Management Of Recurrent Aphthous Stomatitis Research Articles

A Novel Therapeutic Approach of 980 nm Photobiomodulation Delivered with Flattop Beam Profile in Management of Recurrent Aphthous Stomatitis in Paediatrics and Adolescents-A Case Series with 3-Month Follow-Up.

Background/Objectives: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal lesions and a very debilitating lesion, especially in paediatric and adolescent patients. The current pharmacotherapy offers a pain relief but not without side effects, and therefore photobiomodulation (PBM) can be an alternative therapy. To the authors' best knowledge, no published study has explored the efficacy of λ 980 nm laser PBM in the management of all RAS subtypes in paediatric and adolescent patients, and therefore, this prospective observational clinical study was conducted to bridge this gap by evaluating λ 980 nm laser PBM efficacy in symptomatic RAS management in paediatric and adolescent patients. The objectives were to evaluate (1) pain intensity alleviation; (2) wound healing rate; (3) wound size closure; (4) a complete resolution; (5) evidence of recurrence; and (6) patients' treatment satisfaction. Methods: The study's variables were assessed at the following timepoints: T0: pre-treatment; T1: immediately after first PBM session; T2: 5 hours (h) post first PBM session (via telephone call); T3: immediately after second PBM session (three days post first PBM session); T4: three-day follow-up (after complete PBM treatments); T5: two-week follow-up; and T6: three-month follow-up. The following PBM dosimetry and treatment protocols were employed: λ 980 nm; 300 mW; 60 s; 18 J; CW; flattop beam profile of 1 cm2 spot size; 18 J/cm2; and twice-a-week irradiation (72 h interval). Results: At T1, significant immediate pain intensity relief was reported. 33.33% recorded "4" and 66.67% reported "5" on the quantitative numeric pain intensity scale (NPIS), and this continued to improve significantly (83.33%) at T2. All the subjects reported "0" on the NPIS at T3, T4, T5 and T6. There was a significant reduction in the lesion surface area (>50% complete healing) at T3 compared to T0. Complete healing (100%) with no evidence of scarring and lesion recurrence observed at T4, T5 and T6. Very good patients' satisfaction was reported at all timepoints. Conclusions: This is the first report demonstrating λ980 nm efficacy in all RAS subtype management in paediatric and adolescent patients with a 3-month follow-up, whereby its PBM dosimetry and treatment protocols were effective from scientific and practical standpoints, and hence multicentre RCTs with large data are warranted to validate its reproducibility and to enrich the knowledge of PBM application in all RAS subtypes.

Muco-bioadhesive gel containing basil extract (Ocimum basilicum) in the management of recurrent aphthous stomatitis: a randomized clinical and immunological study

Background Recurrent aphthous ulcer (RAU) is a widespread highly prevalent disorder that impairs the life quality of the affected persons and leads to difficulties in daily activities such as talking, eating, and oral hygiene maintenance. Aim To evaluate the efficiency of basil extract (Ocimum basilicum) loaded in poly (vinylacohol)–borate hydrogel for topical application in the treatment of RAU. Patients and methods Twenty patients with a clear history of frequent eruption of RAU, their ages ranges between 18 and 45 years, and presented with mucosal ulcer (2 days or less duration and ≥4 mm in diameter). The patients were randomly allocated into two groups, group I (test group): 10 patients treated with mucoadhesive gel containing 2% of basil extract. Group II (placebo group): 10 patients treated with placebo gel. The healing period, pain scale, and the size of the ulcer were evaluated. Salivary endocan was collected at baseline and 5 days after materials application. Results There was no significant difference between the test and control group, while there were statistically significant differences between them and the healthy group at baseline clinically and immunologically. At 5 days there was a significant reduction in the degree of pain sensation, healing period, ulcer size, and decrease in the level of salivary endocan for both groups with statistically significant differences between them observed in the test group more than the control group in all tested parameters. Conclusion Using the muco-bioadhesive gel containing basil extract (O. basilicum) shows promise as a therapy for the management of patients with RAU.

Atorvastatin mucoadhesive tablets in the management of recurrent aphthous stomatitis: a randomized clinical study

BackgroundAphthous stomatitis is one of the most common oral mucosal diseases. Due to the commonness of recurrent aphthous stomatitis and considering the anti-inflammatory, analgesic, and tissue regenerative properties of atorvastatin and the lack of a study on the effect of statins on minor recurrent aphthous stomatitis, this study investigates the effect of atorvastatin mucoadhesive tablets as a topical treatment on reduction of symptoms and duration of this disease.MethodsThis study is a randomized, double-blinded clinical trial. Patients were divided into two groups, atorvastatin and, placebo; each of the patients received three mucoadhesive tablets daily in the morning, noon, and night. Finally, the patients were examined on days 0 (baseline), 3, 5, and 7 to determine the diameter of the inflammatory halo. The VAS scale was used to evaluate pain intensity for up to 7 days after each meal. The data was entered into SPSS 24 software and analyzed.ResultsThe halo diameter did not significantly differ between the two groups on baseline (P > 0.05). However, on the study’s third, fifth, and seventh days, the difference between the two groups was remarkable, so in the atorvastatin group, the size of the lesions decreased in shorter healing time (P < 0.05). In addition, the patient’s pain intensity (VAS) also showed a significant decrease in the atorvastatin group except on the first, second, and seventh days of the study (P < 0.05).ConclusionAtorvastatin mucoadhesive tablets effectively reduce the pain of patients with minor recurrent aphthous stomatitis and reduce the size and healing time of the lesions, so their application should be considered in treating minor recurrent aphthous stomatitis. The present study was approved by the Medical Ethics Committee of Mazandaran University of Medical Sciences with the ethics code IR.MAZUMS.REC.1400.8346. Also, this study received code IRCT20170430033722N4.

Management of Recurrent Aphthous Stomatitis: An Indian Expert Consensus.

Recurrent aphthous stomatitis (RAS) is characterized by painful, oral mucosal ulcers with wide range of prevalence ranging from 2 to 78%. Etiology of RAS is idiopathic and multifactorial. There are numerous gaps in assessment and management of RAS and the absence of guidelines or a consensus document makes the treatment further difficult.The aim of this document is to provide an Indian expert consensus for management of RAS. Experts from different specialties such as Otorhinolaryngology, Oral Medicine/Dentistry and Internal Medicine from India were invited for face to face and online meetings. After a deliberate discussion of current literature, evidence and clinical practice during advisory meetings, experts developed a consensus for management of RAS. We identify that the prevalence of RAS may lie between 2 and 5%. In defining RAS, we advocate three or more recurrences of aphthous ulcers per year as criterion for RAS. Investigation should include basic hematological (complete blood count) and nutritional (serum vitamin B12, and iron studies) parameters. Primary aim of treatment is to reduce the pain, accelerate ulcer healing, reduce the recurrences and improve the quality of life. In treating RAS, initial choice of medications is determined by pain intensity, number and size of ulcers and previous number of recurrences. Topical and systemic agents can be used in combination for effective relief. In conclusion, this consensus will help physicians and may harmonize effective diagnosis and treatment of RAS.

Management of Recurrent Aphthous Stomatitis with a Novel Herbal Approach: Case Series

Abstract Recurrent aphthous stomatitis (RAS) is a quite common condition among the patients reporting to a dental clinic. As the etiology is multifactorial, the main focus of treatment modalities is toward the symptomatic relief and decrease in the duration of ulcer. A number of treatment options are available including synthetic medicines. However, it is well known that synthetic medicines are often associated with a number of side effects. The nature has provided enough substitutes for such chemicals in plants which possess abundant pharmacological properties. A number of herbs have been reported to have ulcer-healing properties. Among these, Jasminum grandiflorum is the one having a variety of therapeutic qualities, including anti-inflammatory, antibacterial, wound healing, and anti-acne capabilities. Taking advantage of all these properties, the present article describes the therapeutic utility of J. grandiflorum in three cases of RAS which are successfully treated by a novel herbal approach either J. grandiflorum alone or with honey.

Recurrent Aphthous Stomatitis – An Overview

Abstract Recurrent aphthous ulcers are common painful mucosal conditions affecting the oral cavity. Despite their high prevalence and knowledge of many etiological factors, the exact mechanism of disease is still not fully understood. There are three different clinical forms of recurrent aphthous stomatitis and the therapy differs depending on it. The aim of this article is to provide an overview of current knowledge about the possible causes and treatment of recurrent aphthous stomatitis. We discuss its pathogenesis which is currently the least explained in the literature. This review offers scientists and clinicians useful information about clinical presentation, diagnosis, predisposing aetiological factors and recent trends in the management of recurrent aphthous stomatitis.

Therapeutic Evaluation of 5% Topical Amlexanox Paste and 2% Curcumin Oral Gel in the Management of Recurrent Aphthous Stomatitis- A Randomized Clinical Trial

Background: Recurrent aphthous stomatitis (RAS) minor is a painful oral condition that is characterized by shallow ulcers with an erythematous halo. These ulcers cause difficulty in mastication and speech and have a high recurrence rate. Objective: The present study aims to compare the size of the ulcer, erythema, pain score, and recurrence rates in patients using 5% topical amlexanox and 2% curcumin oral paste in the management of RAS minor. Materials and Methods: The present study was conducted among 48 participants who were randomly assigned into two groups. Group A comprised participants who were given 5% topical amlexanox paste and Group B comprised participants who were given 2% curcumin oral gel for application. The participants were evaluated on days 1, 4, and 7 for the size of ulcers, erythema level, and pain score. They were reviewed on days 30, 60, 90, and 180 and recurrence episodes were documented. Results: There was a significant reduction in erythema (0.041) and pain scores (0.012) in Group B participants who used curcumin. The size of the ulcer had reduced in both the groups though there was no significance. Recurrence rates were high in participants who used amlexanox (92%) and were comparatively low in the curcumin using group (50%). Conclusions: Curcumin is a potent, safe substitute in the management of RAS minor for its effectiveness in reducing erythema, pain, and recurrence rates. Further studies should be conducted for evaluating the efficacy of curcumin in various clinical types of RAS.

Comparison of effects of honey and 0.1% triamcinolone acetonide in the management of recurrent aphthous stomatitis - A randomised, single-blind study

Introduction: Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease known to humans and are characterized by the development of painful, recurring solitary or multiple ulcers confined to the oral mucosa. RAS is often painful and worsens during drinking and talking. Aim: To evaluate and compare the effects of honey and 0.1% triamcinolone acetonide in patients with ulcers of recurrent aphthous stomatitis minor. Materials and Methods: Sixty patients having RAS minor were divided into two groups of 30 participants each by simple random sampling. Group A was treated with application of 0.5 ml of honey thrice a day for a week or until complete healing of the ulcer. Group B was treated with application of 5 g of 0.1% triamcinolone acetonide oral paste thrice a day for a week or until complete healing of the ulcer. For all the individuals, baseline parameters like the size of the ulcer, pain, and burning sensation were recorded on day 0, reassessment was done on day 4 and day 7, followed by statistical analysis. Results: The study showed that the reduction in the size of ulcers, VAS score for pain, and VAS score for burning sensation were similar in patients receiving honey as compared to patients receiving 0.1% triamcinolone acetonide. No adverse effects were reported in patients receiving honey, and there were mildly adverse reactions in some patients receiving 0.1% triamcinolone acetonide oral paste. Conclusion: Honey, a natural anti-inflammatory agent, seems to hold immense potential as an alternative medication for managing RAS minor ulcers. It has better patient compliance as compared to 0.1% triamcinolone acetonide.

Comparative Evaluation of Efficacy of Jasminum grandiflorum with Honey and Corticosteroids in Management of Recurrent Aphthous Stomatitis- A Study Protocol

Aim: To determine the efficacy of J grandiflorum in the treatment of aphthous ulcer on the basis of reduction in size of the ulcer, erythema and pain.&#x0D; Study Design: Prospective, Observational.&#x0D; Place and Duration: Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Deemed to be University, Sawangi (Meghe), Wardha. &#x0D; Duration: One year.&#x0D; Methodology: One Hundred and Twenty patients visiting to the dental OPD and diagnosed to have aphthous ulcer will be selected. The patients will be divided in three groups and the formulated gel will be prescribed to one group of patient and other will be given corticosteroid and monitoring will be done.&#x0D; Expected Results: With all the studies performed till now it is expected that the j. grandiflorum and honey together will have good synergistic effect over aphthous ulcer and will help in reduction of size, pain and erythema level of aphthous ulcer.&#x0D; Conclusion: J grandiflorum and honey may be effective in management of recurrent aphthous stomatitis.

Multidisciplinary Management of Recurrent Aphthous Stomatitis Triggered by Severe Depression

Background: Recurrent Aphthous Stomatitis (RAS) is an inflammation of the oral mucosa in the form of a single or more ulcer that occurs repeatedly. One of the predisposing factors that contribute to the onset of RAS is depression. Depression is a mood that is not happy or sadness that is experienced as part of the pattern of life. Objective: Discuss multidisciplinary management in cases of 65-year-old women with large multiple ulcers with depression-triggering factors. Case: Women aged 65 years complained of recurrent canker sores. The frequency of RAS increased by 10 years due to economic and household problems. It has been treated with topical non-steroidal anti-inflammatory drugs but does not heal. Does not have a history of systemic diseases. Case Management: Do investigations are complete peripheral blood examination, Depression Anxiety Stress Scale (DASS), Refer patients to the psychiatric specialist. Multidisciplinary treatment is performed by a psychiatric specialist. Treatment of oral mucosa with topical anti-inflammatory steroid drugs. Conclusions: in accordance with the treatment that has been given, this case has recovered after day 14. So it can be concluded that proper multidisciplinary management and elimination of triggering factors are the main roles to prevent recurrence and reduce the frequency of recurrent aphthous stomatitis.

A comparative study of amlexanox and tetracyclines in the management of recurrent aphthous stomatitis

A comparative study of amlexanox and tetracyclines in the management of recurrent aphthous stomatitis

The efficacy of probiotics in management of recurrent aphthous stomatitis: a systematic review and meta-analysis

There is currently a lack of effective drugs to cure recurrent aphthous stomatitis. This study aimed to evaluate the efficacy of probiotics alone or as an adjunct in recurrent aphthous stomatitis (RAS) patients. Seven randomized controlled trials (RCTs) were included, of which three were included in quantitative analysis. Of five studies evaluating the efficacy of probiotics alone compared with placebo or Oracure gel, two reported no significant difference in relieving oral pain, while probiotics exhibited a higher capacity for decreasing oral pain in the other three. A significant decrease in ulcer severity was found in one, while no significant difference was found in the other four. The remaining two studies demonstrated that probiotics, as an adjunct to steroids or anaesthetic antiseptic gel, significantly reduced the ulcer severity and oral pain. The meta-analysis showed a significant decrease in oral pain (− 1.72, P = 0.0001) with probiotics compared with placebo. In conclusion, probiotics alone were capable of relieving oral pain but not effective in reducing ulcer severity. A combination of probiotics and steroids or anaesthetic antiseptic gel was more effective than steroids or anaesthetic antiseptic gel alone in RAS patients. Probiotics are promising for the treatment of recurrent aphthous stomatitis.

Single application of topical doxycycline in management of recurrent aphthous stomatitis: a systematic review and meta-analysis of the available evidence

BackgroundRecurrent aphthous stomatitis (RAS) is a highly prevalent oral mucosal disease. The management of RAS is quite challenging, and as yet, there is no definitive cure. The present systematic review and meta-analysis assessed the efficacy of a single application of topical doxycycline for the management of RAS.MethodsA comprehensive online search of PubMed, Scopus, Embase, and Web of Science databases was conducted to identify all relevant studies published up to March 31, 2019. All randomized clinical trials that assessed the efficacy of a single application of topical doxycycline in the management of RAS were included. Primary outcome measures were pain scores and/or healing time, while secondary outcomes included the associated side effects. RevMan 5.3 software was used for data analysis.ResultsFive clinical trials fulfilled the eligibility criteria, three of which were included in the meta-analysis. All of the included studies found doxycycline effective in alleviating signs and symptoms of RAS. The results of the pooled 3 studies revealed a statistically significant decrease in the healing time in favor of the doxycycline group as compared to the control groups (I2 = 51%; MD: -1.77, 95% CI: − 2.11, − 1.42, P <0.00001); however, the results showed no significant differences between doxycycline and control groups with regard to pain reduction (I2 = 96%; MD: -1.28, 95% CI: − 2.83, 0.27; P = 0.11).ConclusionAlthough still inconclusive, the available evidence suggests that a single application of topical doxycycline might be effective for reducing signs and symptoms of RAS. However, owing to the limited number of the included studies, further well-designed clinical trials with adequate sample sizes are required to discern the clinical efficacy of topical doxycycline in patients with RAS.

Management of Recurrent Aphthous Stomatitis in a Patient with High Recurrence Frequency

RAS (Recurrent Aphthous Stomatitis) is an inflammation of soft tissues of the oral cavity characterized by recurrent and painful ulcers. These lesions can be marked early on with a burning sensation, and when the wound has formed, the pain is getting worse. Occasional symptoms of precursors, paresthesia and hyperesthesia, are sometimes reported. Pain and discomfort arise along movement around the ulcer e.g. eating, talking and swallowing. Characteristics of RAS are usually single or multiple ulcers occurring recursively on the oral mucosa, round or oval in shape, clearly demarcated, with a grayish-yellow necrotic center and reddish edges. Lesions occur at young ages i.e. children and puberty, and may occur in adults as well. Ulcers usually last in 1 week or month. This disorder is classified into three categories according to size i.e. recurrent aphthous stomatitis minor, major and herpetiformis. The aim of this report is to show the management of cases of Recurrent Aphthous Stomatitis Minor on the left side of tongue, left buccal mucosa, and lower labial mucosa in female patient aged 19 years. A 19-year-old female patient came to the Dental Hospital of Jember University with complaints of thrush on the left side of her tongue, left buccal mucosa and lower labial mucosa, pain, and feeling disturbed due to the pain when eating, talking, and laughing. In this case, the diagnosis showed Recurrent Aphthous Minor Stomatitis on the left side of the tongue, left buccal mucosa, and lower labial mucosa. The therapy was using nonsteroidal anti-inflammatory mouthwash containing aloe Vera and hyaluronic acid as well as giving multivitamin of becomzet (vitamin B complex, A, C, E, and Zinc).&#x0D; &#x0D; Keywords: recurrent aphthous stomatitis; high recurrence

Treatment of Recurrent Aphthous Stomatitis by Crude Topical Sesame Seed Oil in Comparison with Crude Topical Pumpkin Seed Oil

Background: Recurrent aphthous stomatitis (RAS) is the most common disease of the oral mucosa in the general population. Multifactorial etiopathogenesis has been suggested to explain the cause of RAS but the exact etiology and pathogenesis still unknown. Its therapy whether topical or systemic can induce clearance but the relapse rate is high. Objective: To evaluate the efficacy and prophylactic effects of topical Sesame seed oil in comparison with Pumpkin seed oil in the management of recurrent aphthous stomatitis. Patients and Methods: This is a single, blinded, clinical, therapeutic, comparative study where 35 patients with early onset RAS were examined in Center of Dermatology -Baghdad Teaching Hospital, Medical City ,Baghdad, Iraq from April 2018-October 2019. All socio-demographic data related to the disease was obtained from each patient, in addition to clinical examination was performed for each patient. Patients were divided into 2 groups: Group A (15 patients) used crude Sesame seed oil twice daily. Group B (20 patients) was instructed to use Pumpkin seed oil in a similar way to Group A. Short term assessment of each patient of both groups was done to evaluate the therapeutic effect of drug by using oral clinical manifestation index (OCMI). A long term assessment was done for each patient to assess the prophylactic effect of drug by using OCMI before, after 1, 2 and 3 months of therapy. They were seen regularly to record any local or systemic side effects. Results: The patients enrolled in this study were 19 (54.3%) males and 16(45.7%) females, male to female ratio was 1.1: 1. Their ages ranged from 12-60 (35.33 ± 12.06) years. The mean of OCMI in Group A started to decline directly after 4 days of therapy and went to its lower level after 8 days of therapy, and it was statistically significant (P value <0.05). The change in the mean of OCMI of Group B after 8 days of therapy was also statistically significant (P value <0.05). The difference in the response rates after 8 days between Group A and B was statistically significant (P value <0.05). Both groups showed statistically significant prophylactic effect after 1, 2 and 3 months from starting therapy, but sesame seed oil was statistically more significant than pumpkin oil effect during 2nd & 3rd months of therapy. No significant side effects were noticed in both groups as both oils are edible foods. Conclusion: Sesame and pumpkin seed oil have an effective therapeutic and prophylactic action against RAS. No local or systemic side effects were observed during the course of therapy.

Assessment of Efficacy of 5% Topical Amlexanox and 0.1% Topical Triamcinolone Acetonide in Management of Recurrent Aphthous Stomatitis.

ABSTRACTAim:The aim of this study was to assess the efficacy of 5% topical amlexanox and 0.1% topical triamcinolone acetonide in recurrent aphthous stomatitis (RAS) management.Materials and Methods:Sixty adult patients of RAS of both genders were divided into two groups with each group having 30 patients. In group I, 0.1% topical triamcinolone acetonide was prescribed. In group II, 5% topical amlexanox was prescribed. Patients were recalled regularly and size of ulcer, erythema, and pain score was recorded on days 1, 3, and 5.Results:The mean ulcer size (mm) on day 1 in group I was 4.3 and in group II it was 4.1, on day 3 it was 3.5 in group I and in group II it was 3.6, on day 5 in group I it was 1.3 and in group II it was 1.7. The result was not statistically significant (P > 0.05). The mean pain score recorded on visual analog scale was in descending grade day by day on first, third, and fifth days. In group I, healing was seen in 29 (96.6%) patients and in 28 (93.3%) patients in group II. Partially healing was seen in 1 (3.3%) patient in each group, whereas in group II nonhealing was observed in 1 (3.3%) patient. The statistical significance was not achieved as P > 0.05.Conclusion:Authors found that above drugs were effective in reducing pain, size of ulcer, erythema, and improving healing in patients with recurrent aphthous stomatitis. There were better results with triamcinolone acetonide as comparison of amlexanox.

Photobiomodulation therapy for the management of recurrent aphthous stomatitis in children: clinical effectiveness and parental satisfaction.

Background This study aims to evaluate the effectiveness of the photobiomodulation therapy (PBMT) in the treatment of minor recurrent aphthous stomatitis (MiRAS) in children, in terms of pain relief, lesion size reduction and the parental satisfaction of the therapy. Material and Methods This randomized controlled study was carried out on 60 children with clinical diagnosis of MiRAS. Patients were randomized into two groups: group A receiving laser therapy and group B receiving sham therapy (placebo). Laser therapy (diode laser, λ: 645 nm) was administered on day 1 (T0) for three consecutive days. Patients were evaluated also on day 4 (T1), on day 7 (T2) and on day 10 (T3). Oral aphthous lesions size was assessed through a periodontal probe to measure the diameter length (mm); pain was evaluated through the Visual Analogue Scale (VAS); parental satisfaction was assessed through a questionnaire. Results The difference in the reduction of ulcers diameters between the two groups resulted statistically significant at T1 and at T2 (p<0.05). A statistically significant difference in pain reduction between two groups was found at T1 (p<0.05). No statistically significant difference between the two groups of parents was found as concerns the parental acceptance of the procedure and the discomfort for the need of multiple appointments. Conclusions PBMT is to be considered effective in the treatment of MiRAS in children and well- accepted by the parents of the children themselves. Key words:Ulcers, children, lasers

Topical management of recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is a common condition that is affecting young adults. The management of RAS aims at identifying and controlling the possible predisposing factors, exclude possible underlying systemic causes, control pain and to accelerate healing. A wide variety of systemic and topical agents has been suggested for the treatment of RAS. Although there are several trials employing different systemic and/or topical agents in the treatment of RAS, there is no strong evidence on the superiority of any therapeutic or curative agent for this disorder. Topical agents may be sufficient to lessen the pain in some patients; however systemic corticosteroids/immunosuppressant agents may be necessary to control pain in others. Therefore, the severity and frequency of ulcers may be used as guidance in the management of RAS patients. This paper reviews the available topical agents that have been used in the management of RAS.

Effectiveness of booster dose of tetanus and diphtheria toxoids (Td) vaccine in management of recurrent aphthous stomatitis: a prospective, randomized, triple-blind and placebo-controlled clinical trial

Background Recurrent aphthous stomatitis (RAS) is the most common oral disease. The activation of the immune system by vaccines might reduce the interactions between oral mucosa and microorganisms. Aim To evaluate the effect of the tetanus-diphtheria toxoids (Td) vaccine in management of RAS. Design and setting This prospective, randomized, triple-blind and placebo-controlled clinical trial study was conducted on 70 eligible patients with minor RAS at the dermatology outpatient clinic. Method Finally, a total of 66 participants (48 male, 18 female; mean age: 38.56 ± 10.98 years) completed the study in two groups, one in which colchicine and a single dose of vitamin B6 (placebo group) was treated and one in which colchicine and a single dose of Td vaccine (intervention group) was treated. Results After six months of follow-up, the patients were evaluated, which revealed significant effects of the Td vaccine on pain intensity, ulcer size, recovery time, and the interval between episodes. At the end of the six month follow-up, 27 patients (81.8%) in the intervention group and 13 patients (39.4%) in the placebo group showed partial or complete recovery, and there was statistically significant difference between the groups (p < .001). Recovery was not significantly associated with sex, education level, marital status and duration of RAS. However, occupation and positive family history of RAS had significant relations with recovery. Conclusions A booster dose of Td vaccine had relatively favorable effects on pain intensity and recurrence of RAS, but further research is needed to confirm its efficacy.

Comparative evaluation of efficacy of topical 5% amlexanox oral paste and 0.1% triamcinolone acetonide oral paste in the treatment of oral ulcers

Background: Recurrent aphthous stomatitis (RAS) is a common condition of the mucosa of oral cavity. The present study was aimed to compare efficacy of triamcinolone acetonide 0.1% and 5% amlexanox in management of recurrent aphthous stomatitis (RAS). Materials & Methods: The present study was conducted on 48 patients with history of recurrent aphthous stomatitis. Patients were divided into 2 groups of 24 each. Group I was prescribed topical application of 0.1% triamcinolone acetonide and groupie was given topical application of 5% amlexanox. Both were to be applied on ulcers three times a day for 5 minutes. Patients were evaluated on 1st day, 4th day and 7th day for pain, size and erythema. Results: Group I had 10 males and 14 females and group II had 12 males and 12 females. The difference was non- significant (P>0.05). The mean VAS score in group I on 1st day was 5.2, in group II was 6.4. On 4th day it was 3.2 in group I and 3.6 in group II. It was 1.4 in group I and 2.0 in group II on 7th day. The difference was significant (P0.05). On 1st day, there was severe erythema seen in both groups. On 7th day, it was mild in both groups. Conclusion: Both 5% amlexanox and 0.1% triamcinolone acetonide found to be effective in reducing size, erythema and pain in cases of aphthous ulcers.