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Alghutaimel H, Matoug-Elwerfelli M, Alhaji M, Albawardi F, Nagendrababu V, Dummer PMH. Propolis Use in Dentistry: A Narrative Review of Its Preventive and Therapeutic Applications. Int Dent J 2024; 74:365-386. [PMID: 38378400 DOI: 10.1016/j.identj.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
Propolis is a resinous substance produced naturally by bees, and it consists of the exudates of plants mixed with enzymes, wax, and pollen. Propolis continues to gain considerable scientific interest due to its potential health benefits. The modern-day use of propolis in pharmaceutical preparations, such as toothpastes, mouthwashes, chewable tablets, mucoadhesive gels, and sprays, is increasing. However, the effectiveness of using propolis-containing pharmaceuticals in dentistry is not clear. The present paper aims to review the literature on the dental applications of propolis in preventive dentistry, periodontics, oral medicine, and restorative dentistry and discuss its clinical effectiveness. A literature search was conducted using Scopus, PubMed, and Web of Science databases. In total, 104 studies were included, of which 46 were laboratory studies, 5 animal studies, and 53 human clinical studies. Overall, the laboratory studies revealed a range of antimicrobial effects of propolis on oral pathogens. Clinical investigations of propolis in biofilm and dental caries control as well as adjuvant periodontal therapies reported positive outcomes in terms of plaque control, pathogenic microbial count reduction, and periodontal tissue inflammation control. Additional investigations included the use of propolis for the management of recurrent aphthous stomatitis, oral mucositis, and cavity disinfection after caries removal as well as the development of a range of restorative dental materials. Based on the reported outcomes of the studies, the clinical usage of propolis has potential. However, the majority of the evidence is derived from studies with flaws in their methodological design, making their results and conclusions questionable. As a consequence, properly designed and well-reported clinical studies are required to affirm the effectiveness of propolis for dental applications. Additionally, the safety of propolis and the optimal concentrations and extraction methods for its clinical use warrant further investigation. Utilisation of standardised propolis extracts will help in quality control of propolis-based products and lead to the achievement of reproducible outcomes in research studies.
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Affiliation(s)
- Hayat Alghutaimel
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia; Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia.
| | | | - Mayada Alhaji
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fatimah Albawardi
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Vitamia C, Iftinan GN, Latarissa IR, Wilar G, Cahyanto A, Elamin KM, Wathoni N. Natural and Synthetic Drugs Approached for the Treatment of Recurrent Aphthous Stomatitis Over the Last Decade. Drug Des Devel Ther 2024; 18:1297-1312. [PMID: 38681204 PMCID: PMC11048360 DOI: 10.2147/dddt.s449370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/10/2024] [Indexed: 05/01/2024] Open
Abstract
Recurrent aphthous stomatitis (RAS) refers to a sore and frequently recurring inflammation of the oral tissues, distinguished by the presence of small ulcers that cause significant discomfort and cannot be attributed to any underlying disease. Different treatments have been used for RAS. This review aims to provide a comprehensive overview of the treatment options over the past decade for recurrent aphthous stomatitis (RAS), encompassing both natural and synthetic treatments. It will utilize clinical efficacy studies conducted in vivo and in vitro, along with a focus on the pharmaceutical approach through advancements in drug delivery development. We conducted a thorough literature search from 2013 to 2023 in prominent databases such as PubMed, Scopus, and Cochrane, utilizing appropriate keywords of recurrent aphthous stomatitis, and treatment. A total of 53 clinical trials with 3022 patients were included, with 35 using natural materials in their research and a total of 16 articles discussing RAS treatment using synthetic materials. All the clinical trials showed that natural and synthetic medicines seemed to benefit RAS patients by reducing pain score, ulcer size, and number of ulcers and shortening the healing duration.
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Affiliation(s)
- Cszahreyloren Vitamia
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
- Departement of Pharmacy, Akademi Farmasi Bumi Siliwangi, Bandung, Indonesia
| | - Ghina Nadhifah Iftinan
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Irma Rahayu Latarissa
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Gofarana Wilar
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Arief Cahyanto
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Khaled M Elamin
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Nasrul Wathoni
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
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Xu Y, Woo SB, Treister NS. Thalidomide for management of refractory oral mucosal diseases. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:372-378. [PMID: 38388332 DOI: 10.1016/j.oooo.2023.12.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/12/2023] [Accepted: 12/30/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Thalidomide has anti-inflammatory properties and has been used off-label for multiple mucocutaneous disorders, but its application in managing refractory oral mucosal diseases is unclear. This study aimed to review the efficacy and safety of thalidomide in treating various oral mucosal disorders refractory to conventional therapies. METHODS The medical records of patients who were prescribed thalidomide from 2002 through 2021 for oral mucosal disorders were reviewed. Data collected included demographic characteristics, oral mucosal disease diagnosis, treatment courses, and thalidomide dose, duration, response, and side effects. RESULTS Thalidomide was prescribed for 28 patients with diagnoses of recurrent aphthous stomatitis (n = 14), inflammatory oral lichenoid lesions (n = 6), traumatic ulcerative granuloma with stroma eosinophilia (n = 5), chronic radiation-induced mucositis (n = 2), and orofacial granulomatosis (n = 1). Patients were treated for a median duration of 84 days (range 2-1,582). Clinical improvement was observed in 19 of 22 patients who completed at least 1 cycle of thalidomide (86.4%), with complete resolution in 12 patients (54.5%). Adverse events occurred in 75% of patients (n = 21), with 8 requiring thalidomide discontinuation. The most common adverse events included peripheral neuropathy (42.9%), drowsiness (28.6%), and constipation (21.4%). CONCLUSIONS Thalidomide may be considered for the management of refractory oral mucosal disorders. Drug side effects are common and need monitoring closely during use.
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Affiliation(s)
- Yuanming Xu
- Department of Oral Diagnostic Sciences, Division of Oral Medicine, Tufts University School of Dental Medicine, Boston, MA, USA.
| | - Sook Bin Woo
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Nathaniel S Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
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Öner N, Çelikel E, Tekin ZE, Güngörer V, Tekgöz N, Sezer M, Karagöl C, Coşkun S, Kaplan MM, Polat MC, Acar BÇ. The effect of vitamin D supplementation on attacks in PFAPA syndrome patients with low vitamin D levels. Ir J Med Sci 2024; 193:823-830. [PMID: 37870706 DOI: 10.1007/s11845-023-03555-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND-AIM To evaluate the effect of vitamin D supplementation on the frequency and duration of attacks in patients of PFAPA syndrome with low vitamin D levels. METHODS This retrospective study comprised PFAPA patients with vitamin D deficiency/insufficiency between 2018 and 2023. The frequency and duration of PFAPA attacks before and after vitamin D supplementation were noted. RESULTS Seventy-one patients were included. Of the 71 patients, 24 (33.8%) had vitamin D insufficiency, and 47 (66.2%) had vitamin D deficiency. In patients with vitamin D insufficiency, mean attack frequency and mean attack duration before vitamin D supplementation were 4.3 ± 1.9/year and 2.2 ± 1.6 days, respectively, while mean attack frequency and mean attack duration after vitamin D supplementation were 3.5 ± 2.7/year per year and 1.3 ± 0.9 days respectively (p = 0.2, p = 0.2, respectively). In patients with vitamin D deficiency, mean attack frequency and mean attack duration before vitamin D supplementation were 7.4 ± 2.1/year and 2.2 ± 1.6 days, respectively, while mean attack frequency and mean attack duration after vitamin D supplementation were 3.3 ± 2.4/year and 1.3 ± 0.9 days respectively (p < 0.01, p = 0.04, respectively). When the vitamin D level and the frequency of attacks were compared, the cut-off value of vitamin D was found to be 29.7 nmol/L. CONCLUSIONS In PFAPA patients with low vitamin D levels, the frequency and duration of PFAPA attacks were reduced with vitamin D supplementation. Especially at vitamin D level cut-off > 29.7 nmol/L, the frequency of attacks reduced significantly.
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Affiliation(s)
- Nimet Öner
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey.
| | - Elif Çelikel
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Zahide Ekici Tekin
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Vildan Güngörer
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Nilüfer Tekgöz
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Müge Sezer
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Cüneyt Karagöl
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Serkan Coşkun
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Melike Mehveş Kaplan
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Merve Cansu Polat
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
| | - Banu Çelikel Acar
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent, Ankara, 06800, Turkey
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Tao SY, Zhang HO, Yuan Q, Li CX, Guo X, Sunchuri D, Guo ZL. Network pharmacology-based strategy combined with molecular docking to explore the potential mechanism of agarwood against recurrent aphthous stomatitis. Medicine (Baltimore) 2024; 103:e37660. [PMID: 38552047 PMCID: PMC10977553 DOI: 10.1097/md.0000000000037660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/28/2024] [Indexed: 04/02/2024] Open
Abstract
To explore the antiinflammatory mechanism of agarwood on recurrent aphthous stomatitis (RAS). RAS is the most common mucosal disease in the oral cavity. The clinical application of traditional Chinese medicine found that agarwood has significant curative effect on peptic ulcer, but the effect and mechanism of agarwood on RAS remain unclear. This study is intended to predict the potential antiinflammatory mechanisms by which agarwood acts on RAS through network pharmacology and molecular docking. TCMSP database was used to screen the active components of agarwood. RAS targets were screened in Genecards, DisGeNET, and OMIM database. Venny, an online tool, screens for interacting genes between the two. Cytoscape software was used to construct the gene regulation map of active compounds target of agarwood. String Database building protein-protein interaction network. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathways were enriched in DAVID database. The key active ingredients and core targets were further verified by molecular docking. There were 9 effective compounds and 186 target genes in agarwood; RAS has 793 target genes. There were 41 interacting genes between agarwood and RAS. Interleukin 6, tumor necrosis factor, interleukin 1 beta, and cellular component motif ligand 2 may be key targets. Gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses predicted multiple pathways associated with RAS. Molecular docking results showed that the active compounds of agarwood combined well and stably with the target. The Chinese herbal medicine agarwood can relieve the inflammation of RAS through multiple targets and various ways. Its active compounds may be nominated as candidates for antiinflammatory drugs of RAS.
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Affiliation(s)
- Si-Yu Tao
- School of Dentistry, Hainan Medical University, Haikou, P.R. China
- Department of Dentistry, The First Affiliated Hospital of Hainan Medical University, Haikou, P.R. China
| | - Hai-Ou Zhang
- The 928th Hospital of People’s Liberation Army Joint Logistic Support Force, Haikou, P.R. China
| | - Qing Yuan
- School of Dentistry, Hainan Medical University, Haikou, P.R. China
- Department of Dentistry, The First Affiliated Hospital of Hainan Medical University, Haikou, P.R. China
| | - Chu-Xing Li
- Department of Dentistry, The Second Affiliated Hospital of Hainan Medical University, Haikou, P.R. China
| | - Xiang Guo
- School of Dentistry, Hainan Medical University, Haikou, P.R. China
- Department of Dentistry, The First Affiliated Hospital of Hainan Medical University, Haikou, P.R. China
| | - Diwas Sunchuri
- School of International Education, Hainan Medical University, Haikou, P.R. China
| | - Zhu-Ling Guo
- School of Dentistry, Hainan Medical University, Haikou, P.R. China
- Department of Health Management Center, The First Affiliated Hospital of Hainan Medical University, Haikou, P.R. China
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Salehi M, Saeedi M, Negarandeh R, Savabi A, Lotfizadeh A, Hosseinnataj A, Molania T. Evaluation of caffeic acid mucoadhesive tablets on minor recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled clinical trial. BMC Oral Health 2024; 24:210. [PMID: 38336696 PMCID: PMC10858486 DOI: 10.1186/s12903-024-03936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Oral aphthous stomatitis is a chronic inflammatory condition. Numerous medications have been investigated to treat the symptoms of the disease. However, these days patients prefer herbal medicines due to lower side effects. Considering the anti-inflammatory, analgesic, and anti-oxidant properties of Caffeic acid and its few side effects, the aim of this study was to assess the impact of Caffeic acid on recurrent aphthous stomatitis (RAS). investigating the effect of caffeic acid mucoadhesive tablets on the size and pain intensity of the aphthous lesions. METHODS in this double-blinded clinical trial study, 47 patients who met the inclusion criteria were selected by convenient sampling method. The patients were assigned to two groups randomly; the control group (placebo recipients) and the intervention group (Caffeic acid recipients). Patients were followed up for 7 days following the intervention. The diameter of the inflammatory lesion was measured in millimeters, and the pain intensity was recorded based on the VAS scale (Visual Analogue Scale). This trial was approved by the medical ethics committee of Mazandaran University of Medical Sciences (Ethical code: IR.MAZUMS.REC.1401.261) and received IRCT code of IRCT20220815055700N1on 03/09/2022. RESULTS the diameter of the lesion in both groups decreased over time, and there was no significant difference between the intervention and control groups, except on the fifth day when the diameter of the lesion was significantly greater in the control group (P = 0.012). From the second day, the control group's average pain intensity was significantly higher than the intervention group's pain intensity (P < 0.05). CONCLUSIONS when comparing mucoadhesive tablets containing Caffeic acid and placebo, the findings demonstrated that Caffeic acid has a significant efficacy in reducing aphthous lesions' diameter and pain intensity of the patients and are suggested for palliative oral aphthous lesions treatment since they showed significant anti-inflammatory and analgesic effects on recurrent aphthous stomatitis.
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Affiliation(s)
- Maedeh Salehi
- Department of Oral Medicine, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- 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
| | - Reza Negarandeh
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
- Student Research Committee, Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | | | | | - Abolfazl Hosseinnataj
- Department of Biostatistics, Faculty of health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Molania
- Department of Oral Medicine, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
- Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran.
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Wei W, Deng Y, Wang Y, Yao H, Du G, Tang G. Dynamic salivary cytokine profile of recurrent aphthous stomatitis patients in thalidomide maintenance treatment. Clin Oral Investig 2024; 28:140. [PMID: 38334890 DOI: 10.1007/s00784-024-05531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To dynamically compare the longitudinal (time axis) and transverse (between groups) differences of the salivary cytokines during thalidomide maintenance treatment of recurrent aphthous stomatitis. METHODS A randomized, controlled, clinical trial was performed. After the initial prednisone treatment, thalidomide (50 mg/d vs. 25 mg/d) was used as a maintenance drug for 4 or 8 weeks. The salivary IL-4, 5, 6, 10, TNF-α, and IFN-γ were dynamically detected with a cytometric bead array. RESULTS Overall, the level of six elevated salivary cytokines after prednisone treatment was significantly downregulated, remained low during thalidomide maintenance, and rebounded at recurrence. The effect of 50 mg/d thalidomide on the salivary cytokines was not superior to 25 mg/d medication. The relapse-free period following drug withdrawal was the longest in the subgroup using 25 mg/d thalidomide for 8 weeks. The order of magnitude of IL-6 was the most obvious, and at week 8, only the level of IL-6 in the group (25 mg/d thalidomide for 8 weeks) continued to decline compared with the other groups. CONCLUSION Thalidomide maintenance treatment can effectively sustain low levels of salivary IL-4, 5, 6, 10, TNF-α, and IFN-γ of recurrent aphthous stomatitis patients. IL-6 displayed a good correlation with the disease and is expected to become an index for diagnosis and follow-up. CLINICAL RELEVANCE Low-dose long-term thalidomide maintenance treatment was supported for recurrent aphthous stomatitis. TRIAL REGISTRATION Trial registration number of ChiCTR-IPR-16009759 at http://www.chictr.org/index.aspx .
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Affiliation(s)
- Wei Wei
- Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai Key Laboratory of Translational Medicine On Ear and Nose Diseases, Shanghai, 200092, China
| | - Yiwen Deng
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Yufeng Wang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Hui Yao
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Guanhuan Du
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China.
| | - Guoyao Tang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China.
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Prayoga DK, Aulifa DL, Budiman A, Levita J. Plants with Anti-Ulcer Activity and Mechanism: A Review of Preclinical and Clinical Studies. Drug Des Devel Ther 2024; 18:193-213. [PMID: 38318501 PMCID: PMC10840521 DOI: 10.2147/dddt.s446949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
Ulcer disorders including the oral mucosa, large intestine, and stomach mucosa, cause significant global health burdens. Conventional treatments such as non-steroid anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), histamine H2 receptor antagonists (H2RAs), and cytoprotective agents have drawbacks like mucosal injury, diminish gastric acid secretion, and interact with concurrent medications. Therefore, alternative therapeutic approaches are needed to tackle this health concern. Plants are rich in active metabolites in the bark, roots, leaves, fruits, and seeds, and have been utilized for medicinal purposes since ancient times. The use of herbal therapy is crucial, and regulations are necessary to ensure the quality of products, particularly in randomized studies, to assess their efficacy and safety in treating ulcer disorders. This study aims to explore the anti-ulcer activity of medicinal plants in treating peptic ulcer disease, ulcerative colitis, and aphthous ulcers. Articles were searched in Scopus and PubMed, and filtered for publication from 2013 to 2023, resulting in a total of 460 from Scopus and 239 from PubMed. The articles were further screened by title and abstract and resulted in 55 articles. Natural products, rich in active metabolites, were described to manage ulcer disease by protecting the mucosa, reducing ulcer effects, inhibiting pro-inflammatory factors, and reducing bacterial load, thus improving patients' quality of life. Natural extracts have proven effective in managing other health problems, including ulcers by reducing pain and decreasing lesions. This review provides an overview of preclinical and clinical studies on medicinal plants, focusing on their effectiveness in treating conditions like peptic ulcers, ulcerative colitis, and aphthous ulcers.
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Affiliation(s)
- Deshanda Kurniawan Prayoga
- Master Program in Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang, West Java, 45363, Indonesia
| | - Diah Lia Aulifa
- Department of Pharmaceutical Analysis and Medicinal Chemistry, Faculty of Pharmacy, Padjadjaran University, Sumedang, 45363, Indonesia
| | - Arif Budiman
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Padjadjaran University, Sumedang, 45363, Indonesia
| | - Jutti Levita
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Padjadjaran University, Sumedang, 45363, Indonesia
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Yao H, Deng Y, Du G, Wang Y, Tang G. Cardiovascular diseases, risk factors, and ulcer relapse in older adults with aphthous stomatitis. J Oral Pathol Med 2024; 53:3-7. [PMID: 37932031 DOI: 10.1111/jop.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To test the hypothesis that cardiovascular diseases and risk factors are associated with ulcer relapse in after-retirement patients with recurrent aphthous stomatitis. SUBJECTS AND METHODS This retrospective cohort study analyzed the data of 40 minor recurrent aphthous stomatitis patients aged 55-75 years, admitted to Oral Medicine Clinic at one university hospital in China between 2016 and 2018. The diagnosis of minor recurrent aphthous stomatitis was made based on the history and manifestation of oral ulcers. The ulcer relapse was evaluated after a 5-week anti-inflammatory treatment, and the history of systemic diseases was collected. cardiovascular disease/metabolic risk referred to the presence of any cardiovascular diseases and metabolic cardiovascular disease risks. Associations among cardiovascular diseases, risk factors, and ulcer relapse were evaluated. RESULTS The mean age of 40 patients with minor recurrent aphthous stomatitis was 62.4 years (SD 5.1), and 60% were women. The ulcer relapse rate was 37.5% (95% CI, 0.242-0.530). The proportion of cardiovascular disease/metabolic risk was higher in the relapse group than in the no-relapse group after 5-week anti-inflammatory treatment (Fisher's exact test, p = 0.041). CONCLUSIONS According to this single-center experience, older patients with cardiovascular disease/metabolic risk may be more prone to oral ulcer recurrence. Nevertheless, larger prospective studies are needed to confirm our findings.
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Affiliation(s)
- Hui Yao
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Yiwen Deng
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Guanhuan Du
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Yufeng Wang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Guoyao Tang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
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Yao H, Deng Y, Du G, Wang Y, Tang G. Elevated serum fibrinogen levels in Chinese patients with minor recurrent aphthous stomatitis: An observational study. Exp Dermatol 2024; 33:e14915. [PMID: 37638770 DOI: 10.1111/exd.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/01/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
Fibrinogen is a protein that reflects systemic inflammation and regulates the immune response to disease. However, there is a scarcity of data on fibrinogen in recurrent aphthous stomatitis (RAS). We aimed to test the hypothesis that fibrinogen is involved in the aetiology of RAS. Between November 2016 and November 2018, we included 109 minor RAS patients and 29 age- and sex-matched controls in a single-center, observational study. Their clinical history and ulcer manifestations led to the diagnosis of minor RAS. The ulcer severity score (USS) was used to assess disease severity, and fibrinogen was also collected. We conducted three analyses: Analysis 1 (comparison of fibrinogen levels between patients and controls), Analysis 2 (comparison of fibrinogen levels between high and low USS patients) and Analysis 3 (comparison of fibrinogen levels between before and after anti-inflammatory treatment in patients). The fibrinogen levels in the 109 minor RAS patients were statistically higher than in the 29 controls (mean [SD], 2.6 [0.5] vs. 2.3 [0.3]; Student's t-test, p < 0.001). However, there were no significant differences in fibrinogen levels among the 43 patients with high USS and the 39 patients with low USS (mean [SD], 2.7 [0.5] vs. 2.6 [0.4]; Student's t-test, p = 0.278). Furthermore, fibrinogen levels were significantly higher before anti-inflammatory treatment in comparison to those after anti-inflammatory treatment in the 35 paired patients (mean [SD], 2.6 [0.4] vs. 2.5 [0.4]; Student's t-test, p = 0.026). Interestingly, fibrinogen levels were significantly higher in the 35 paired patients after anti-inflammatory treatment compared to the 29 control subjects (mean [SD], 2.5 [0.4] vs. 2.3 [0.3]; Student's t-test, p = 0.026]. Fibrinogen may play a role in the aetiology of RAS and may be a drug target for RAS treatment. Clinicians should be alert that high serum fibrinogen levels might be associated with the risk of RAS.
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Affiliation(s)
- Hui Yao
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yiwen Deng
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Guanhuan Du
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yufeng Wang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Guoyao Tang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
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Samiraninezhad N, Kazemi H, Rezaee M, Gholami A. Effect of lactobacillus reuteri-derived probiotic nano-formulation on recurrent aphthous stomatitis: a double-blinded randomized clinical trial. BMC Oral Health 2023; 23:1019. [PMID: 38114936 PMCID: PMC10729528 DOI: 10.1186/s12903-023-03756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVES We aimed to assess the therapeutic effects of a topical probiotic nano-formulation derived from Lactobacillus reuteri on treating recurrent aphthous stomatitis. MATERIALS AND METHODS 60 participants were randomly allocated into two groups (control and probiotic). Probiotic group administered topical probiotic nano-formulation three times a day for seven days. The control group administered a standard analgesic oral rinse. The size of ulcer(s) and pain severity were recorded on days 0, 3, 5, and 7 after intervention. RESULTS Before the intervention, the groups had no significant differences in terms of pain severity (P-value = 0.28) and lesion size (P-value = 0.24). Both groups exhibited significant reductions in pain severity and lesion size over the course of the intervention. After one week, the probiotic group had a notably larger lesion size reduction than the control group (P-value = 0.01). The probiotic group also showed a significantly greater reduction in pain severity than the control group (P-value = 0.04). CONCLUSIONS Applying topical probiotic nano-formulation derived from Lactobacillus reuteri three times a day decreased lesion size and pain severity in RAS patients faster than the local analgesic oral rinse. CLINICAL RELEVANCE Lactobacillus reuteri-derived probiotic nano-formulation might be a promising treatment option for RAS.
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Affiliation(s)
| | - Hojat Kazemi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Rezaee
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
- Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ahmad Gholami
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Medical Nanotechnology, School of Advanced Medical Science and Technology, Shiraz University of Medical Sciences, Shiraz, Iran
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12
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Kapustova L, Banovcin P, Bobcakova A, Jurkova Malicherova E, Kapustova D, Petrovicova O, Slenker B, Markocsy A, Oleksak F, Vorcakova K, Jesenak M. The use of ketotifen as long-term anti-inflammatory prophylaxis in children with PFAPA syndrome. Front Immunol 2023; 14:1302875. [PMID: 38143757 PMCID: PMC10748580 DOI: 10.3389/fimmu.2023.1302875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome (PFAPA) is the most frequent periodic fever syndrome in children. Its pathogenesis is still unknown, but some disease-modifying factors were observed. Several medications were tested for the long-term prophylaxis of inflammatory flares; however, none are standardly used. Methods This prospective clinical trial enrolled 142 children (71 girls, 50%) meeting diagnostic criteria for PFAPA syndrome. We analysed selected clinical characteristics and compared laboratory parameters during the flare and attack-free period (at least two weeks after the attack). Moreover, we assessed the possible therapeutic effect of ketotifen on the duration of attack free-periods and clinical picture. Results The mean age of patients was 6.81 ± 3.03 years and the mean age of onset of symptoms was 2.31 ± 2.02 years. No significant differences were observed between genders.We recorded a positive family history for PFAPA in 31.69% of patients. Attacks lasted for 2.8 ± 1.2 days, with intervals between attacks of 4 ± 1 weeks. We administered ketotifen in 111 (77.8%) patients, and a positive effect was observed in 86 (77.5%) of patients. We observed prolonged attack-free intervals in patients treated with ketotifen (14.7 ± 8.9 days in comparison with 4.4 ± 1.9 days before the treatment; p<0.001). The used dose of ketotifen was 0.08 ± 0.01 mg/kg/day. Mild side effects were observed in four patients (restlessness, irritability, agitation and constipation). Discussion Our data supports the use of ketotifen for long-term prophylaxis in children with PFAPA syndrome with positive effects on the attenuation of disease activity and the prolongation of attack-free periods. Further well-designed studies should confirm the preliminary data.
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Affiliation(s)
- Lenka Kapustova
- Centre for Periodic Fever Syndromes, Department of Paediatrics, University Hospital in Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin, Slovakia
| | - Peter Banovcin
- Centre for Periodic Fever Syndromes, Department of Paediatrics, University Hospital in Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin, Slovakia
| | - Anna Bobcakova
- Department of Pneumology and Phthisiology, University Hospital in Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin, Slovakia
| | - Eva Jurkova Malicherova
- Centre for Periodic Fever Syndromes, Department of Paediatrics, University Hospital in Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin, Slovakia
| | - Daniela Kapustova
- Centre for Periodic Fever Syndromes, Department of Paediatrics, University Hospital in Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin, Slovakia
| | - Otilia Petrovicova
- Centre for Periodic Fever Syndromes, Department of Paediatrics, University Hospital in Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin, Slovakia
| | - Branislav Slenker
- Centre for Periodic Fever Syndromes, Department of Paediatrics, University Hospital in Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin, Slovakia
| | - Adam Markocsy
- Centre for Periodic Fever Syndromes, Department of Paediatrics, University Hospital in Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin, Slovakia
| | - Filip Oleksak
- Centre for Periodic Fever Syndromes, Department of Paediatrics, University Hospital in Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin, Slovakia
| | - Karolina Vorcakova
- Clinic of Dermatovenerology, University Hospital in Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin, Slovakia
| | - Milos Jesenak
- Centre for Periodic Fever Syndromes, Department of Paediatrics, University Hospital in Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin, Slovakia
- Department of Pneumology and Phthisiology, University Hospital in Martin, Jessenius Faculty of Medicine of Comenius University in Bratislava, Martin, Slovakia
- Department of Clinical Immunology and Allergology, University Hospital in Martin, Martin, Slovakia
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13
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Nozu T, Ohhira M, Ishioh M, Okumura T. Adult-onset Periodic Fever, Aphthous Stomatitis, Pharyngitis and Cervical Adenitis Syndrome Responsive to Colchicine. Intern Med 2023; 62:3555-3558. [PMID: 37062730 PMCID: PMC10749813 DOI: 10.2169/internalmedicine.1364-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/08/2023] [Indexed: 04/18/2023] Open
Abstract
We herein report a rare case of periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome that occurred in an 18-year-old man. He visited our hospital with recurrent episodes of a fever, pharyngitis and adenitis without suggestive findings of infection. These episodes resolved within 5 days and recurred quite regularly, with an interval of about 30 days. As the febrile episodes significantly impaired his quality of life, he was treated with colchicine (0.5 mg) as prophylaxis. This completely prevented the episodes during six months of follow-up. Colchicine may therefore be effective in cases of adult-onset PFAPA syndrome.
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Affiliation(s)
- Tsukasa Nozu
- Department of Regional Medicine and Education, Asahikawa Medical University, Japan
- Center for Medical Education, Asahikawa Medical University, Japan
| | - Masumi Ohhira
- Department of General Medicine, Asahikawa Medical University, Japan
| | - Masatomo Ishioh
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Toshikatsu Okumura
- Department of General Medicine, Asahikawa Medical University, Japan
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
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14
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Cheng YO, Veettil SK, Syeed MS, Shetty NY, Gopinath D. COMPARATIVE EFFICACY OF THERAPEUTIC INTERVENTIONS FOR THE MANAGEMENT OF RECURRENT APHTHOUS ULCERS: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. J Evid Based Dent Pract 2023; 23:101918. [PMID: 38035895 DOI: 10.1016/j.jebdp.2023.101918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/26/2023] [Accepted: 08/04/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Recurrent aphthous ulceration (RAU) is an oral condition cavity affecting 2.5 billion people worldwide. We aimed to assess the comparative efficacy and safety of available interventions in the management of RAU. MATERIALS AND METHODS An electronic search of 3 databases (Medline, CENTRAL, Scopus) was performed to identify randomized control trials evaluating the efficacy of RAU interventions published until December 2022. A network meta-analysis (NMA) was conducted on 4 outcomes: reduction in pain, duration of ulceration, the diameter of ulceration, and area of ulceration. The interventions are then arranged using the surface area under cumulative ranking (SUCRA). RESULTS A total of 38 trials involving 2773 patients were included were included in quantitative synthesis by NMA. Our analysis showed that Diode laser [MD, -4.865 ± 1.951 (95%CI = (-8.690, -1.041)] was the most effective in reducing the pain score followed by Amlexanox [MD, -2.673 ± 1.075 (95%CI = -4.779, -0.566)]. Iralvex performed the best in reducing the duration of ulceration [MD, -6.481 ± 1.841 (95%CI = -10.090, -2.872)]. Diode laser, acacia nilotica with licorice formulation, and amlexanox were the most effective interventions for reduction of ulcer diameter. Majority of the trials reported absence of any adverse effects and those reported were mild. CONCLUSION Our NMA has identified several interventions to be more effective than a placebo. Laser therapy may be an option for promoting pain management, however, most have only been tested in 1 or 2 trials. Further studies with rigorous methodology on larger samples are recommended to strengthen the current evidence.
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Affiliation(s)
- Yung On Cheng
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Sajesh K Veettil
- International Medical University, School of Pharmacy, Department of Pharmacy Practice, Kuala Lumpur, Malaysia; School of Medicine, Taylor's University, 47500 Subang Jaya
| | - M Sakil Syeed
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, USA
| | - Naresh Y Shetty
- Department of Clinical Sciences , College of Dentistry, Ajman University, United Arab Emirates; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
| | - Divya Gopinath
- Department of Basic Medical and Dental Sciences, College of Dentistry, Ajman University, United Arab Emirates; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates.
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15
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Peng SL, Ge YM, Yu XY, Chen HC, Song DQ, Pu HY, Yang P. Effectiveness of Zhibai Dihuang pill (Chinese herbal formula) in combination with western drugs in the treatment of recurrent aphthous stomatitis: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e35180. [PMID: 37904377 PMCID: PMC10615440 DOI: 10.1097/md.0000000000035180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/22/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The pain caused by recurrent aphthous stomatitis (RAS) and the recurrent nature of RAS lead to diminished quality of life for RAS patients. An alternative treatment for RAS is the oral administration of the Chinese herbal medicine Zhibai Dihuang pill (ZBDHP). Our study aims to investigate the clinical efficacy of ZBDHP when used in combination with Western medicine (WM) for the treatment of RAS and its effectiveness in preventing the recurrence of RAS. METHODS Following the PRISMA 2020 guidelines, we conducted a literature search on 7 electronic databases according to predefined criteria. The methodological quality of randomized controlled trials (RCTs) was evaluated based on the Cochrane Handbook, and data analysis was performed using RevMan 5.3 software. RESULTS A meta-analysis which included 7 studies and 669 participants in total was carried out in this study. The quantitative analysis revealed that the combined treatment of ZBDHP and WM has witnessed significantly improved overall clinical efficacy (RR = 1.20, 95% CI [1.12, 1.28], P < .05), reduced recurrence rate (RR = 0.24, 95% CI [0.13, 0.45], P < .05), decreased ulcer area (MD = -0.75, 95% CI [-0.91, -0.59], P < .05), and reduced pain visual simulation score (MD = -0.42, 95% CI [-0.52, -0.33], P < .05). No significant heterogeneity was observed among the studies. Qualitative analysis showed that the combination therapy significantly reduced serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 and interleukin-10, shortened ulcer healing time and pain disappearance time, with no adverse effects observed. CONCLUSION It was found that the combination of ZBDHP and WM is more effective in treating RAS than the use of WM alone, which thus provides clinicians with a more optimal treatment option. However, due to limitations in the methodological quality of the included original studies and the small sample size, we hold the opinion that more rigorous and scientific clinical trials are needed to further evaluate the efficacy of ZBDHP in treating RAS.
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Affiliation(s)
- Shuang-li Peng
- Hubei University of Traditional Chinese Medicine, Hubei, Wuhan, China
| | - Ya-mei Ge
- Hubei University of Traditional Chinese Medicine, Hubei, Wuhan, China
| | - Xing-yu Yu
- Hubei University of Traditional Chinese Medicine, Hubei, Wuhan, China
| | - Hong-ci Chen
- Hubei University of Traditional Chinese Medicine, Hubei, Wuhan, China
- Hubei Provincial Hospital of Traditional Chinese Medicine, Hubei, Wuhan, China
| | - Deng-qin Song
- Hubei University of Traditional Chinese Medicine, Hubei, Wuhan, China
| | - Hui-yun Pu
- Hubei University of Traditional Chinese Medicine, Hubei, Wuhan, China
| | - Ping Yang
- Hubei University of Traditional Chinese Medicine, Hubei, Wuhan, China
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Alsahaf S, Alkurdi KA, Challacombe SJ, Tappuni AR. Topical betamethasone and systemic colchicine for treatment of recurrent aphthous stomatitis: a randomised clinical trial. BMC Oral Health 2023; 23:709. [PMID: 37789351 PMCID: PMC10548625 DOI: 10.1186/s12903-023-03335-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/19/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Recurrent Aphthous Stomatitis (RAS) is painful oral ulceration frequently treated with topical steroids. There is limited published evidence for the efficacy of any treatment for RAS and there remains a need for longitudinal randomised clinical trials to evaluate and compare the effectiveness of different therapies in the management of RAS. The aim of the current project was to assess the efficacy of betamethasone mouthwash and colchicine tablets, individually and combined, for the treatment of RAS, and to establish the optimum treatment period necessary for a significant reduction in the disease severity. METHODOLOGY A randomised, prospective, parallel-group clinical trial was conducted over one year, to compare the efficacy of three therapies in RAS. One hundred and six patients were randomized into three groups; 35 received betamethasone mouthwash, 35 had colchicine tablets and 36 received both therapies. The response was evaluated quantitatively every 3 months for 1 year, using the Ulcer Severity Score (USS). RESULTS For all three treatment regimes, the mean USS decreased by about 30% in the first 3 months (p < 0.001). Further improvement was noted for up to 9 months. At the end of the study, the mean USS had improved by 50% from 34.9 ± 7.2 before treatment to 17.5 ± 8.9 after treatment (p < 0.001). Of included participants, 86% showed significant clinical improvement by the end of the study. There were no significant differences in outcomes between the three regimes (p < 0.05). CONCLUSIONS This clinical trial has provided evidence for the efficacy of betamethasone mouthwash and for colchicine tablets in the treatment of RAS and has shown that at least six months of treatment may be required for optimum effect. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN3267716. Date of clinical trial registration: 15/04/2018.
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Affiliation(s)
- Surab Alsahaf
- Oral Medicine, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, and Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Khlood A Alkurdi
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, Office 7, Floor 4, London, E1 2AD, UK
| | - Stephen J Challacombe
- Oral Medicine, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, and Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Anwar R Tappuni
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, Office 7, Floor 4, London, E1 2AD, UK.
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17
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Mashrah MA, Fang Y, Song W, Al-Maweri SA, Lan Y, Linhu G, Wang L. Topical medications for the treatment of recurrent aphthous stomatitis: A network meta-analysis. J Oral Pathol Med 2023; 52:811-825. [PMID: 37753744 DOI: 10.1111/jop.13480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The present network meta-analysis aims to answer the question "what is the best topical intervention for the treatment of recurrent aphthous stomatitis that can provide an acceptable pain relief and promote wound healing?" METHODS From inception to October 2022, PubMed, Embase, Scopus, Cochrane Library, and China National Knowledge Infrastructure were searched to identify all potentially eligible randomized controlled trials. The primary outcomes were pain scores and/or healing time, while the secondary outcomes were the associated side effects. The Bayesian network meta-analysis accompanied by a random effect model and 95% credible intervals were calculated. RESULTS Forty-three randomized controlled trials with a total of 3067 participants, comparing 20 different topical medications, were included. Concerning pain reduction, the network meta-analysis failed to show any statistically significant differences when different topical treatments were compared together or even with a placebo at different time intervals. Except for doxycycline, which showed a statistically significant difference in terms of accelerating healing time, other topical interventions showed no statistically significant differences when compared with placebo or with each other. CONCLUSION Within the limitations of the current network meta-analysis, it seems that: A low to moderate quality of evidence showed no superiority of any topical treatment over others concerning pain reduction, although rank probability tests revealed sucralfate, doxycycline, hyaluronic acid, and chamomile as the most efficacious treatment options at different evaluation times. Hence, further well-designed clinical trials with larger sample sizes are warranted. Topical doxycycline was shown to be the most efficacious intervention in promoting healing of recurrent aphthous stomatitis.
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Affiliation(s)
- Mubarak Ahmed Mashrah
- Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
- Suzhou Stomatological Hospital, Suzhou, China
| | - Ying Fang
- Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
- Suzhou Stomatological Hospital, Suzhou, China
| | - Wanxing Song
- Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
- Suzhou Stomatological Hospital, Suzhou, China
| | | | - Yang Lan
- Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
- Suzhou Stomatological Hospital, Suzhou, China
| | - Ge Linhu
- Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
- Suzhou Stomatological Hospital, Suzhou, China
| | - Liping Wang
- Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
- Suzhou Stomatological Hospital, Suzhou, China
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18
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Dorsareh F, Vahid-Dastjerdi G, Bouyahya A, Zarshenas MM, Rezaie M, Yang WM, Amiri-Ardekani E. Topical Licorice for Aphthous: A Systematic Review of Clinical Trials. Iran J Med Sci 2023; 48:437-447. [PMID: 37786470 PMCID: PMC10541548 DOI: 10.30476/ijms.2022.94467.2576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/06/2022] [Accepted: 06/25/2022] [Indexed: 10/04/2023]
Abstract
Background Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects oral mucosa. The coating agents, topical analgesics, and topical steroids are usually used as treatment methods. Glycyrrhiza glabra has been used for RAS treatment based on its anti-inflammatory, antioxidant, and immunomodulatory properties. In this study, a systemic review on the therapeutic effect of topical licorice on RAS management was performed. Methods Science Direct, Scopus, Cochrane databases, PubMed Google Scholar, and ResearchGate were searched up to September 2021 to find all English randomized clinical trials studying the effect of G. glabra, or its compositions on RAS. Meta-analysis was not conducted because of data heterogeneity. Articles were reviewed qualitatively, and only those with a Jadad score ≥3 were included. Animal studies, in vitro, review papers, non-English papers, and case reports were excluded. Results Six studies with 314 subjects were included after screening. The result showed licorice has significant effects on RAS pain reduction, ulcer size, and healing time. Its effectiveness is related to its dose-dependent anti-inflammatory and antioxidant effects through several mechanisms. It also has antibacterial effects against Streptococci mutans and Porphyromonas gingivalis as another mechanism of action in RAS treatment. In addition, licorice can elevate the epidermal growth factor (EGF) level compared to the control group, which has an essential role in oral mucosal tissue integrity. Conclusion Licorice extract has been used in different dosage forms, including paste, patch, and mouthwash with concentrations of 1% or 5%. The healing time after licorice therapy is expected to be within 4-8 days. Licorice did not show any adverse effect in the intervention groups, indicating its effectiveness and safety in RAS treatment.
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Affiliation(s)
- Fereshteh Dorsareh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Scientific Association of Indigenous Knowledge, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gita Vahid-Dastjerdi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Scientific Association of Indigenous Knowledge, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdelhakim Bouyahya
- Laboratory of Human Pathologies Biology, Department of Biology, Faculty of Sciences, and Genomic Center of Human Pathologies, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Mohammad Mehdi Zarshenas
- Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
- Traditional Medicine and Hydrotherapy Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mostafa Rezaie
- Department of Oral and Maxillofacial Medicine, School Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Woong Mo Yang
- Department of Convergence Korean Medical Science, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ehsan Amiri-Ardekani
- Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Zhang Z, Zhang Q, Gao S, Xu H, Guo J, Yan F. Antibacterial, anti-inflammatory and wet-adhesive poly(ionic liquid)-based oral patch for the treatment of oral ulcers with bacterial infection. Acta Biomater 2023; 166:254-265. [PMID: 37187300 DOI: 10.1016/j.actbio.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/21/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Abstract
Oral aphthous ulcers are a common inflammatory efflorescence of oral mucosa, presenting as inflammation and oral mucosal damage and manifesting as pain. The moist and highly dynamic environment of the oral cavity makes the local treatment of oral aphthous ulcers challenging. Herein, a poly(ionic liquid)-based diclofenac sodium (DS)-loaded (PIL-DS) buccal tissue adhesive patch fabricated with intrinsically antimicrobial, highly wet environment adhesive properties and anti-inflammatory activities to treat oral aphthous ulcers was developed. The PIL-DS patch was prepared via polymerization of a catechol-containing ionic liquid, acrylic acid, and butyl acrylate, followed by anion exchange with DS-. The PIL-DS can adhere to wet tissues, including mucosa muscles and organs, and efficiently deliver the carried DS- at wound sites, exerting remarkable synergistic antimicrobial (bacteria and fungi) properties. Accordingly, the PIL-DS elicited dual therapeutic effects on oral aphthous ulcers with Staphylococcus aureus infection through antibacterial and anti-inflammatory activities, significantly accelerating oral aphthous ulcer healing as an oral mucosa patch. The results indicated that the PIL-DS patch, with inherently antimicrobial and wet adhesion properties, is promising for treating oral aphthous ulcers in clinical practice. STATEMENT OF SIGNIFICANCE: Oral aphthous ulcers are a common oral mucosal disease, which could lead to bacterial infection and inflammation in severe cases, especially for people with large ulcers or low immunity. However, moist oral mucosa and highly dynamic oral environment make it challenging to maintain therapeutic agents and physical barriers at the wound surface. Therefore, an innovative drug carrier with wet adhesion is urgently needed. Herein, a poly(ionic liquid)-based diclofenac sodium (DS)-loaded (PIL-DS) buccal tissue adhesive patch was developed to treat oral aphthous ulcers showing intrinsically antimicrobial and highly wet environment adhesive properties due to the presence of catechol-containing ionic liquid monomer. Additionally, the PIL-DS showed significantly therapeutic effects on oral aphthous ulcers with S. aureus infection through antibacterial and anti-inflammatory activities. We expect that our work can provide inspiration for the development of treatment for microbially infected oral ulcers.
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Affiliation(s)
- Zijun Zhang
- Jiangsu Engineering Laboratory of Novel Functional Polymeric Materials, Jiangsu Key Laboratory of Advanced Negative Carbon Technologies College of Chemistry, Suzhou Key Laboratory of Soft Material and New Energy, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou 215123, China
| | - Qiuyang Zhang
- Jiangsu Engineering Laboratory of Novel Functional Polymeric Materials, Jiangsu Key Laboratory of Advanced Negative Carbon Technologies College of Chemistry, Suzhou Key Laboratory of Soft Material and New Energy, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou 215123, China
| | - Shuna Gao
- Jiangsu Engineering Laboratory of Novel Functional Polymeric Materials, Jiangsu Key Laboratory of Advanced Negative Carbon Technologies College of Chemistry, Suzhou Key Laboratory of Soft Material and New Energy, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou 215123, China
| | - Hui Xu
- Jiangsu Engineering Laboratory of Novel Functional Polymeric Materials, Jiangsu Key Laboratory of Advanced Negative Carbon Technologies College of Chemistry, Suzhou Key Laboratory of Soft Material and New Energy, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou 215123, China
| | - Jiangna Guo
- Jiangsu Engineering Laboratory of Novel Functional Polymeric Materials, Jiangsu Key Laboratory of Advanced Negative Carbon Technologies College of Chemistry, Suzhou Key Laboratory of Soft Material and New Energy, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou 215123, China.
| | - Feng Yan
- Jiangsu Engineering Laboratory of Novel Functional Polymeric Materials, Jiangsu Key Laboratory of Advanced Negative Carbon Technologies College of Chemistry, Suzhou Key Laboratory of Soft Material and New Energy, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou 215123, China.
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20
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Kadhim M, Musa H, Barzanji A. The Effectiveness of Intralesional Platelet Rich Plasma in Recurrent Aphthous Stomatitis Compared With Triamcinolone Acetonide. J Drugs Dermatol 2023; 22:398-403. [PMID: 37026888 DOI: 10.36849/jdd.7218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Recurrent aphthous stomatitis (RAS) is an autoimmune disease that affects 25% of the population, with no cure until now. Intralesional triamcinolone acetonide (TA) injections are an effective classic treatment for RAS; and, more recently, intralesional platelet rich plasma (PRP) has been used to manage oral lesions of some autoimmune diseases. OBJECTIVES To try intralesional PRP injections in the management of recurrent oral ulceration of Behcet's disease and compare their clinical effect with intralesional TA injections; and to study the effects of both treatments on the serum level of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α. METHODS Thirty patients diagnosed with RAS were recruited for this trial, with a male to female ratio of 1:1, and ages ranging from 12 to 66 years. For 6 months, 15 patients were treated monthly with intralesional PRP injections and the other 15 were treated monthly with intralesional TA injections. The clinical effects of both treatments were registered in the oral clinical manifestation index (OCMI), as were their effects on the serum levels of IL-1β, IL-6, and TNF-α. RESULTS The OCMI of PRP-treated patients initially ranged from 8 to 23 with a mean±SD of (13.5±4.6). This mean decreased to 5.7 by the end of month 6, with a statistically highly significant P-value compared with baseline. The OCMI of TA-treated patients initially ranged from 8 to 20 with a mean±SD of (13.5±3.8). This mean decreased to 10.5 by the end of month 6, with a statistically significant P-value compared with baseline. Both treatments significantly decreased the serum levels of IL-1β, while only PRP significantly decreased the TNF-α. CONCLUSION Intralesional PRP injections are a new, safe, and effective treatment for RAS. J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.7218 Citation: Kadhim MAA, Musa HD, Barzanji HAA. The effectiveness of intralesional platelet rich plasma in recurrent aphthous stomatitis in comparison with triamcinolone acetonide. J Drugs Dermatol. 2023;22(4):398-403. doi:10.36849/JDD.7218.
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Abbasi F, Rasoulzadeh Z, Yavari A. The effect of sage (Salvizan gel) compared to triamcinolone acetonide on the treatment of recurrent aphthous stomatitis: a double-blinded randomized clinical trial. BMC Oral Health 2023; 23:157. [PMID: 36934268 PMCID: PMC10024424 DOI: 10.1186/s12903-023-02861-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/06/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Recurrent Aphthous Stomatitis (RAS) is one of the most common lesions of the oral mucosa. Herbal medicine can be used for the treatment of this disease. The present study aimed to compare the effects of topical application of Sage (Salvizan) and triamcinolone acetonide gels on RAS. METHODS This double-blind clinical study recruited sixty patients with minor aphthous ulcers. Half of the patients were treated with Salvizan gel, and the other half were treated with oral triamcinolone acetonide gel. The effect of Salvizan topical gel was evaluated and compared with that of oral triamcinolone acetonide gel. Factors such as Pain recovery time, wound healing time, and pain level was evaluated. Data were analyzed by SPSS version 22 using independent t-test, paired t-test, repeated measures ANOVA, and survival analysis, including Kaplan-Meier and Cox regression. RESULTS The mean duration of pain recovery was 1.5 days for Salvizan and 2.5 days for triamcinolone acetonide (p < 0.001). Moreover, the duration of wound healing was 3.3 days for Salvizan and 6 days for triamcinolone acetonide (p < 0.001). Patients' satisfaction from factors such as taste and smell had no significant difference between the two groups. CONCLUSION The results of this study showed that Salvizan gel is very effective in the treatment of RAS. It was significantly better than triamcinolone acetonide in the pain recovery and wound healing. These promising results favor herbal treatments and show that they can be used more commonly for treating diseases such as RAS. TRIAL REGISTRATION This study was approved by the ethics committee of Isfahan University of Medical Sciences (IR.MUI. RESEARCH REC.1399.834) on 17/03/2021. It was also registered in the Iranian Registry of Clinical Trials (IRCT20100202003251N7).
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Affiliation(s)
- Fatemeh Abbasi
- Department of Oral and Maxillofacial Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zeinab Rasoulzadeh
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirmohammad Yavari
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
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Affiliation(s)
- Takuya Suda
- Department of Nephrology and Rheumatology, Ishikawa Prefectural Central Hospital, Japan
| | - Hiroshi Fujii
- Department of Nephrology and Rheumatology, Ishikawa Prefectural Central Hospital, Japan
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Shady NH, Altemani AH, Altemani FH, Maher SA, Elrehany MA, Saber EA, Badawi AM, El-Mordy FMA, Mohamed NM, Abourehab MAS, Sayed AM, Abdelmohsen UR, Mohamad SA. The Potential of Corchorus olitorius Seeds Buccal Films for Treatment of Recurrent Minor Aphthous Ulcerations in Human Volunteers. Molecules 2022; 27:7020. [PMID: 36296628 PMCID: PMC9610436 DOI: 10.3390/molecules27207020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 09/02/2023] Open
Abstract
Aphthous ulcers are very common disorders among different age groups and are very noxious and painful. The incidence of aphthous ulcer recurrence is very high and it may even last for a maximum of 6 days and usually, patients cannot stand its pain. This study aims to prepare a buccoadhesive fast dissolving film containing Corchorus olitorius seed extract to treat recurrent minor aphthous ulceration (RMAU) in addition to clinical experiments on human volunteers. An excision wound model was used to assess the in vivo wound healing potential of Corchorus olitorius L. seed extract, with a focus on wound healing molecular targets such as TGF-, TNF-, and IL-1. In addition, metabolomic profiling using HR-LCMS for the crude extract of Corchorus olitorius seeds was explored. Moreover, molecular docking experiments were performed to elucidate the binding confirmation of the isolated compounds with three molecular targets (TNF-α, IL-1β, and GSK3). Additionally, the in vitro antioxidant potential of C. olitorius seed extract using both H2O2 and superoxide radical scavenging activity was examined. Clinical experiments on human volunteers revealed the efficiency of the prepared C. olitorius seeds buccal fast dissolving film (CoBFDF) in relieving pain and wound healing of RMAU. Moreover, the wound healing results revealed that C. olitorius seed extract enhanced wound closure rates (p ≤ 0.001), elevated TGF-β levels and significantly downregulated TNF-α and IL-1β in comparison to the Mebo-treated group. The phenotypical results were supported by biochemical and histopathological findings, while metabolomic profiling using HR-LCMS for the crude extract of Corchorus olitorius seeds yielded a total of 21 compounds belonging to diverse chemical classes. Finally, this study highlights the potential of C. olitorius seed extract in wound repair uncovering the most probable mechanisms of action using in silico analysis.
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Affiliation(s)
- Nourhan Hisham Shady
- Department of Pharmacognosy, Faculty of Pharmacy, Deraya University, Universities Zone, New Minia 61111, Egypt
| | - Abdullah H. Altemani
- Department of Family and Community Medicine, Faculty of Medicine, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Faisal H. Altemani
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Sherif A. Maher
- Department of Biochemistry, Faculty of Pharmacy, Deraya University, Universities Zone, New Minia 61111, Egypt
- Department of Biochemistry, Faculty of Pharmacy, New Valley University, El Kharga 71511, Egypt
| | - Mahmoud A. Elrehany
- Department of Biochemistry, Faculty of Pharmacy, Deraya University, Universities Zone, New Minia 61111, Egypt
| | - Entesar Ali Saber
- Department of Histology and Cell Biology, Faculty of Medicine, Minia University, Minia 61519, Egypt
| | - Ahmed M. Badawi
- Department of Otorhinolaryngology, Faculty of Medicine, Minia University, Minia 61519, Egypt
| | - Fatma Mohamed Abd El-Mordy
- Department of Pharmacognosy and Medicinal Plants, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo 11754, Egypt
| | - Nada M. Mohamed
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Modern University for Technology, and Information (MTI), Cairo 11754, Egypt
| | - Mohammed A. S. Abourehab
- Department of Pharmaceutics, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
- Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Minia University, Minia 61519, Egypt
| | - Ahmed M. Sayed
- Department of Pharmacognosy, Faculty of Pharmacy, Nahda University, Beni-Suef 62513, Egypt
| | - Usama Ramadan Abdelmohsen
- Department of Pharmacognosy, Faculty of Pharmacy, Deraya University, Universities Zone, New Minia 61111, Egypt
- Department of Pharmacognosy, Faculty of Pharmacy, Minia University, Minia 61519, Egypt
| | - Soad A. Mohamad
- Department of Pharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, Deraya University, Universities Zone, New Minia 61111, Egypt
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Banday AZ, Joshi V, Arora K, Sadanand R, Basu S, Pilania RK, Jindal AK, Vignesh P, Gupta A, Sharma S, Dhaliwal M, Rawat A, Singh S, Suri D. Challenges in the diagnosis of periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome in developing countries—A decade of experience from North India. Front Immunol 2022; 13:958473. [PMID: 36203600 PMCID: PMC9530276 DOI: 10.3389/fimmu.2022.958473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background Reports of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome from developing countries are sparse. Recognizing PFAPA is often challenging in these regions due to a higher incidence of infectious illnesses and significant resource constraints. Herein, we present our experience from North India regarding the diagnosis and management of PFAPA syndrome. Methods We reviewed cases of non-monogenic periodic fever syndrome diagnosed at our center from January 2011 to December 2021. A total of 17 children who fulfilled the Marshall criteria for PFAPA syndrome were included. Data regarding basic clinical features, treatment/outcome, and performance of the recently proposed Eurofever/PRINTO and Takeuchi criteria were analyzed. Results Besides recurrent fever, the triad of oral aphthae, pharyngitis, and adenitis was noted in only 18% of patients. Episodes of exudative pharyngitis/tonsillitis were documented in 24%. These figures were lower than the values reported from developed countries. The Takeuchi and Eurofever/PRINTO criteria were fulfilled in 76% and 71% cases, respectively. In addition to antipyretics and supportive care, intermittent steroid therapy was the main treatment modality used. Additional treatment with colchicine (n = 3) and thalidomide (n = 1) was used successfully in a few patients. Before the diagnosis of PFAPA, all patients had received multiple courses of antimicrobials (without microbiological confirmation). These included multiple courses of antibacterials for fever, pharyngotonsillitis, and/or cervical adenitis in all patients and antivirals for fever and aphthous stomatitis in a patient. Empiric antitubercular therapy had also been administered in two patients. Conclusions A significant proportion of patients with PFAPA seem to remain undiagnosed in the Indian subcontinent. Increased awareness and improvement in basic healthcare facilities are crucial in enhancing the recognition of PFAPA, which would eliminate the unprecedented scale of undesirable antimicrobial use in such children.
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25
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Liu HL, Hsu PY, Chung YC, Lin CH, Lin KY. Effective licorice gargle juice for aphthous ulcer pain relief: A randomized double-blind placebo-controlled trial. Pak J Pharm Sci 2022; 35:1321-1326. [PMID: 36451559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The aim of this study was to determine the effects of licorice gargle juice on aphthous ulcers, which is a common and painful disease that causes loss of normal mucous tissues and results in inflammatory ulcers in the oral mucosa. A randomized double-blind placebo-controlled trial involving primary care patients suffering from aphthous ulcer was performed. The intervention group received licorice gargle juice for 1 and 2 days. Of the 54 patients that participated in the study, 30 were included in the intervention group and 24 in the placebo group. A 10-point visual analog scale (VAS) was used to assess the patients' self-assessed pain levels before and after treatment. Statistical analyses were performed by using the nonparametric Mann-Whitney test. The licorice gargle juice group had a significantly reduced pain level rate compared with the placebo group at day 1 (mean VAS, 2.47 [95% CI, 1.95-2.98] vs. 4.75 [3.96-5.54]; P<0.001) and day 2 (mean VAS, 1.07 [95% CI, 0.81-1.32] vs. 4.08 [3.23-4.94]; P<0.001).The current study indicates that licorice gargle juice rapidly reduce pain and healing time and thus can improve the quality of life of a patient with aphthous ulcer.
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Affiliation(s)
- Hsin-Li Liu
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung City, Taiwan
| | - Po-Ya Hsu
- Department of Computer Science and Engineering, University of California, California, USA
| | - Yueh-Chin Chung
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung City, Taiwan
| | - Chair-Hua Lin
- Changhua Christian Hospital, Changhua County, Taiwan
| | - Kuan-Yu Lin
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung City, Taiwan
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26
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Vuletic M, Jakovljevic V, Zivanovic S, Papic M, Papic M, Mladenovic R, Zivkovic V, Srejovic I, Jeremic J, Andjic M, Kocovic A, Sretenovic J, Mitrovic S, Božin B, Kladar N, Bolevich S, Bradic J. The Evaluation of Healing Properties of Galium verum-Based Oral Gel in Aphthous Stomatitis in Rats. Molecules 2022; 27:molecules27154680. [PMID: 35897855 PMCID: PMC9332434 DOI: 10.3390/molecules27154680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 01/25/2023] Open
Abstract
Although oral ulcers represent one of the most frequent oral mucosal diseases, the available treatment is not sufficient to provide complete ulcer recovery without side-effects. Therefore, the aim of our study was to prepare a mucoadhesive oral gel based on Galium verum ethanol extract (GVL gel) and reveal its healing effects in the model of aphthous stomatitis in rats. Rats with oral ulcers were divided into the following groups: control (untreated), gel base (ulcer was treated with the gel base, three times per day for 10 days), and GVL gel group (the ulcer was treated with GVL gel in the same way as the gel base). Animals from each group were sacrificed on days 0, 3, 6, and 10 for collecting blood and ulcer tissue samples. Healing properties of oral gel were determined by clinical evaluation, as well as biochemical and histopathological examinations. Our findings suggest a significant decrease in the ulcer size in GVL gel group, with healing effects achieved through the alleviation of oxidative stress, reduction in COX-2 immunopositivity, and increase in collagen content in buccal tissue. Significant ulcer repairing potential of GVL gel highlights this oral mucoadhesive gel as a promising tool for prevention and treatment of RAS.
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Affiliation(s)
- Miona Vuletic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujeva, Serbia; (M.V.); (S.Z.); (M.P.); (M.P.); (R.M.)
| | - Vladimir Jakovljevic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (V.J.); (V.Z.); (I.S.); (J.S.)
- Department of Human Pathology, 1st Moscow State Medical University I.M. Sechenov, 119991 Moscow, Russia;
| | - Suzana Zivanovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujeva, Serbia; (M.V.); (S.Z.); (M.P.); (M.P.); (R.M.)
| | - Milos Papic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujeva, Serbia; (M.V.); (S.Z.); (M.P.); (M.P.); (R.M.)
| | - Mirjana Papic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujeva, Serbia; (M.V.); (S.Z.); (M.P.); (M.P.); (R.M.)
| | - Rasa Mladenovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujeva, Serbia; (M.V.); (S.Z.); (M.P.); (M.P.); (R.M.)
| | - Vladimir Zivkovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (V.J.); (V.Z.); (I.S.); (J.S.)
| | - Ivan Srejovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (V.J.); (V.Z.); (I.S.); (J.S.)
| | - Jovana Jeremic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.J.); (M.A.); (A.K.)
| | - Marijana Andjic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.J.); (M.A.); (A.K.)
| | - Aleksandar Kocovic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.J.); (M.A.); (A.K.)
| | - Jasmina Sretenovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (V.J.); (V.Z.); (I.S.); (J.S.)
| | - Slobodanka Mitrovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Biljana Božin
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (B.B.); (N.K.)
- Center for Medical and Pharmaceutical Investigations and Quality Control, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Nebojša Kladar
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (B.B.); (N.K.)
- Center for Medical and Pharmaceutical Investigations and Quality Control, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Sergey Bolevich
- Department of Human Pathology, 1st Moscow State Medical University I.M. Sechenov, 119991 Moscow, Russia;
| | - Jovana Bradic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.J.); (M.A.); (A.K.)
- Correspondence: ; Tel.: +381-34306800
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Milia E, Sotgiu MA, Spano G, Filigheddu E, Gallusi G, Campanella V. Recurrent aphthous stomatitis (RAS): guideline for differential diagnosis and management. Eur J Paediatr Dent 2022; 23:73-78. [PMID: 35274547 DOI: 10.23804/ejpd.2022.23.01.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM Recurrent aphthous stomatitis (RAS) is a painful and common ulcerative form that can pose a diagnostic challenge. In fact, similar oral ulcers can appear secondary to a variety of well-defined pathological conditions. Thus, the purpose of this work was to update the current knowledge about RAS METHODS: A narrative review is presented aiming to clarify the extensive differential diagnosis of RAS and its management. CONCLUSION As a first aid in relieving the pain, topical applications of corticosteroids, antibiotics, and analgesics are highly recommended, while systemic therapy of RAS should be used in the case of multiple painful ulcerations compromising the quality of life of the patient. Also, natural anti-inflammatory substances from medicinal herbs, in the form of essential oils and extracts are promising agents in the management of RAS.
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Affiliation(s)
- E Milia
- Department of Medicine, Surgery and Experimental Sciences, University of Sassari, Sassari, Italy
| | - M A Sotgiu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - G Spano
- Dental Unit, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - E Filigheddu
- Dental Unit, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - G Gallusi
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - V Campanella
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
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Halboub E, Al-Maweri SA, Parveen S, Al-Wesabi M, Al-Sharani HM, Al-Sharani A, Al-Kamel A, Albashari A, Shamala A. Zinc supplementation for prevention and management of recurrent aphthous stomatitis: a systematic review. J Trace Elem Med Biol 2021; 68:126811. [PMID: 34146924 DOI: 10.1016/j.jtemb.2021.126811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/26/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recurrent aphthous stomatitis (RAS) is a very common oral ulcerative disease with no definitive cure. Growing evidence suggests a significant association between zinc deficiency and RAS. OBJECTIVES To assess the efficacy of systemic zinc supplementations in the prevention and management of RAS. METHODS Five databases were searched for all English and Chinese studies published up to November 2020. All clinical trials that assessed the efficacy of zinc supplementations in the management and/or prevention of RAS were included. RESULTS Seven clinical trials comprising 482 RAS patients (250 in zinc group) fulfilled the inclusion criteria. The follow-up period ranged from three months to one year. Five studies showed significantly better efficacy of zinc in reducing the recurrence rates of RAS, whereas two studies did not report any significant differences compared to the controls. Four studies reported on signs/symptoms of RAS, three of which showed superior outcomes in favour of zinc, while one study reported comparable results. CONCLUSION Zinc supplementation seems to be efficacious in the management and prevention of RAS. However, further clinical trials with standardized methodologies and adequate follow-up periods are required to confirm the efficacy of zinc supplementations.
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Affiliation(s)
- Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia; Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Yemen.
| | - Sadeq A Al-Maweri
- Department of Oral Medicine and Diagnostic Sciences, Vision Colleges of Dentistry and Nursing, Riyadh, Saudi Arabia; Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Yemen.
| | - Sameena Parveen
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia.
| | - Mohammed Al-Wesabi
- Department of Preventive and Biomedical Science, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen.
| | - Hesham Mohammed Al-Sharani
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Yemen; Department of Maxillofacial Surgery, School of Stomatology, Harbin Medical University, Harbin, China.
| | - Amani Al-Sharani
- 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.
| | | | - Anas Shamala
- Department of Preventive and Biomedical Science, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen.
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Li W, Gao X, Wang Y, Xu Y, Zhang X, Chen J. Oral lichen planus induced by long-term use of antimicrobials for recurrent aphthous ulcer: A case report and literature review. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46:666-672. [PMID: 34275937 PMCID: PMC10930191 DOI: 10.11817/j.issn.1672-7347.2021.200817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Indexed: 11/03/2022]
Abstract
The precise etiology of oral lichen planus (OLP) is still unclear, but the existing evidence suggests that drug intake, virus infection, fungal infection, psychological disorders, and immunodeficiency are closely associated with the pathogenesis of OLP. We report a case of OLP accompanied with candidiasis induced by long-term use of antimicrobials for recurrent aphthous ulcer (RAU) and update the literature, to discuss the possible association between OLP and misuse of antimicrobials, and to inform general dentists and pharmacists the importance for practice with optimal antimicrobial stewardship. In this case, a 42-year-old man presented to Xiangya Stomatological Hospital with white reticular patterns spreading in the oral cavity for almost 1 year. He was diagnosed with OLP via histopathological examination. He had a 5-year history of RAU which occurred every 1-2 months, and he was given antimicrobials ingested or injected whenever the ulcers came up. Satisfactory treatment results were obtained by stopping the abuse of antimicrobials and local antifungal therapy. Meanwhile, the exacerbation and alleviation of OLP was closely related to the administration of antimicrobials. Combined with literature review, antimicrobial might contribute to the development of OLP by inducing candidiasis, a common side-effect of misuse of antimicrobials. Considering the seriousness of antimicrobial resistance and opportunistic infection, dentists should prescribe antimicrobials judiciously according to guidelines and evidence-based indications. Appropriate prescribing of antimicrobials is a professional responsibility to all dentists.
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Affiliation(s)
- Wenjie Li
- Xiangya Stomatological Hospital, Xiangya School of Stomatology, Central South University, Changsha 410008.
- State Key Laboratory of Powder Metallurgy, Changsha 410083.
- National Key Laboratory of Science and Technology on High-strength Structural Materials, Changsha 410083.
| | - Xuyang Gao
- Xiangya Stomatological Hospital, Xiangya School of Stomatology, Central South University, Changsha 410008
| | - Yuetong Wang
- Xiangya Stomatological Hospital, Xiangya School of Stomatology, Central South University, Changsha 410008
| | - Yiqi Xu
- Xiangya Stomatological Hospital, Xiangya School of Stomatology, Central South University, Changsha 410008
| | - Xin Zhang
- School of Stomatology, Peking University, Beijing 100081, China
| | - Jun Chen
- Xiangya Stomatological Hospital, Xiangya School of Stomatology, Central South University, Changsha 410008.
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Rogulj AA, Z. Alajbeg I, Brailo V, Škrinjar I, Žužul I, Vučićević-Boras V, Alajbeg I. Topical NAVS naphthalan for the treatment of oral lichen planus and recurrent aphthous stomatitis: A double blind, randomized, parallel group study. PLoS One 2021; 16:e0249862. [PMID: 33831097 PMCID: PMC8031371 DOI: 10.1371/journal.pone.0249862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
AIM To evaluate the effectiveness of non-aromatic very rich in steranes (NAVS) naphthalan in the treatment of oral lichen planus (OLP) and recurrent aphthous stomatitis (RAS). Null hypothesis was that there would be no difference between NAVS and topical steroids in the treatment of OLP and RAS. METHODS The study consisted of two sub-trials conducted as randomized, double-blind controlled studies: first included OLP patients and second patients with RAS. Patients received either NAVS or 0.05% betamethasone dipropionate. Primary outcomes were activity score (OLP patients), No of lesions and lesion diameter (RAS patients) and pain intensity (VAS) while secondary outcome included the impact of the disease on quality of life assessed by Oral health impact profile (OHIP 14). RESULTS No significant differences in terms of OLP clinical signs (p = 0.84, η2 = 0.001) and responses on the OHIP-14 (p = 0.81, η2 = 0.002) or on VAS (p = 0.14, η2 = 0.079) between NAVS and betamethasone groups were observed. In RAS patients, no significant differences between the groups in terms of lesion number (at days 3 and 5, p = 0.33 and p = 0.98, respectively), lesion diameter (days 3 and 5, p = 0.24 and p = 0.84, respectively) were observed. However, in NAVS group a significant reduction of lesions diameter was observed on the 3rd day, while in betamethasone group a significant reduction in lesions diameter was evident only after the 5th day. No significant differences in VAS (p > 0.05) and the OHIP-14 (p > 0.05) between groups were found. CONCLUSION No evidence of differences between the two compared interventions was found. REGISTRATION Retrospective registration of this trial was conducted in ClinicalTrials.gov on September 30, 2016; trial registration number: NCT02920658. https://clinicaltrials.gov/ct2/show/NCT02920658?term=NAVS&draw=2&rank=4.
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Affiliation(s)
- Ana Andabak Rogulj
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Iva Z. Alajbeg
- Department of Dentistry, Clinical Hospital Center Zagreb, Zagreb, Croatia
- Department of Removable Prosthodontics, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Vlaho Brailo
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dentistry, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Ivana Škrinjar
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dentistry, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Ivona Žužul
- Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Vanja Vučićević-Boras
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dentistry, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Ivan Alajbeg
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dentistry, Clinical Hospital Center Zagreb, Zagreb, Croatia
- * E-mail:
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Raman P, Pitty R, Krithika CL, Anand SPN, Subramani GP. Topical Curcumin and Triamcinolone Acetonide in Recurrent Minor Aphthous Ulcers: A Pilot Trial. J Contemp Dent Pract 2020; 21:884-890. [PMID: 33568610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM To evaluate the efficacy of topical curcumin and topical triamcinolone acetonide in a professional population with minor aphthous ulcers by assessing six clinical variables: site, size, pain, healing period, frequency of recurrence and number of ulcers. MATERIALS AND METHODS This randomized, parallel designed pilot trial was performed on 60 symptomatic individuals with minor aphthous ulcer. Willing participants were allocated randomly into group I and group II. Participants in group I were treated with topical curcumin and group II were treated with topical triamcinolone acetonide for a period of 6 months. All participants were blinded to the drug they received. Participants were assessed on day 1, day 3, day 5, day 7, and after healing for symptomatic reduction in pain, size, healing period, frequency of recurrence, and in the number of ulcers. Statistically, independent sample t test, Chi-square test, and Log rank Kaplan-Meier survival analysis were performed. RESULTS Lower labial mucosa was found to be the predominant site of minor aphthous ulcer in both the groups. A gradual reduction in pain and size was noted in both the groups with statistical significance of p value <0.001. All the ulcers in both the groups healed completely without scarring within 2 weeks with statistical significance. In both the treatment groups, new ulcers occurred throughout the follow-up period of 6 months. The mean number of the ulcers are statistically not significant with p value >0.05. CONCLUSION Our study showed clinically beneficial effects with topical curcumin with regard to ulcer size, pain, healing, and recurrence rate. Also topical curcumin gel was well tolerated and performed ot par with topical triamcinolone acetonide oral paste with a borderline favorable result with triamcinolone. CLINICAL RELEVANCE Curcumin can be safely recommended on a long-term basis as a more appealing therapeutic agent and is a better alternative choice for aphthous ulcers in children, pregnant woman, lactating mother, and in immunocompromised individuals.
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Affiliation(s)
- Praveena Raman
- Department of Oral Medicine and Radiology, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India, Phone: +91 7373230303, e-mail:
| | - Raghuram Pitty
- Department of Oral Medicine and Radiology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | | | - S P Nehru Anand
- Span Dental Care Centre, Mylapore, Chennai, Tamil Nadu, India
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Yalcin AD, Yalcin AN. A case of asthma with Behcet's disease: successful treatment with omalizumab and its effects on recurrent aphthous lesions. Immunopharmacol Immunotoxicol 2020; 42:379-382. [PMID: 32605504 DOI: 10.1080/08923973.2020.1789656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Monoclonal antibody therapies have revolutionized the treatment of autoinflammatory-immune/genetic disease including spondylarthritis, asthma and rheumatoid arthritis. Behcet's disease (BD) is a multi-systemic vasculitis, which is generally recurrent aphthous lesions (RAL) as well as ocular and skin lesions. Today, the immunohistopathogenesis of BD is mostly unknown. METHOD Omalizumab (Anti-IgE humanized monoclonal antibody) therapy is given for severe persistent allergic asthma, and unintentionally it had effect on RAL. Our patient has received omalizumab treatment for 3 years. The steroid treatment was completely discontinued a month later and the systemic-steroid dependent diabetes mellitus was healed. The IL-1 β, IL-6, IL-8, IL-33, IL-25, IL-10, IL-23, and IL-17A levels were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) kit. RESULTS After a long-term omalizumab treatment administered, the levels of WBC, d-dimer, IL-33, IL-6, IL-25 and IL-1 β decreased. The patient's hsCRP decreased from 3 to 0.1 and Eosinophil Cationic Protein (ECP) levels decreased from 78 to 21. A significant improvement was noticed in the RAL, the asthma symptoms (cough, shortness of breath), the number of emergency admissions, and the average length of stay of the patient within the days following the initiation of the omalizumab treatment. CONCLUSIONS Here, for the first time, we introduce omalizumab treatment of a patient diagnosed with BD and the examination of the treatment for the clinical manifestations and the cytokines/coagulant protein levels. A significant improvement is observed in the patient's RAL following the initiation of omalizumab. There is strong evidence that the serum proinflammatory cytokines/coagulant factors could also play an important role in the relationship between RAL and IgE-dependent vascular autoinflammation.
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Affiliation(s)
- Arzu Didem Yalcin
- Department of Internal Medicine, Allergy and Clinical Immunology, Academia Sinica, Genomics Research Center, Taipei, Taiwan
| | - Ata Nevzat Yalcin
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Akdeniz University, Antalya, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Patlolla VGR, Holbrook WP, Gizurarson S, Kristmundsdottir T. Long-term Stabilization of Aqueous Doxycycline Formulations, in Mucoadhesive Hydrogels for Treatment of Oral Mucosal Conditions. Curr Drug Discov Technol 2020; 17:376-386. [PMID: 30806319 DOI: 10.2174/1570163816666190222193902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The main aim of this work was to develop stable (>2 years) doxycycline formulation, at clinically relevant concentrations and using clinically relevant formulation. Doxycycline has a MMP- inhibitory effects that is important for the treatment of various oral mucosal conditions. Therefore, protecting doxycycline from degradation in aqueous formulation requires halting or prevention of oxidation and epimerisation of the active compound. METHODS Stabilizing excipients were intuitively put together to enhance the stability as a cumulative effort. A total of 30 hydrogels were compared with different types and concentrations of stability enhancing excipients, pH, storage temperatures (4, 25 and 40°C) and mucoadhesive polymers. The duration of the study was from day 1 and up to 58 months. The gelation temperature was adjusted below the actual body temperature. The complexation efficiency between the doxycycline and HPβCD was studied using the DSC, FTIR and XRPD. RESULTS The majority of formulations at 4°C were highly stable by the end of 58 months and their stabilities were improved at all 3 temperatures. CONCLUSION In conclusion, it is possible to prevent doxycycline from both oxidation and epimerization in an aqueous formulation, for up to 5 years.
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Affiliation(s)
- Venu G R Patlolla
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, 107 Reykjavik, Iceland
| | - William P Holbrook
- Faculty of Odontology, University of Iceland, Vatnsmýrarvegi 16, 101 Reykjavík, Iceland
| | - Sveinbjorn Gizurarson
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, 107 Reykjavik, Iceland
| | - Thordis Kristmundsdottir
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, 107 Reykjavik, Iceland
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Affiliation(s)
| | | | | | | | - Onur Boyman
- University Hospital Zurich, Zurich, Switzerland
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Rydenman K, Berg S, Karlsson-Bengtsson A, Fasth A, Wekell P. [PFAPA syndrome - An important differential diagnosis in children with recurrent fever]. Lakartidningen 2019; 116:FP9U. [PMID: 31661147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Periodic Fever, Aphthous Stomatitis, Pharyngitis and Cervical Adenitis (PFAPA) syndrome is the most common autoinflammatory disorder among children in many parts of the world and an important differential diagnosis in children presenting with recurrent fever episodes. Commonly, PFAPA has an onset under the age of 5 years. Fever episodes in PFAPA usually last 3-6 days and are associated with one or more of the cardinal symptoms aphthous stomatitis, pharyngitis and cervical adenitis. The fever episodes typically recur with an interval of 3-6 weeks, often with a striking regularity. During the episodes, the patient has elevated inflammatory variables such as CRP and serum amyloid A (SAA) and may sometimes have additional symptoms such as abdominal pain, nausea and leg pain. Between the fever episodes, the patient is typically free of symptoms with normalized inflammatory variables and grows normally. Awareness and recognition of PFAPA is key to providing the patient with adequate treatment and avoiding misdiagnosis.
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Affiliation(s)
- Karin Rydenman
- NU-sjukvården - Barn- och ungdomskliniken Uddevalla, Sweden NU-sjukvården - Barn- och ungdomskliniken Uddevalla, Sweden
| | - Stefan Berg
- Institutionen för kliniska vetenskaper, Sahlgrenska Akademin, Göteborgs Universitet - Avdelningen för pediatrik Göteborg, Sweden Institutionen för kliniska vetenskaper, Sahlgrenska Akademin, Göteborgs Universitet - Avdelningen för pediatrik Göteborg, Sweden
| | - Anna Karlsson-Bengtsson
- Avdelningen för reumatologi och inflammationsforskning, Institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet - Göteborg, Sweden Institutionen för medicin, Sahlgrenska akademin, Göteborgs Universitet. - Avdelningen för reumatologi och inflammationsforskning Göteborg, Sweden
| | - Anders Fasth
- Drottning Silvias barn- och ungdomssjukhus - Göteborg, Sweden Goteborgs universitet Sahlgrenska Akademin - pediatrik Goteborg, Sweden
| | - Per Wekell
- NU-sjukvården - Barn- och ungdomskliniken Uddevalla, Sweden NU-sjukvården - Barn- och ungdomskliniken Uddevalla, Sweden
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Dalessandri D, Zotti F, Laffranchi L, Migliorati M, Isola G, Bonetti S, Visconti L. Treatment of recurrent aphthous stomatitis (RAS; aphthae; canker sores) with a barrier forming mouth rinse or topical gel formulation containing hyaluronic acid: a retrospective clinical study. BMC Oral Health 2019; 19:153. [PMID: 31311529 PMCID: PMC6636158 DOI: 10.1186/s12903-019-0850-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Use of hyaluronic acid-based products has become a valuable alternative to drug-based approaches in the treatment of recurrent aphthous stomatitis (RAS). The presented study aimed to investigate the effect of a barrier forming hyaluronic acid containing mouth wash or a topical gel formulation on the healing of RAS and patient's quality of life. METHODS For this single-center retrospective study, medical records of the Dental School of the University of Brescia were screened for adult and systemically health patients suffering from minor recurrent aphthous stomatitis (RAS) and treated with either a barrier forming, hyaluronic acid containing mouth wash (GUM® AftaClear® rinse) or a topical gel (GUM® AftaClear® gel) in 2015. All patients fulfilling the in-/exclusion criteria and presenting full data sets on lesion diameter, lesion color, as well as pain perception for baseline (day 0) and 4 and 7 days after treatment were enrolled into the presented study. RESULTS Out of 60 screened patients, a total of 20 patients treated with the Rinse formulation and 25 treated with the Gel formulation were eligible for the enrollment into this study. Both groups showed equal distribution in patient's age, sex and presented a similar mean lesion size (3.0 ± 1.0 mm), lesion color distribution as well as pain perception at baseline. All patients showed significant normalization of lesion color, reduction of pain, and lesion dimension within the course of their treatment. After 7 days, the mean percentage of lesion reduction was highly significant for both groups attaining 77.4 ± 30.1% in the Rinse group and 81.2 ± 23.1% in the Gel group with a complete lesion closure obtained in 60 and 56% of the cases, respectively. However, a significant (p < 0.05) higher percentage of lesions in the Gel group (72%) compared to the Rinse group (40%) showed an improvement in lesion size already after 3 days. CONCLUSIONS Within the limitation of retrospective design, it can be concluded that both the barrier forming hyaluronic acid containing mouth rinse as well as the topical gel formulation are effective in the treatment of minor recurrent aphthous stomatitis (RAS), with a trend for an earlier healing onset for the topical Gel formulation.
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Affiliation(s)
- Domenico Dalessandri
- 0000000417571846grid.7637.5School of Dentistry, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Francesca Zotti
- 0000 0004 1763 1124grid.5611.3Department of Surgical Sciences, Paediatrics and Gynecology, University of Verona, Policlinico “Giovanni Battista Rossi” Piazzale Ludovico Antonio Scuro, 37134 Verona, Italy
| | - Laura Laffranchi
- 0000000417571846grid.7637.5School of Dentistry, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Marco Migliorati
- 0000 0001 2151 3065grid.5606.5School of Dentistry, University of Genova, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Gaetano Isola
- 0000 0004 1757 1969grid.8158.4Department of General Surgery and Surgical-Medical Specialities, School of Dentistry, University of Catania, via Plebiscito, 625. Building 15a, 95123 Catania, Italy
| | - Stefano Bonetti
- 0000000417571846grid.7637.5School of Dentistry, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Luca Visconti
- 0000000417571846grid.7637.5School of Dentistry, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
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Arafa MG, Ghalwash D, El-Kersh DM, Elmazar MM. Propolis-based niosomes as oromuco-adhesive films: A randomized clinical trial of a therapeutic drug delivery platform for the treatment of oral recurrent aphthous ulcers. Sci Rep 2018; 8:18056. [PMID: 30575794 PMCID: PMC6303391 DOI: 10.1038/s41598-018-37157-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/29/2018] [Indexed: 11/09/2022] Open
Abstract
Oromuco-adhesive films for buccal delivery of Propolis extract (PPE) entrapped in niosomes, were prepared to treat oral recurrent aphthous ulcer (RAU). PPE was investigated for antimicrobial compounds. Niosomes composed of span60 and cholesterol were evaluated for particles size, polydispersity index (PDI), zeta-potential, entrapment efficiency and in vitro release. The formed oromuco-adhesive films containing niosomal PPE were evaluated for swelling, mucoadhesion and elasticity. 24 patients suffering from RAU were divided equally into medicated and placebo groups and participated in this study to examine the onset of ulcer size reduction, complete healing and pain relief. Ultra-performance liquid chromatography-high resolution mass spectrometry revealed the presence of pinocembrin, pinobanksin, chrysin and galangin as antimicrobial flavonoids with total content of 158.7 ± 0.15 µg quercetin equivalents and phenolic content of 180.8 ± 0.11 µg gallic acid equivalents/mg. Multilamellar niosomes of 176-333 nm displayed entrapment efficiency of 91 ± 0.48%, PDI of 0.676 and zeta potential of -4.99. In vitro release after 8 h from niosomal dispersion and films were 64.05% and 29.09 ± 0.13% respectively. Clinical results revealed duration of film adherence from 2-4 h in the two groups. The onset of ulcer size reduction in medicated group was attained within second and third day, complete healing was achieved within first 10 days of treatment and pain relief lasted for more than 4-5 h, in contrast to the placebo group. This oromuco-adhesive films which offer controlled and targeting drug delivery can be proposed as a new therapeutic strategy in the treatment of oral recurrent aphthous ulcer.
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Affiliation(s)
- Mona G Arafa
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, The British University in Egypt (BUE), El-Sherouk city, Cairo, 11837, Egypt.
- Chemotheraputic Unit, Mansoura University Hospitals, Mansoura, 35516, Egypt.
| | - Dalia Ghalwash
- Department of Oral Medicine and Periodontology, Faculty of dentistry, The British University in Egypt (BUE), El-Sherouk city, Cairo, 11837, Egypt
| | - Dina M El-Kersh
- Department of Pharmacognosy, Faculty of Pharmacy, The British University in Egypt (BUE), El-Sherouk city, Cairo, 11837, Egypt
| | - M M Elmazar
- Department of Pharmacology, Faculty of Pharmacy, The British University in Egypt (BUE), El-Sherouk city, Cairo, 11837, Egypt
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Guo Q, Yang J, Yu M. Observing the effect of traditional Chinese medicine Kouchuang Xiaotong powder on patients with recurrent aphthus ulcer. Pak J Pharm Sci 2018; 31:1687-1690. [PMID: 30203763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The effect of traditional Chinese medicine Kouchuang Xiaotong powder on patients with recurrent aphthous ulcer is observed and analyzed. 140 patients with recurrent aphthous ulcer in our hospital were selected as research objects, which were randomly divided into two groups: study group and control group. Among them, the patients in study group were treated with traditional Chinese medicine kouchuang xiaotong powder, and patients in control group were given the general routine treatment, comparing overall effective treatment of the two groups. Through comparing the time of pain disappearance, the size of ulcer after treatment, ulcer healing time and the time of feeding improvement, the results showed that study group had more obvious advantages than control group with P<0.05; through comparing pain score and overall curative effect of the two groups, study group was significantly superior than control group with P<0.05.The treatment of traditional Chinese medicine Kouchang Xiaotong powder on patients with recurrent aphthous ulcer, it can obtain good effect, significantly improve the curative effect and promote recovery as soon as possible.
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Affiliation(s)
- Qingwen Guo
- School of Stomatology, Qingdao University, Qingdao, China
| | - Jianjun Yang
- Department of Stomatolog, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Meizhi Yu
- Department of Stomatolog, Weifang People's Hospital (Hanting District), WeiFang, China
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Zhu S, Shi Q, Lu J. Curative effect of oral ulcer powder on the treatment of recurrent aphthous ulcer. Pak J Pharm Sci 2018; 31:1175-1178. [PMID: 29735470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Recurrent aphthous ulcer (RAU) is a common and frequently occurring disease in the Department of Stomatology. The clinical manifestations are localized ulcer of oral mucosa, and the ulcer mask is self limiting and easy to recur. In this paper, by adopting the randomized study method, the author study the effect of oral ulcer powder combined with traditional Chinese drugs on patients with recurrent aphthous ulcer, and analyze its effect on inflammatory factor. Kangfuxin liquid combined with oral ulcer powder helps reduce recurrent aphthous ulcer patients the levels of inflammatory factors, improve the symptoms of pain. The recurrence rate of the patients in the observation group for 6 months was 12.8%, which was significantly lower than that of the control group (31.42%). The difference was statistically significant (P<0.05). At the same time, the average TNF-a, IL-1 and IL-6 water in the observation group were significantly lower than that of the control group, proving that the treatment regimen could reduce the inflammatory response.
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Affiliation(s)
- Shenshan Zhu
- Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Stomatology Hubei, China
| | - Qiaoyun Shi
- Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Stomatology Hubei, China
| | - Jian Lu
- Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Stomatology Hubei, China
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Abstract
Colchicine is a treatment for gout that has been used for more than a millennium. It is the treatment of choice for familial Mediterranean fever and its associated complication, amyloidosis. The 2009 U.S. Food and Drug Administration approval of colchicine as a new drug had research consequences. Recent investigations with large cohorts of patients with gout who have been taking colchicine for years have demonstrated novel applications within oncology, immunology, cardiology and dermatology. Some emerging dermatological uses include the treatment of epidermolysis bullosa acquisita, leucocytoclastic vasculitis, aphthous stomatitis and others. In this work we relate the history and the new horizon of this ancient medicine.
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Affiliation(s)
- B Dasgeb
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, U.S.A
- Section of Analytical and Functional Biophotonics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, U.S.A
| | - D Kornreich
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - K McGuinn
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - L Okon
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - I Brownell
- Division of Basic and Translational Biophysics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, U.S.A
| | - D L Sackett
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, U.S.A
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Casale M, Moffa A, Vella P, Rinaldi V, Lopez MA, Grimaldi V, Salvinelli F. Systematic review: the efficacy of topical hyaluronic acid on oral ulcers. J BIOL REG HOMEOS AG 2017; 31:63-69. [PMID: 29202564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The management of oral ulcers is a challenge for clinicians. Whilst there is widespread use of topical corticosteroids, antibiotics and antimicrobial, there is only weak evidence for the effectiveness of any of the topical treatments. Hyaluronic Acid (HA) has been recently proposed for topical administration in the treatment of oral ulcers and other painful oral lesions. The aim of the study is to systematically review the published literature regarding all the therapeutic effects of HA on painful oral lesions such as oral ulcers and oral lichen planus. Relevant published studies were found in PubMed, Google Scholar and Ovid using a combined keyword search or medical subject headings. At the end of our study selection process, 4 relevant publications were included: two regarding oral lichen planus, one Behcets Disease and Recurrent Aphthous ulcer and one in oral ulcers in general. Both subjective parameters such as healing period, VAS for pain and objective assessments such as number of ulcers, maximal area of ulcer and inflammatory signs, significantly improved after HA treatment. These data allow us to suggest that HA may play a pivotal role in the treatment of oral ulcers.
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Affiliation(s)
- M Casale
- Unit of Otolaryngology, University Campus Bio-Medico, Rome, Italy
| | - A Moffa
- Unit of Otolaryngology, University Campus Bio-Medico, Rome, Italy
| | - P Vella
- Unit of Otolaryngology, University Campus Bio-Medico, Rome, Italy
| | - V Rinaldi
- Unit of Otolaryngology, University Campus Bio-Medico, Rome, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico
| | - M A Lopez
- Dentist, Oral Surgeon, Private Practitioner, Rome, Italy
| | | | - F Salvinelli
- Unit of Otolaryngology, University Campus Bio-Medico, Rome, Italy
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Yarom N, Zelig K, Epstein JB, Gorsky M. The efficacy of minocycline mouth rinses on the symptoms associated with recurrent aphthous stomatitis: a randomized, double-blind, crossover study assessing different doses of oral rinse. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:675-679. [PMID: 28411006 DOI: 10.1016/j.oooo.2017.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/30/2017] [Accepted: 02/14/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of the study was to assess the efficacy of 2 different concentrations of minocycline mouthwashes on the symptoms of recurrent aphthous stomatitis (RAS). STUDY DESIGN The 2-year study was designed as a randomized, double-blind, crossover study. Healthy patients with frequent RAS episodes received 2 sealed and computer-randomized marked kits containing minocycline mouthwashes (0.2% and 0.5% solution). The patients were asked to use 1 of the kits on the first episode of RAS, starting with the first onset of prodromal symptoms, until the symptoms resolved or up to a maximum of 10 days (whichever came first). The patients were asked to use their second kit during a subsequent episode. RESULTS A total of 14 patients (8 males, 6 females) completed the 2 arms of the study. The mean intensity of pain was significantly lower when the 0.5% solution was used compared with the 0.2% solution (P = .027). The difference reached the level of statistical significance as soon as the end of the second day of use (P = .032). Only minor and temporary adverse reactions were documented. CONCLUSIONS We found that 0.5% minocycline mouth rinse was more effective than the 0.2% concentration, which had been suggested by our group in previous studies for the management of RAS.
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Affiliation(s)
- Noam Yarom
- Oral Medicine Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Keren Zelig
- Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; and Consulting staff, City of Hope, Duarte, CA, USA
| | - Meir Gorsky
- Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Semianchuk VB. Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (pfapa) syndrome in children. Wiad Lek 2017; 70:144-147. [PMID: 28343210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome refers to a group of primary immunodeficiencies, namely autoinflammatory diseases. Most pediatricians and otolaryngologists do not suspect PFAPA syndrome when treating recurrent pharyngitis (according to Ukrainian classification - tonsillitis) and stomatitis. Therefore, patients with a given syndrome receive unnecessary treatment (antibiotic therapy or antiviral drugs) and the diagnosis is made late. The aim of the research was to provide pediatricians, family physicians and otolaryngologists with information on the importance of early diagnosis of PFAPA syndrome. MATERIALS AND METHODS The analysis of the prevalence and diagnosis of PFAPA syndrome in Ukraine and worldwide has been made as well as a late diagnosis of PFAPA syndrome in a child living in Ivano-Frankivsk, Ukraine has been described (case report). RESULTS The Сase report 7-year-old boy, who grows and develops normally. The symptoms of pharyngitis including high body temperature (>40 º С), sore throat and white spots on the tonsils appeared for the first time at the age of two years. The boy received antibacterial drugs about 10 times a year. During a four-year period of recurrent episodes of the disease antimicrobial susceptibility testing to determine susceptibility of the oropharyngeal flora to the antibiotics were continuously performed, different blood tests for herpes viruses, Epstein-Barr virus infection and cytomegalovirus in particular were made using the enzyme immunoassay (EIA) and polymerase chain reaction (PCR) in addition to long-term treatment. CONCLUSIONS An example of late diagnosing PFAPA syndrome (four years after the onset of first symptoms) resulting in regular examinations, medical manoeuvres, outpatient and inpatient treatment, use of antibiotic therapy including intravenous injections on a monthly basis has been studied.
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Affiliation(s)
- Vira B Semianchuk
- State Higher Educational Institution "Ivano-Frankivsk National Medical University", Department Of Children Diseases Of Postgraduate Medical Education Faculty, Ivano-Frankivsk, Ukraine
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Mahboubi M. Myrtus communis L. and its application in treatment of Recurrent Aphthous Stomatitis. J Ethnopharmacol 2016; 193:481-489. [PMID: 27693775 DOI: 10.1016/j.jep.2016.09.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 06/06/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In Iranian Traditional Medicine, M. communis is a famous plant in treatment of oral ulcers and "Gholaa"- the ancient name of aphthous. OBJECTIVE The aim of this review is to create a bridge between the traditional claims about the application of M. communis in treatment of "Gholaa" and its prescription for aphthous, the current form of "Gholaa" in modern medicine METHODS: We extracted the information about the application of M. communis in treatment of aphthous from different resources including Google scholar, Pubmed, ScienceDirect, Springer, ethnobotanical, the traditional books from Traditional Medicine Tehran University of Medical Sciences. RESULTS In Iranian traditional texts, "Gholaa" was the corrosive diseases on the surface and inner layer of mouth and tongue and divided into three types of bloody, phlegmatic and burned black bile types. Recurrent Aphthous Stomatitis (RAS) is equal to the black bile and phlegmatic types and minor aphthous type can be matched with phlegmatic type. The corrosive propagated lesions can be herpetic aphthous. In modern medicine, M. communis essential oil and its decoction decreased the average time of pain relief and decreased the size of ulcers in patients with minor RAS without any adverse effects. The number of ulcers was not the subjects of any different clinical trials. All patients were satisfied with M. communis topical essential oil (5%), and 81% patients were satisfied with M. communis topical decoctions (5%). It appears the efficacy of M. communis is related to its analgesic, anti-inflammatory, antiseptic and wound healing effects. CONCLUSION M. communis is effective in minor RAS as its traditional claims and confirming its efficacy in major and herpetiform RAS and comparing the efficacy of its decoction topical formulations or essential oil topical ones are required more and larger experimental and clinical investigations in future.
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Affiliation(s)
- Mohaddese Mahboubi
- Microbiology Department, Medicinal Plant Research Center of Barij, Kashan, Iran.
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Bardellini E, Amadori F, Conti G, Majorana A. Clinical efficacy of a solution composed by sodium bicarbonate and alginate, aloe vera, propoli, chamomile, calendula and honey, in the treatment of minor recurrent aphthous stomatitis in children. Minerva Pediatr 2016; 68:507-509. [PMID: 27768020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Elena Bardellini
- Department of Oral Medicine, University of Brescia, Brescia, Italy -
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Shao Y, Zhou H. Clinical evaluation of a toothpaste containing lysozyme for the treatment of recurrent aphthous stomatitis: A 3-month, double-blind, randomized study. Am J Dent 2016; 29:303-306. [PMID: 29178716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To assess the efficacy and safety of a toothpaste containing lysozyme for the treatment of minor recurrent aphthous stomatitis (MiRAS) in a 3-month clinical trial. METHODS 71 participants with MiRAS were recruited to this randomized, parallel-controlled, double-blind clinical trial. Participants were allocated randomly to the test group or the control group. Demographic data and pain score (visual analogue scale, VAS) were recorded at baseline. Healing time of MiRAS, recurrence frequency and side effects were recorded at the 1-, 2- and 3-month follow-up visits. All data were analyzed using SAS software version 8.0. RESULTS There was no significant difference (P>0.05) in pain score between the treatment group (3.00 ± 1.66) and the control group (2.66 ± 1.51). The average healing time was significantly reduced (P< 0.01) in the treatment group (5.66 ± 2.02) compared with the control group (7.46 ± 2.69), while the recurrence frequency also showed a significant reduction from 4.40 ± 2.89 in the control group to 3.06 ± 1.48 in the treatment group (P< 0.05). No obvious side effects were observed. CLINICAL SIGNIFICANCE The results of this clinical study supported the conclusion that a toothpaste containing lysozyme was effective in promoting healing and reducing recurrence frequency without significant side effects in the treatment of minor recurrent aphthous stomatitis.
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Affiliation(s)
- Yanxiong Shao
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Haiwen Zhou
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Gao MS, Liu S, Wang AW. [Preparation and clinical observation of Koukuining granules in 50 patients with recurrent aphthous ulcer]. Shanghai Kou Qiang Yi Xue 2016; 25:579-582. [PMID: 28116431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To prepare Koukuining granules and observe its efficiency in the treatment of recurrent aphthas ulce (RAU). METHODS In accordance with the theories of traditional Chinese medicine, the prescriptions of Koukuining granules were composed of rhizoma coptidis, radix scutellariae and other Chinese herbs, and the preparation procedure was conducted by means of wet granulation technology. One hundred patients with RAU were randomly divided into experimental group and control group equally. Patients in the experimental group took particles orally after a meal, 3 times a day, 1 bag each time, for successive 10 days as one treatment course. The treatment was repeated after 3 days of interval. Patients in the control group took vitamin C, compound vitamin B2, orally for 2 courses. The treatment effect was evaluated. Data analysis was performed using SPSS 11.5 software package. RESULTS The preparation process was controllable and the quality of the products was stable. The overall effective rate of the experimental group was 88.4% and there was a significant difference compared with the control group. CONCLUSIONS The preparation of Koukuining granules was feasible with stable quality of final products. Treatment of RAU with the granules was effective and worthy of clinical application.
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Affiliation(s)
- Meng-Shan Gao
- Stomatological Hospital of Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration. Jinan 250012, China E-mail:
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Nosratzehi T, Akar A. Efficacy of Omega-3 in Treatment of Recurrent Aphthous Stomatitis: A Randomised, Double-blind, Placebo-controlled Study. Chin J Dent Res 2016; 19:159-64. [PMID: 27622219 DOI: 10.3290/j.cjdr.a36681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the potential of omega-3 polyunsaturated fatty acid supplement as an effective, safe and inexpensive medicine for the treatment of recurrent aphthous stomatitis. METHODS In this double-blind clinical trial, 50 patients with recurrent aphthous stomatitis were randomly divided into the omega-3 group and placebo group. Patients in the omega-3 group received 1000 mg omega-3 group capsules (Daroupakhsh Company, Tehran, Iran) for 6 months; while those in the placebo group received placebo capsules with the same instructions. The pain, size, duration and recurrence rate of ulcers were recorded in each follow-up phase. Follow-up was done weekly in the first month of drug prescriptions and then monthly in the next 5 months. The data were analysed with SPSS-20 through the Mann-Whitney test to compare the groups with respect to each variable and the Wilcoxon and Friedman tests to compare the groups over time. Values were significant at P < 0.05. RESULTS In the omega-3 group, pain was lessened from 4.96 to 3.04, irritation was reduced from 5.88 to 4.00 (P = 0.0627) and the size of ulcers was decreased from 2.30 to 1.48 mm (P = 0.062). No significant change was observed in the aforementioned variables in the placebo group. Moreover, the number of ulcers indicated a significant reduction in the fourth, fifth and sixth months in comparison with the placebo group (P = 0.00). CONCLUSION The recurrence of ulcers in the omega-3 group showed a significant decrease in the fifth and sixth months compared with the placebo group (P < 0.05). The current study indicated that omega-3 consumption decreased the symptoms of recurrent aphthous stomatitis.
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