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Al-Maweri SA, Al-Qadhi G, Halboub E, Alaizari N, Almeslet A, Ali K, Osman SAA. Vitamin D deficiency and risk of recurrent aphthous stomatitis: updated meta-analysis with trial sequential analysis. Front Nutr 2023; 10:1132191. [PMID: 37426194 PMCID: PMC10325032 DOI: 10.3389/fnut.2023.1132191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Background Growing evidence suggests a significant association between vitamin D deficiency and RAS. Hence, the present meta-analysis and trial sequential analysis sought to investigate the potential association between low serum vitamin D levels and RAS. Methods PubMed, Scopus, Embase, and Web of Science were comprehensively searched on December 1st, 2022 to retrieve all relevant studies. The grey literature was also searched via ProQuest. All case-control studies on the association between vitamin D and RAS were considered. The quality appraisal of the included studies was done using Newcastle-Ottawa scale. RevMan 5.0 and trial sequential analysis (TSA) programs were used for analyses. Results A total of 14 case-control studies with 1468 subjects (721 RAS patients and 747 controls) were included. The pooled data revealed a significant association between low serum levels of vitamin D and the risk of RAS (mean difference = - 8.73, 95% CI: - 12.02 to - 5.44, I2 = 94%, P < 0.00001). Additionally, TSA findings indicated that the current studies surpassed the required information size, confirming that the differences were reliable. Conclusion The available evidence suggests that Vitamin D deficiency may have a role in the pathogenesis of RAS. Therefore, evaluation of vitamin D should be considered in RAS patients. Additionally, the results support the possibility of using vitamin D supplements in the management of RAS patients with inadequate serum levels of vitamin D. Future interventional studies are required to evaluate the benefits of vitamin D replacement in prevention and treatment of RAS.
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Affiliation(s)
| | - Gamilah Al-Qadhi
- Department of Basic Dental Sciences, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen
| | - Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jizan, Saudi Arabia
- Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Sana'a, Yemen
| | | | - Asma Almeslet
- Department of Oral Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Kamran Ali
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
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Recurrent Aphthous Stomatitis – An Overview. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2021-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Recurrent aphthous ulcers are common painful mucosal conditions affecting the oral cavity. Despite their high prevalence and knowledge of many etiological factors, the exact mechanism of disease is still not fully understood. There are three different clinical forms of recurrent aphthous stomatitis and the therapy differs depending on it.
The aim of this article is to provide an overview of current knowledge about the possible causes and treatment of recurrent aphthous stomatitis. We discuss its pathogenesis which is currently the least explained in the literature. This review offers scientists and clinicians useful information about clinical presentation, diagnosis, predisposing aetiological factors and recent trends in the management of recurrent aphthous stomatitis.
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The Impact of DNA Methylation on IL6 mRNA Levels in Hematinic Deficiency and Atopy-Associated Recurrent Aphthous Stomatitis Patients. Int J Dent 2021; 2021:5560695. [PMID: 33936205 PMCID: PMC8055433 DOI: 10.1155/2021/5560695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the DNA methylation using pyrosequencing and its effects on the upregulation of IL6 mRNA in patients with recurrent aphthous stomatitis (RAS) in connection with hematinic deficiency and atopy. Material and Methods. This cross-sectional study was conducted at Dr. Hasan Sadikin Hospital, Bandung, from January–March 2019 and was approved by the Health Research Ethics Committee of Universitas Padjadjaran (Ethics No. 990/UN6.KEP/EC/2018). Furthermore, the subjects had RAS ulcers with a history of at least twice a year along with atopy and dietary imbalance with no history of recurrent intraoral herpes or any systemic diseases. This study was performed on 23 RAS patients and 21 healthy subjects, and the sampling was carried out consecutively. The blood samples were collected from all the subjects, and then, the DNA and RNA were extracted from the peripheral blood mononuclear cells (PBMCs). Consequently, the bisulfite-modified DNA was used to confirm the methylation status of the IL6 gene promoter through the pyrosequencing method. The methylation levels of the IL6 promoter were assessed by a reverse transcriptase-polymerase chain reaction technique. The gene expression of RAS and the control group was analyzed by the 2−ΔΔCT method. The statistical analysis using the Mann–Whitney U test was conducted to evaluate IL6 mRNA levels and DNA methylation with p value <0.05 considered to be statistically significant. Result The IL6 mRNA levels were approximately 1.88-fold in RAS patients, and there was a significant relationship between the expression of the IL6 gene and the increased risk of RAS (p < 0.001). It was reported that four out of six sites in the cytosine phosphate guanine (CpG) island IL6 promoter had a lower degree of methylation, and two other sites in patients with RAS had greater methylation compared with control, but not statistically significant. Conclusion This study showed the upregulation of IL6 mRNA levels in RAS patients compared to control. DNA methylation in the present study is at sites 566–658, whereas the location of the IL6 promoter is at sites 1–1684. Thus, it would be necessary conducting some research at other CpG sites of IL6 promoter islands to determine the status of DNA methylation.
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Al-Maweri SA, Halboub E, Al-Sharani HM, Shamala A, Al-Kamel A, Al-Wesabi M, Albashari A, Al-Sharani A, Abdulrab S. Association between serum zinc levels and recurrent aphthous stomatitis: a meta-analysis with trial sequential analysis. Clin Oral Investig 2021; 25:407-415. [PMID: 33409687 DOI: 10.1007/s00784-020-03704-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The present meta-analysis sought to investigate the potential association between zinc levels and recurrent aphthous stomatitis (RAS). METHODS A comprehensive search of online databases (PubMed, Scopus, Web of Science, and China National Knowledge Infrastructure (CNKI)) was conducted to identify all English and Chinese studies published up to August 2020. All case-control studies that assessed plasma/serum zinc levels were eligible for inclusion. Data were analyzed using Comprehensive Meta-Analysis software version 2.2.046 (Biostat, Englewood, NJ, USA). Trial sequential analysis (TSA) was conducted with the trial sequential analysis program. RESULTS Nineteen case-control studies, involving 1079 RAS cases and 965 controls, were included in the meta-analysis. The pooled results of 19 studies showed that zinc level was significantly lower in RAS patients than in healthy controls (weighted difference in means = - 21.092, 95% CI - 26.695 to - 15.490, I2 = 95.375%, P < 0.001). Upon subgroup analysis by geographic distribution of the sample (Chinese vs. others), the association remained significant in each individual subgroup, although the association was more pronounced among Chinese populations. TSA indicated that the current studies surpassed the required information size, confirming that the differences were reliable. CONCLUSION The results suggest a significant association between low serum zinc levels and the occurrence of RAS. Although TSA confirmed a solid conclusion, conducting large-scale studies with the highest standards of quality is encouraged. CLINICAL RELEVANCE Determining zinc levels should be considered in diagnosis, management, and prevention of RAS.
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Affiliation(s)
- Sadeq A Al-Maweri
- Department of Oral Medicine and Diagnostic Sciences, AlFarabi Colleges of Dentistry and Nursing, Riyadh, Saudi Arabia.
- Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Sana'a, Yemen.
| | - Esam Halboub
- Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Sana'a, Yemen
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jizan, Saudi Arabia
| | - Hesham Mohammed Al-Sharani
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
- Department of Maxillofacial Surgery, School of Stomatology, Harbin Medical University, Harbin, China
| | - Anas Shamala
- Department of Preventive and Biomedical Science, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen
| | - Ahlam Al-Kamel
- Department of Preventive and Biomedical Science, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen
| | - Mohammed Al-Wesabi
- Department of Preventive and Biomedical Science, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen
| | | | - Amani Al-Sharani
- Department of Preventive and Biomedical Science, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen
| | - Saleem Abdulrab
- Madinat Khalifa Health Center, Primary Health Care Corporation, Doha, Qatar
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Owlia MB, Mirzadeh M, Mehrpoor G. Penicillin in oral aphthosis, new insight for an old drug: A randomized, double-blind, controlled clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2020; 25:95. [PMID: 33273940 PMCID: PMC7698373 DOI: 10.4103/jrms.jrms_748_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 04/25/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oral aphthosis is a painful ulceration of mucus membranes characterized by round or oval lesions with central necrosis and erythematous haloes. Due to unknown etiology, treatment is highly controversial and based mainly on individual experience. The aim of this study was to investigate the safety and efficacy of topical penicillin 6.3.3 for the treatment of recurrent aphthous stomatitis. MATERIALS AND METHODS This randomized, double-blind, controlled clinical trial was done in Shahid Sadoughi Hospital Clinic in Yazd (2011-2012). Fifty patients aged 15-45 with recurrent oral aphthosis were randomly divided into two groups. After obtaining informed consents, patients in the case and control groups were treated (four times/day for a week), respectively, by topical penicillin 6.3.3 powder and placebo in similar vial. The patients who had acute-onset oral aphthae (≤48 h of appearance) with diameter ≥5 mm were included. History of sensitivity to β-lactam antibiotics and cephalosporin; spontaneous recovery during <5 days in previous episodes; concurrent systemic, infectious, or any autoimmune disorders; history of taking drugs (local or systemic) from 2 weeks prior to presentation; alcohol or drug abuse; smoking cigarette or tobacco; and poor compliance were exclusion criteria. Patients were examined in days 0, 3, 6, and 8. The main outcome measure was reduction in the median pain. Burning, pain, erythema, and inflammation were recorded as complications. RESULTS Of 25 patients receiving penicillin, 13 were female and 12 were male. Regarding the pain score (mean difference = 1.6 vs. 0.88, P = 0.012) and size of aphthus (mean difference = 9.43 vs. 1.24, P = 0.008), patients who received penicillin had significantly better results than the placebo group on day 8 after the treatment. The mean duration to healing was 3 days for penicillin group and 6 days for placebo group (P = 0.016). No topical or systemic adverse effects were observed. CONCLUSION Our study showed a dramatic response to topical penicillin with respect to placebo. Hence, it seems that penicillin could be a safe and effective option in managing oral aphthosis.
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Affiliation(s)
- Mohammad Bagher Owlia
- Department of Internal Medicine, Division of Rheumatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahboobeh Mirzadeh
- Department of Internal Medicine, Division of Rheumatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Golbarg Mehrpoor
- Department of Internal Medicine, Division of Rheumatology, Alborz University of Medical Sciences, Karaj, Iran
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Bao ZX, Yang XW, Shi J, Wang YF. The profile of hematinic deficiencies in patients with oral lichen planus: a case-control study. BMC Oral Health 2020; 20:252. [PMID: 32912209 PMCID: PMC7488047 DOI: 10.1186/s12903-020-01229-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/23/2020] [Indexed: 05/11/2023] Open
Abstract
Background Oral lichen planus (OLP) is a relatively common mucocutaneous disorder, and its causative factors and pathogenesis are not fully understood. Existing studies on the association between hematinic deficiencies and OLP are limited and inconsistent. The aim of this study was to assess the hematinic deficiencies in a cohort of OLP patients and evaluate the correlation between hematinic deficiencies and OLP. Methods A total of 236 OLP patients and 226 age-and-gender-matched healthy controls were enrolled in this study. The levels of hemoglobin (Hb), serum folate, vitamin B12 and ferritin were measured and compared between OLP patients and healthy controls. An REU (reticular/hyperkeratotic, erosive/erythematous, ulcerative) scoring system was adopted and compared between the OLP patients with and without hematinic deficiencies. The correlation between hematinic deficiencies and OLP was analyzed. Results The frequencies of serum ferritin and vitamin B12 deficiency in OLP patients were both significantly higher than those of the healthy controls. According to gender and age, the profiles of hematinic deficiencies in OLP patients were significantly different. As for the REU score, no significant difference existed between OLP patients with and without hematinic deficiencies. Both serum ferritin deficiency and serum vitamin B12 deficiency were significantly correlated with OLP. Conclusions The present study suggested a significant association between hematinic deficiencies and OLP. Iron, folate, and vitamin B12 levels in OLP patients should be monitored routinely. Further studies are warranted to explore the interactions between OLP and hematinic deficiencies.
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Affiliation(s)
- Zhe-Xuan Bao
- Department of Oral Medicine, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Xiao-Wen Yang
- Department of Hospital Infection Control, Shanxi Provincial People's Hospital: China, Taiyuan, Shanxi, China
| | - Jing Shi
- Department of Oral Medicine, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Yu-Feng Wang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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Al-Maweri SA, Halboub E, Ashraf S, Alqutaibi AY, Qaid NM, Yahya K, Alhajj MN. Single application of topical doxycycline in management of recurrent aphthous stomatitis: a systematic review and meta-analysis of the available evidence. BMC Oral Health 2020; 20:231. [PMID: 32831085 PMCID: PMC7444455 DOI: 10.1186/s12903-020-01220-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 08/13/2020] [Indexed: 12/14/2022] Open
Abstract
Background Recurrent aphthous stomatitis (RAS) is a highly prevalent oral mucosal disease. The management of RAS is quite challenging, and as yet, there is no definitive cure. The present systematic review and meta-analysis assessed the efficacy of a single application of topical doxycycline for the management of RAS. Methods A comprehensive online search of PubMed, Scopus, Embase, and Web of Science databases was conducted to identify all relevant studies published up to March 31, 2019. All randomized clinical trials that assessed the efficacy of a single application of topical doxycycline in the management of RAS were included. Primary outcome measures were pain scores and/or healing time, while secondary outcomes included the associated side effects. RevMan 5.3 software was used for data analysis. Results Five clinical trials fulfilled the eligibility criteria, three of which were included in the meta-analysis. All of the included studies found doxycycline effective in alleviating signs and symptoms of RAS. The results of the pooled 3 studies revealed a statistically significant decrease in the healing time in favor of the doxycycline group as compared to the control groups (I2 = 51%; MD: -1.77, 95% CI: − 2.11, − 1.42, P <0.00001); however, the results showed no significant differences between doxycycline and control groups with regard to pain reduction (I2 = 96%; MD: -1.28, 95% CI: − 2.83, 0.27; P = 0.11). Conclusion Although still inconclusive, the available evidence suggests that a single application of topical doxycycline might be effective for reducing signs and symptoms of RAS. However, owing to the limited number of the included studies, further well-designed clinical trials with adequate sample sizes are required to discern the clinical efficacy of topical doxycycline in patients with RAS.
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Affiliation(s)
- Sadeq Ali Al-Maweri
- Department of Oral Medicine and Diagnostic Sciences, AlFarabi Colleges for Dentistry and Nursing, Riyadh, Saudi Arabia.,Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Sana'a, Yemen
| | - Esam Halboub
- Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Sana'a, Yemen.,Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Sajna Ashraf
- Department of Oral Medicine and Diagnostic Sciences, AlFarabi Colleges for Dentistry and Nursing, Riyadh, Saudi Arabia
| | - Ahmed Y Alqutaibi
- Department of Prosthodontics, Taibah University, AlMadina AlMonawara, Saudi Arabia
| | - Nashwan Mohammed Qaid
- Department of Restorative Dental Sciences, AlFarabi Colleges for Dentistry and Nursing, Riyadh, Saudi Arabia
| | - Kamila Yahya
- Tooth Corner Dental Offices, Mississauga, ON, Canada
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