743 DOI: 10.1111/j.1600-0714.2006.00379.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The study was designed to determine the efficacy of OraDisc (active component 2 mg amlexanox) on the prevention of aphthous ulcers treated at the prodromal stage. METHODS Thermographic imaging was used to confirm the presence of a prodromal ulcer. Fifty-two patients were randomized to receive OraDisc (N = 26) or vehicle patches (N = 26). Patches were applied four times a day for 72 h over the prodromal area. The percentage of subjects who developed an ulcer at 72 h was compared between groups using the Fisher's exact test. RESULTS About 50% of subjects in the OraDisc group developed an ulcer by day 4 compared with 69% in the vehicle group. Erythema score, ulcer size, pain scores and thermographically active area and temperature all showed trends towards healing in the OraDisc group. CONCLUSION The OraDisc prevents ulcers from developing when compared with the vehicle patch.
Collapse
Affiliation(s)
- B Murray
- The Oral Science Research Centre, School of Dentistry, Queen's University Belfast, Royal Group Hospitals and Dental Hospital, Belfast, UK
| | | | | |
Collapse
|