Recurrent Aphthous Stomatitis Lesions Research Articles

The Correlation Between the Recurrent Aphthous Stomatitis Lesion and Quality of Life Among Productive-Age Patients

Background: Recurrent Aphthous Stomatitis (RAS) is an ulcerative disease in oral mucosa. These lesions are usually located on the non-keratinized oral mucosa with the characteristics of recurrent ulcerated lesions and the presence of pain. Some people affected by RAS will have various impacts on speech, swallowing, and chewing functions. Patients with RAS usually experience pain, and this impact greatly affects their quality of life. Objective: This study examined the relationship between RAS and patients' quality of life. Materials and Methods: This study is a cross-sectional observational study. The method of taking the subjects was done using consecutive sampling with 32 subjects. Data collection was carried out with objective and subjective data. Results: A significant relationship exists between RAS and patient quality of life p = 0.044 (Fisher's Exact Test,p0.05). There is a significant correlation between RAS and patient quality of life Spearman's correlation test, significance p0.05) with a value of p = 0.018 with a strength level of a correlation coefficient of 0.415, which means that it has a moderate level and a direction of the correlation is positive. Conclusion: Aspects of social functioning limitation and bodily pain are most influenced by the emergence of RAS lesions. There is a positive correlation between RAS and patients' quality of life.

Effects of honey-lemon spray on recurrent aphthous stomatitis comparing to Triamcinolone ointment

Recurrent aphthous stomatitis (RAS) is recurrent and painful diseases of the oral mucosa that can be very painful and annoying despite their small size. There is no definitive cure for this disease and the usual treatments are mainly based on pain control. The aim of this study was to investigate the effect of honey-lemon spray (mucotin) in the treatment of recurrent aphthous stomatitis. Methods: This study is a randomized controlled clinical trial conducted in 2020 at Zahedan University of Medical Sciences on 46 RAS patients. The participants were randomly assigned to the intervention (mucotin) or control groups (Triamcinolone ointment) equally (23 patients in each group). Patients were evaluated for the severity of pain and ulcer size. Evaluations were performed on days 0, 2, 7 of the treatment using VAS. Data were analyzed using ANOVA statistical test. Results: The inner aspect of the lower lip was the most common site of RAS in the participants (48.8%) and the lowest site went for hard palate (2.4%). Four items including pain, burning sensation, necrosis area, and erythematous area were evaluated in both groups. There was no significant difference in all parameters before the treatment period (day 0). The mean pain score, burning sensation, necrosis, erythematous areas were not different in days 0, 2 and 7 between groups respectively (p=0.849, p=0.105, p=0.917, p=0.442). Conclusion: Honey-lemon spray (Mucotin) and topical corticosteroid have similar effects in RAS treating, So Mucotin can be used as the first line of treatment for RAS lesions. This herbal medicine has no side effects.

Management of recurrent aphthous ulcers with therapeutic Nd:YAG laser, using two different methods.

Low-level laser therapy (LLLT) has been applied for the management of craniomaxillofacial disorders, including intraoral wounds, as well as recurrent aphthous stomatitis (RAS) lesions. However, the proper combination of laser features and tissue characteristics remains the major challenge in the realm of photobiomodulation (PBM). The aim of the present study was to assess the feasibility of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy in treating RAS lesions, and to compare 2 techniques, different with regard to the distance between the fiber tip and the ulcer. A total of 138 patients (94 males and 44 females) with untreated RAS were divided into 3 groups: focused laser (energy density: 48 J/cm2; power density: 0.797 W/cm2; spot size: 0.1256 cm2); defocused laser (energy density: 21 J/cm2; power density: 0.354 W/cm2; spot size: 0.2826 cm2); and placebo. In the focused group, laser irradiation was performed with the laser tip kept 1 mm away from the lesion. Acrylic cylinders were prepared to precisely fit the handpiece tip and hold it in the proper position. In the defocused group, acrylic cylinders were prepared to set the laser tip 6 mm away from the lesion to obtain defocused irradiation. Finally, in the placebo group, a routine laser therapy procedure was carried out with a helium-neon (He-Ne) red light laser. The lesion size, and pain intensity and duration were recorded. Photobiomodulation showed a significantly more efficient pain relief as compared to the placebo group (p < 0.001) and also significantly better results in decreasing pain duration (p < 0.001). Besides, the diameter of the lesions in the exposed cases decreased during the 3 consecutive days of the study, while an increase in the diameter of the lesions was noticed in the placebo group. The Nd:YAG laser therapy, with the conditions and adjustments of the present study, may be successfully applied to manage RAS lesions, using either focused and defocused scanning techniques.

Oral microbiota in active and passive states of recurrent aphthous stomatitis: An analysis of case-control studies

ObjectiveThis study was presented to reveal the most distinct microbial prevalence in recurrent aphthous stomatitis (RAS) lesions compared to healthy controls. DesignThe case-control studies were selected in electronic databases until Nov 2022 with key search terms, and the eligible publications were screened and analyzed by independent authors. ResultsA total of 14 studies were identified, which included 531 cases of active states of RAS (AS-RAS), 92 cases of passive states of RAS (PS-RAS) and 372 healthy controls. The most sample pattern was the mucosa swab performed in 8 of 14 studies, biopsies in 3 studies, followed by micro-brush, and saliva. A variety of bacteria in higher or lower abundance were observed in RAS lesions. ConclusionsThe etiopathogenesis of RAS may not be ascribed to a single pathogen. A possible explanation is that microbial interactions modify immune response or destroy the epithelial integrity, thus contributing to the development of the condition.

Efficacy of Oral Mucoadhesive N-Acetylcysteine Tablets in Treatment of Recurrent Aphthous Stomatitis: A Randomized Double-Blind, Placebo-Controlled Clinical Trial.

Objectives: This study aimed to assess the efficacy of oral mucoadhesive N-acetylcysteine (NAC) tablets for treatment of recurrent aphthous stomatitis (RAS). Materials and Methods: Forty-nine patients with RAS were randomized to receive mucoadhesive NAC tablets (n=25) or placebo (n=24). Tablets were prescribed three times a day for 7 days in each group. Pain intensity was evaluated with visual analog scale (VAS) three times a day from day 1 to day 7. Also, patients were clinically examined on days 0 (before entering the study), 3, 5, and 7 using a metal caliper to measure the diameter of the lesions. The data were statistically analyzed and P<0.05 was considered statistically significant. Results: Regarding the VAS score, all participants in the treatment group showed complete recovery on day 7 (P<0.01). Also, the diameter of the lesions was significantly smaller in the treatment group than the placebo group at the end of the study (P<0.001). Conclusion: The results of this clinical trial showed for the first time that mucoadhesive NAC tablets can significantly decrease pain and the diameter of RAS lesions without any systemic complications.

&lt;strong&gt; Correlation between presence of bacillus species and OHI-s in recurrent aphthous stomatitis patients &lt;/strong&gt;

ABSTRACTIntroduction: The approximate prevalence of Recurrent Aphthous Stomatitis (RAS) was 45.42% at Gusti Hasan Aman Dental Hospital Banjarmasin. Bacillus sp. is a bacterium that can form spores that can be transmitted through air, dust, water and food. Poor oral conditions will increase the possibility of bacterial contamination, especially for ulcers found in RAS. This study aimed to analyzed correlation between the presence of Bacillus species and OHI-S in the oral ulceration of RAS patients. Methods: This was an analytical cross-sectional study conducted among Oral Medicine Department outpatients at Gusti Hasan Aman Dental Hospital, Banjarmasin, Indonesia. A total of 38 subjects were examined to assess Oral Hygiene Index Simplified and obtained bacteria samples using the swabs technique. Bacteria were then inoculated in blood agar base media and concurrently presented with gram staining. Bacteria were then identified using the catalase test, urease test, and oxidase test. Results: Bacillus species were predominantly identified in oral ulceration of RAS patients at Gusti Hasan Aman Dental Hospital Banjarmasin. Bacillus sp. (60,5%), Streptococcus sp. (34,2%), Neisseria sp. (2,6%), and Lactobacillus sp. (2,6%) were found in ulcerated RAS lesions. Spearman test resulted in p = 0.862 (p &gt; 0.05), where no significant difference was obtained between presence of bacillus species and OHI-s in recurrent aphthous stomatitis patients. Conclusion: Bacillus species were predominantly identified in oral ulceration of RAS patients a. However, the presence of Bacillus sp. was not associated with OHI-S in RAS patients.Keywords: bacillus sp.; oral hygiene index simplified; recurrent aphthous stomatitis

Effectiveness of low-level Diode laser therapy in recurrent aphthous stomatitis treatment at Can Tho University of Medicine And Pharmacy Hospital in 2020-2022

Background: Recurrent aphthous stomatitis (RAS) are the most common oral ulceration in lesions of the oral mucosa. Treatment aims to reduce pain and healing time. Low-level Diode laser therapy can relieve pain, anti-inflammatory, reduce edema, stimulate cell biology, and stimulate healing. Low-level Diode laser therapy is an alternative therapy to conventional drug use, promising to help improve the quality of life, improve the patient's quality of life and avoid complications caused by long-term drug use. Objectives: To evaluate the therapeutic effect of a low-level Diode laser on RAS treatment to reduce pain, size of ulcers, and healing time. Materials and methods: A clinical study was conducted on 30 patients who presented RAS lesions were treated with low-level laser therapy. The patients were evaluated for the size, position, pain score, form of ulcers, healing time before and immediately, fourth and sixth day after treatment. The data was analyzed using SPSS 20. Results: The VAS score pre-treatment was 4.33±1.65, immediately post-treatment was 1.20±1.06. The size of ulcers pre-treatment was 4.58±2.35mm, and post-treatment fourth day was 2.47±2.30mm. The healing time was 5.04±0.32 days. Conclusion: Low-level Diode laser therapy is effective in RAS treatment to reduce pain, size of ulcers, and healing time.

Correlation of the Protein Expression of Salivary Cortisol, Serum Vitamin B12 and Interleukin 1 Beta in Patients with Recurrent Aphthous Stomatitis

This study will help in determining which molecules participate in the ulceration with an integrated approach combining external and internal factors. Recurrent aphthous stomatitis (RAS) is a common condition affecting the oral mucosa. Clinically it is manifested through recurrent painful lesions. A total of 28 subjects were recruited for this systematic case-controlled study (14 Control and 14). Whole unstimulated saliva was used for measuring Cortisol and IL-1 b levels. Patients with RAS lesions exhibited an elevated salivary cortisol level as against their healthy counterparts. The mean value for salivary cortisol among RAS patients was determined to be 16.2 nM/dL as against the control group which had a mean salivary cortisol of 12 nM/dL. Overall, this study helps provide insights into the correlation of the different biomarkers and RAS patients which can eventually lead to better therapeutic options and prevent recurrence in patients.

Vitamin D and hematinic deficiencies in patients with recurrent aphthous stomatitis.

Recurrent aphthous stomatitis (RAS) represents a dysfunction in focal inflammatory processes. With the emerging anti-inflammatory roles of vitamin D (VD), we wanted to investigate the association between the onset and severity of RAS and serum VD level. Fifty-two RAS cases and sex and age-matched controls were screened for serum iron, B12, folic acid, VD and red cell indices. Variables were compared using independent samples t test and chi square. Binary logistic regression was used to assess the association between the severity of RAS and various hematinic deficiencies. VD was deficient in 53% of the study population with no statistically significant difference between the RAS patients and healthy controls (53.6 versus 51.5 nmol/l, respectively). In comparison with controls, RAS patients had lower means of iron (81.0 versus 89.3 μg/dl), vitamin B12 (368.5 versus 412.7 pg ml) and most of the red cell indices; however, these differences were not statistically significant. No correlations were seen between RAS severity assessed by ulcer diameter, number of ulcers and their frequency and hematinic deficiencies. However, logistic regression showed a significant association between the number of ulcers (single or multiple) and VD deficiency (OR 4.978; 95% CI 1.204-20.576; p value = 0.027), adjusted for age, sex and other hematinics. VD deficiency appears to have a role in aggravating RAS ulcerative episodes, but not their onset. Multiple aphthous ulcers might represent a subcategory of RAS lesions in which VD deficiency plays a role in aggravating the oral ulcerative condition.

Detection of HSV1 and HSV2 viruses among Iraqi patients with recurrent Stomatitis Aphthous

Background: Recurrent aphthous stomatitis (RAS) is a global oral case that stay incompletely understood yet. It was classified into three main types of minor, major or herpetiform, based on clinical features, but the exact causative agent is unknown, therefore treatments are primarily should be experimental and aimed at decrease symptoms rather than remedy or prevention. The aim of study is to detection of Herpes simplex virus-1 and Herpes simplex virus-2 in saliva of patients with recurrent aphthous stomatitis (RAS) as a causative agents of the disease by the enzyme-linked immunosorbent assay (ELISA) assay, and correlation between positive results and finding of age, gender, and family history. Materials and Methods: Study group of (40) saliva samples were taken from 40 patients with RAS lesions included 15 male and 25 female, with mean age at (34) years, at range about (18-55) years , and healthy control group were (20) healthy volunteers were suffered from oral traumatic ulcers, consist women (13), men (7), mean age (33) years in range (18-55). for detection of HSV viruses types that may causes this disease, and healthy control group were (20) healthy volunteers were suffered from oral traumatic ulcers, ELISA method used for diagnosis HSV-1 and HSV-2, from saliva samples of the patients with (RAS) with correlation between positive results and finding of age, gender, and family history. Results: Diagnostic specimens were consisted of two groups, study group of (40) saliva samples taken from 40 patients with RAS lesions. The results of ELISA to detect HSV had high significant (17): 42.5% from (40) patients with (RAS), HSV-1: (13)32.5%, and HSV-2: (4)10%. Conclusion: This high number of RAS cases by HSV, and presence of HSV-2 in patients saliva in this study acted important cause of prevalence of this disease in Iraq, were in age group (18-25) mostly in female especially in those with family history of infection. Keywords: Recurrent Aphthous Stomatitis (RAS), Aphthous ulcer, HSV-1&amp;2 viruses, ELISA method

Evaluation and Comparison of Total Antioxidant Capacity of Saliva Between Patients with Recurrent Aphthous Stomatitis and Healthy Subjects.

Background & Objectives: Recurrent Aphthous Stomatitis (RAS) is one of the most common chronic ulcerative lesions of the oral mucosa and its development may be associated with oxidative stress. The aim of this study was to evaluate salivary Total Antioxidant Capacity (TAC) in patients with minor RAS.Materials & Methods:In this case-control study, 27 patients with minor RAS and 28 age- and sex-matched controls without RAS were enrolled. TAC was measured in unstimulated saliva for patients (during active lesion phase and after healing) and controls by immunologic assay. Data were analyzed by SPSS 18 using paired and unpaired t-tests (P<0.05).Results:Salivary TAC levels of patients presented a significant increase from active lesion phase (0.26±0.16) to healing time (0.43±0.41); (P=0.034). There was no significant difference in the level of salivary TAC between patients during active lesion phase and controls (0.24±0.13); (P=0.641).Conclusion:Increasing level of salivary TAC may be involved in remission of RAS lesions, suggesting its evaluation in future studies.

Relationship between salivary calprotectin levels and recurrent aphthous stomatitis: A preliminary study.

Recurrent aphthous stomatitis (RAS) is an inflammatory condition of the oral mucosa. The etiology of RAS remains unclear. Calprotectin is a major cytoplasmic protein contained in granulocytes, monocytes/macrophages and epithelial cells, and its level is increased body fluids in some inflammatory diseases. The aim is to determine the relationship between salivary calprotectin and RAS. In the cross-sectional study, 67 patients with active lesions of RAS (F/M: 43/24, mean age: 30.27 ± 9.14 years) and 42 healthy controls (HC, F/M: 30/12, 30.54 ± 9.49 years) were included. Calprotectin levels were evaluated in unstimulated whole saliva samples by using the ELISA method in both groups. Salivary calprotectin levels were significantly higher in RAS group (23.72 ± 4.28 mg/L) compared to the HC group (21.59 ± 4.27 mg/L) (P = 0.013). No significant relationship was found between calprotectin levels and age or gender in both groups (P >0.05). RAS is a very common inflammatory ulcerative condition of the oral cavity and its etiology is uncertain. Regarded as an inflammatory mechanism, releasing a high level of calprotectin in saliva has been suggested that it may play a role in pathogenesis of RAS.

Experimental and Clinical Evaluation of Plantago australis Extract as an Anti-Inflammatory Agent to Treat Oral Pathologies

Background: Plantago australis is a native plant from Southern Brazil used to reduce inflammation. Interestingly, there are no previous studies evaluating its use to treat oral lesions. Objectives: The study aimed to investigate in vivo the anti-inflammatory activity of 10% ethanol extract of P. australis in recurrent aphthous stomatitis (RAS), erosive lichen planus (ELP) and actinic cheilitis (AC). Methods: Thirty patients with RAS, ELP and AC were treated topically with 10% P. australis solution-based or cream. Results: In the comparison of in vivo data before and after the treatment and between different lesions, all P values were less than 0.05. Conclusions: The pharmaceutical formulation of 10% P. australis was therapeutically effective in the subjects with inflammatory oral lesions of RAS, ELP and AC.

Ozone treatment of recurrent aphthous stomatitis: a double blinded study.

This study aimed to evaluate the use of ozone to treat recurrent aphthous stomatitis (RAS). Consecutive sixty-nine participants with RAS were recruited into this non-randomized double blind, controlled cohort observational study (test group). A control group of 69 RAS patients who matched test group with age and gender was recruited. RAS lesions in test group were exposed to ozone in air for 60 seconds while controls received only air. Ulcer size and pain were recorded for each participant at baseline and daily for 15 days. Ulcer duration was determined by recording the time taken for ulcers to disappear. The main outcome measures were pain due to the ulcer, ulcer size and ulcer duration. 138 RAS participants (69 participants and 69 controls) were analyzed. Ulcer size was reduced starting from the second day in test group and from the fourth day in controls (p ≤ 0.004). Pain levels were reduced starting from the first day in the test group and from the third day in controls (p ≤ 0.001). Ulcer duration, ulcer size after day 2 and pain levels were more reduced in the test group. In conclusion, application of ozone on RAS lesions for 60 seconds reduced pain levels and enhanced ulcers’ healing by reducing ulcers’ size and duration.

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is the most common acute oral ulcerative condition in North America. RAS is divided into a mild, common form, simple aphthosis, and a severe, less common form, complex aphthosis. Aphthosis is a reactive condition. The lesions of RAS can represent the mucosal manifestation of a variety of conditions. These include conditions with oral and genital aphthae such as ulcus vulvae acutum, reactive nonsexually related acute genital ulcers, and Behçet disease. The mouth is the beginning of the gastrointestinal (GI) tract, and the lesions of RAS can be a manifestation of GI diseases such as gluten-sensitive enteropathy, ulcerative colitis, and Crohn disease. Complex aphthosis may also have correctable causes. The clinician should seek these in a careful evaluation. Successful management of both simple and complex aphthosis depends on accurate diagnosis, proper classification, recognition of provocative factors, and the identification of associated diseases. The outlook for patients with both simple and complex aphthosis is positive.

A comparison of the effect of triamcinolone ointment and mouthwash with or without zinc on the healing process of aphthous stomatitis lesions.

Background. Recurrent aphthous stomatitis (RAS) is one of the most common ulcerative diseases of the oral mucosa. Definitive etiology of RAS has not been conclusively established. There is no certain treatment for aphthous stomatitis but some drugs such as steroids are commonly used for the treatment of RAS. Regarding the effect of zinc on the healing process of epithelial layer and cell division, in this research the effect of triamcinolone (with orabase) in combination with a zinc-containing mouthwash and triamcinolone alone on the healing process of RAS lesions was assessed.Methods. The present study consisted of 20 patients diagnosed with RAS. The patients were instructed to rinse the mouth-wash or placebo three times a day and triamcinolone ointment twice a day for two weeks. The largest dimension of the ulcer was measured by a digital caliper and the severity of pain was assessed by visual analogue scale (VAS). Number, size, duration, ulcer-free period and pain of the lesions were evaluated twice a week for twomonths. Data were analyzed by SPSS 16 using Mann-Whitney U test and t-test.Results. A decrease was seen in the mean pain severity score (P = 0.631) and the size of the lesions but it was not statistically significant (P = 0.739). Also the difference between the number of lesions (P = 0.739), duration and ulcer-free period (P = 0.873) were not statistically significant.Conclusion. Zinc mouthwash seems to be as effective on wound healing process as typical treatment modalities for RAS.

Salivary cortisol determination in patients from the basque country with recurrent aphthous stomatitis. A pilot study

Objectives: Stress and anxiety are controversial factors involved in the complex pathogenesis of Recurrent Aphthous Stomatitis (RAS). The determination of salivary cortisol is a useful, simple and safe test to detect states of high stress or anxiety. The aim of this study is to check for changes in salivary cortisol levels in patients with RAS during periods of active disease. Study design: A measurement of cortisol employing Enzyme-Linked Immuno Sorbent Assay (ELISA) was carried out in samples of unstimulated saliva from 20 patients with active lesions of RAS and 10 healthy individuals used as controls. Results: Increased levels of salivary cortisol were detected in 3 cases, all of them within the group of patients with RAS. In none of the control group patients the level of salivary cortisol was increased. The mean level of salivary cortisol was 0.64 mg / dl (range 0.2 to 1.62) for patients with RAS and 0.57 mg / dl (range 0.25 to 1.09) for controls. Conclusion: Salivary cortisol levels are not statistically higher in patients with active lesions of RAS. Key words:Recurrent aphthous stomatitis, cortisol, oral ulcers, canker sores, salivary cortisol.

Total Serum Oxidant/Antioxidant Status and Arylesterase Activity in Recurrent Aphthous Stomatitis

BackgroundRecurrent aphthous stomatitis (RAS) is a chronic relapsing inflammatory disorder of the oral mucosa with unknown etiology. Oxidative stress (OS) is suggested to play a main role in the etiopathogenesis in RAS.ObjectiveIn this study, we hypothesize that a systemic OS is present in patients with RAS.MethodsForty-four patients with active RAS lesions and 38 healthy controls were being included in the study. Serum total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and paraoxonase 1 arylesterase (ARES) activity were being determined.ResultsRAS patients had significantly lower TAS levels and higher TOS and OSI values than controls. The patients had a lower ARES activity when compared to healthy controls. No correlations were observed between OS parameters and age, gender, duration of disease or frequency of RAS attacks per month.ConclusionA systemic OS is determined with an imbalance in oxidant/antioxidant status and lower ARES activity in RAS. Systemic OS may have an important role in the pathogenesis of RAS formation.

Validation of anamnestic diagnostic criteria for recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is characterized by painful recurrent oral ulcers and is typically diagnosed via history and clinical examination. Our aim was to validate a set of anamnestic diagnostic criteria (RASDX) to increase the accuracy of RAS diagnosis, particularly when a clinical examination is not feasible. Participants were enrolled during an unmatched case-control study. RASDX consisted of an initial phone screening using standardized questionnaires and recognition of RAS photographs in the clinic. The proportion of agreement with an examination by an oral medicine expert was calculated. A total of 115 participants were scheduled for a clinical diagnostic visit and 11 were withdrawn. The remaining 104 participants were aged 18-50years, 54% women, 64% White and 20% Hispanic. Of these, all 49 controls with negative RASDX had no clinical ulcers. Of the 54 cases diagnosed with RAS by RASDX, 53 were clinically confirmed to have RAS lesions (99% agreement; exact one-sided 95% CI=95-100%). RASDX, based on a combination of history and photograph recognition, was highly accurate compared with a diagnosis that employed an oral examination.

HSP 60 expression in recurrent oral ulcerations of Behçet's disease

The aim was to investigate heat shock protein 60 (HSP60) expression in oral ulcerations of Behçet's disease (BD). Biopsy specimens were obtained from patients with BD (n = 11), recurrent aphthous stomatitis (RAS) (n = 11), oral lichen planus (OLP) (n = 11) and healthy individuals (HI) (n = 11). Eight samples in BD and RAS groups were evaluable. All groups were analyzed by biotin streptavidin-aminoethylcarbazole using monoclonal mouse antibodies to HSP60 Ab-1 (clone LK1). Immunostaining indicative of HSP60 expression in BD and RAS were significantly higher than HI. No significant difference was found between BD and OLP except in the suprabasal layer of epithelium. Altered expression of HSP60 was found in ulcerative lesions of BD and RAS suggesting that HSP60 has an association with the etiology or chronicity of these inflammatory lesions.