Management Of Recurrent Aphthous Ulcers Research Articles

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.

Appraising the Clinical Efficacy of Herbal Topical Medications in the Treatment of Recurrent Aphthous Stomatitis - A Review

: Oral ulcers are common complaints to the dental clinic. Among these, Recurrent Aphthous Stomatitis/Ulcer (RAS) is frequently reported lesions of which recurrent minor aphthous ulcers are most prevalent. Though these mucosal lesions are self-limiting, painful ulcerative and inflamed mucosa could affect the patient’s daily routine such as food intake, speaking and swallowing. Since precise etiology is unknown, various treatment options are tailor made to each individual patient’s condition. Topical steroids are the widely prescribed medication as local therapy. In spite of a dearth in evidence based data on the effectiveness of plant based topical therapies for oral aphthous ulcers, these are used as primary medications which aids in natural cure of such lesions. These alternative medications are also useful to patients who refuse to take allopathic medicines, having history of drug allergies, history of multiple drug therapy, when allopathic medication is not recommended and in refractory cases. Hence the aim of this paper is to review the clinical efficacy of potential herbal medications for the topical management of recurrent aphthous ulcers. An electronic data search was performed using different search engines and the relevant articles were reviewed. All the placebo controlled studies have shown clinically significant results in the treated group in various outcome measures without noticeable side effects. Generally, topical herbal treatment were effective on RAS as palliative therapy, however more scientific evidence is needed for clinical recommendation in repeated cases.Key words: Aphthous stomatitis /ulcer, Alternative medications, Topical herbs, Topical treatment, Recurrent oral ulcer,Herbal medications.

Low-Level Diode Laser Therapy (LLLT) versus Topical Corticosteroids in the Management of Recurrent Aphthous Stomatitis Patients. A Randomized Controlled Trial

Objectives: The current study was conducted to evaluate the effect of low-level laser therapy (LLLT) on recurrent aphthous stomatitis for reduction of pain score and ulcer size. Subjects and Methods: 28 participants with symptomatic minor recurrent aphthous ulcers were randomly allocated into two groups. The treatment group received a 980 nm diode laser and the control group received topical triamcinolone acetonide 0.1%. The measured outcomes included pain score as visual analog scale (VAS) at baseline, second day, and seventh day, and the lesion size at baseline and seventh day. Results: A statistically significant difference was found between the laser and the corticosteroid groups when comparing VAS scores on day two (pain reduction was -2.2 ± 0.9 and -4.786 ± 1 for corticosteroid and laser groups respectively with a p -value of 0.001) and day seven (pain reduction was -4.643 ± 1.646 and -6.071 ± 1.439 for corticosteroid and laser groups respectively with a p -value of 0.024) in favor of the laser group. Moreover, a statistically significant difference was noticed between the laser and the corticosteroid groups regarding the decrease in lesion size (lesion diameter reduction was -3.036 ± 1.447 and -4.536 ± 1.846 for corticosteroid and laser groups respectively with a p -value of 0.024) in favor of the laser group. Two participants experienced severe mouth dryness after corticosteroid application. None of the laser patients experienced any side effects. Conclusion: LLLT can be considered a reliable alternative to topical steroids in the management of recurrent aphthous ulcers since it was more effective in reducing both pain intensity and ulcer size.

Low Level Laser Therapy (LLLT) in the Effective Management of Recurrent Aphthous Ulcers (RAU): Clinical Case Reporting 3 Patients: A Case Series

Low-Level Laser therapy (LLLT) was employed for the treatment of three patients diagnosed with recurrent aphthous ulcers (RAU’s). The patients presented with recurrent aphthous ulcers in the region of floor of the mouth and buccal mucosa. The three patients with RAU’s were provided with a wavelength of946nm starting the use at 320µm fibre optic at a distance of 1-3 mm, peak power of 2W, frequency 10 Hz with no tissue contact in circular motion from outside to inside for 2 cycles with 100% duty for 30s for 3 consecutive days. The LLLT made possible an effective improvement in the reduction of pain and size associated with ulcers. It proved to be a safe and cost effective therapy in the management of recurrent aphthous ulcers.

Comparative assessment of low-level laser therapy (LLLT) vs. topical application of amlexanox + lidocaine to treat recurrent aphthous ulcers (RAUs): A randomized controlled trial.

Background. The present study aimed to assess and compare the pain perception and ulcer sizes before and after applying low-level laser therapy (LLLT) and Amlexanox + lidocaine. Methods. Twenty-six patients referring to the out-patient department of the institution and diagnosed with recurrent aphthous ulcers (RAU) were assigned to two groups to receive either LLLT or Amlexanox + lidocaine. In group 1, the patients were provided with amlexanox + lidocaine to apply topically four times daily. In group 2, the patients underwent LLLT with no tissue contact in inward circular motions for two cycles for 30 seconds. This study was registered in "the Clinical Trials Registry- India" (CTRI), with the registration number CTRI/2019/09/028222. The data were analyzed with SPSS 16. Results. The intergroup comparison was performed using Mann-Whitney U test, and intragroup comparisons were made using Wilcoxon’s signed-rank test. The level of significance was set at P <0.05. The results showed that pain perception and ulcer size were significantly lower in group 2 subjects than group 1 subjects (P <0.05). Conclusion. LLLT was more effective than amlexanox + lidocaine in the management of RAU. It is a cost-effective therapy for treating RAU.

Treatment of recurrent minor aphthous stomatitis using diode laser (940 nm).

The exact etiology of recurrent aphthous ulcers (RAUs) is unknown. The management of RAUs is not always straightforward. Ulcers in the mouth (recurrent aphthous stomatitis [RAS]) are very common and may vary in size from very small to very large. To evaluate reduction in pain intensity and duration of pain relief, reduction in size of ulcer, and duration for healing of ulcer (healing time) in patients with RAS after application of Low-Level Light Amplification by Stimulated Emission of Radiation therapy (LLLT) comparing with topical Anginovag spray medication and control group. A total of 21 individuals diagnosed as RAS were divided into three equal groups as follows: Group 1: Minor aphthous ulcer, which was treated by giving LLLT using Diode LASER; Group 2: Minor aphthous ulcer, which was treated by topical Anginovag spray medication.; Group 3: Minor aphthous ulcer, which was treated conservatively with motivation and follow-up. In this randomized, controlled, clinical study, LLLT using Diode LASER causes reduction in pain intensity due to RAUs, thereby reducing morbidity. There is also reduction in the diameter and healing time of the ulcer as compared to Anginovag spray medication and the control group. Although various treatment modalities have been used and LLLT is not commonly used to treat aphthous ulcers, this study suggests that using LLLT would be a safe and effective treatment modality for RAUs patients.

Management of recurrent aphthous ulcers exploiting polymer-based Muco-adhesive sponges: in-vitro and in-vivo evaluation

Recurrent aphthous ulcer (RAU) is a well-known painful, inflammatory disease with uncertain etiology for which local symptomatic therapy is only available. The aim of this study was to formulate and characterize muco-adhesive sponges containing a mixture of tenoxicam and miconazole nitrate to manage pain, inflammation and avoid candida infection that may accompany RAU due to poor oral hygiene. Two polymers at different concentrations were used to prepare sponges applying simple freeze-drying. Medicated chitosan (2%) sponges (mC2) showed acceptable physical appearance, surface pH (6.3 ± 0.042), porosity (25.7% ± 1.8), swelling index (5.7 ± 0.11), in-vivo and ex-vivo muco-adhesion time (115 min.±0.813 and 155 min.±1.537, respectively), ex-vivo muco-adhesion force (0.09 N ± 0.002) and scanning electron microscope (SEM) images. For concurrent clear-cut determination of tenoxicam and miconazole nitrate from mC2, a new UPLC method was developed and validated. mC2 sponges exhibited superior in-vitro drug release profiles where ∼100% of tenoxicam released within 5 min for fast pain relief with a more prolonged miconazole nitrate release. Furthermore, in-vivo animal study revealed that mC2 caused a significant decrease in the acetic acid-induced ulcer size in rats after 6 days of treatment (p < .0001) compared to negative and positive controls. Additionally, histopathological examination showed faster healing with complete restoration of the normal oral histology in rats. The present study concludes that chitosan sponge loaded with a combination of tenoxicam and miconazole nitrate could improve healing of RAU cases.

Topical insulin-liposomal formulation in management of recurrent aphthous ulcers: A randomized placebo-controlled trial.

To evaluate the effectiveness of topical insulin-liposomal gel in aphthous ulcer treatment. 80 participants with minor aphthous ulcers were randomly divided to receive either topical insulin-liposomal gel or placebo gel (once daily) for 6days. Assessment of outcomes included visual analog scale (VAS) for pain (primary outcome), and secondary outcomes included ulcer duration and impact of treatment on quality of life using the Oral Health Impact Profile 14 (OHIP-14). Testing of the outcomes was carried out at 1, 2, 3, 4 and 6days after treatment for VAS and at 6days for OHIP-14. For pain scores, the test group showed a significant decrease by time, this was evident from day 1 (P<.001); at day 3, median and interquartile range (IQR) values were 0 (0-1). For the placebo group, a non-significant change by time was reported between baseline and day 1; at day 3, the median value was 7 (IQR, 7-9). The test group showed significantly lower mean duration than the placebo group (P<.001). OHIP-14 scores after 6days showed that the test group had a significantly lower score than placebo (P<.001). Topical insulin-liposomal formulation showed marked effectiveness in management of aphthous ulcers.

Medicinal plant and their bioactive phytochemicals in the treatment of recurrent aphthous ulcers: A review of clinical trials

Considering the unclear etiology of recurrent aphthous ulcers (RAUs), the clinical management of RAU is based on no optimal therapeutic approach. The current study aimed to review the clinical trials on the effectiveness of medicinal plants and their active phytochemicals in the treatment of RAU. Five databases including PubMed, Science Direct, Web of Science, Scopus, and Cochrane Library were searched for retrieving all the relevant clinical trials. The results indicate that a wide range of scientific evidence has approved the therapeutic benefits of natural medicaments in the management of RAU, including Satureja khuzistanica, Aloe vera, Myrrh, Glycyrrhiza glabra, Alchemilla vulgaris, Myrtus communis, Melissa officinalis, Rhizophora mangle, Chamomile, Rosa damascena, Nicotiana tabacum, Punica granatum, Ageratina pichinchensis, Norwegian LongoVital, Lavender oil, and Perilla oil that are known anti-aphthous medical plants. Berberine and acemannan are bioactive substances with diverse pharmacological and therapeutic benefits in patients with aphthous, which made them as the promising alternatives for new pharmacological drugs. This review provides evidence that medicinal plants can be considered as future pharmaceutical drugs or adjuvant treatment with conventional therapeutic approaches to improve their efficacy and alleviate the side effects in the management of RAU. Further clinical studies are also necessary to confirm the efficacy and safety of plant-derived natural products with potential effects in treating RAU.

Management of Recurrent Aphthous Ulcers: An Update

Management of Recurrent Aphthous Ulcers: An Update

Versatility of diode lasers in low-level laser therapy for the management of recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is a painful condition, often leading to impairment of the basic functions such as mastication, speech, and brushing. Several treatment modalities have been advocated in the past, but none hasve been proven efficacious. A novel treatment modality in the form of low-level laser therapy (LLLT) has evolved in recent years. LLLT also known as cold laser works on the principle of biostimulation. This biomodulatory effect plays a pivotal role in accelerating the healing process and provides analgesia. Hence, it constitutes an alternative to processes that present pain and inflammatory reaction. The present series of cases throw light regarding the use of diode laser for LLLT as an effective and quick tool in the painless management of recurrent aphthous ulcers.

Guidelines for the diagnosis and management of recurrent aphthous ulcers (draft)

复发性阿弗他溃疡(recurrent aphthous ulcer,RAU)又称复发性口腔溃疡,是最常见的口腔黏膜溃疡类疾病,调查发现至少10％ ～25％的人群患有该病,在特定人群中,RAU的患病率可高达50％,女性的患病率一般高于男性.RAU的好发年龄为10～30岁,溃疡疼痛明显,且反复发作,影响患者进食、言语、情绪,给患者的生活和工作造成了较大困扰。

A consensus on guidelines for the diagnosis and management of recurrent aphthous ulcers

复发性阿弗他溃疡(recurrent aphthous ulcer,RAU)是最常见的口腔黏膜溃疡类疾病,我国RAU的患病率居各类口腔黏膜病之首.近年来,随着社会压力、人口老龄化等问题的加剧,RAU的患病率有逐年升高的趋势.由于RAU的病因和发病机制至今尚未明确,导致对该病的诊疗存在较大的误区。

Aphthous ulcers

Aphthous ulcers are one of the most common oral diseases worldwide. Their clinical presentation is characterized by multiple, recurrent, small, round, or ovoid ulcers with circumscribed margins and erythematous haloes present in different sizes. Oral lesions similar to aphthous ulcers may be present in several systemic diseases. This article will summarize the differential diagnosis of aphthous ulceration, with emphasis on a practical guide for the management of recurrent aphthous ulceration, including topical and systemic therapy.

Transient benefits for topical hyaluronic acid in recurrent aphthous ulceration

A randomised controlled trial. A topical application of 0.2% hyaluronic acid (HA) gel or placebo was initially applied by a clinician to the ulcerated area. Patients were instructed how to apply gel for subsequent applications. Patients recorded discomfort from the ulcerated area on a 100-mm visual analogue scale (VAS). The boundaries of the scale were marked "no soreness" and "worst possible soreness". Recordings were made at baseline (before gel application) and at 5, 10, 15, 20, 30, 45, 60, 120, 180 and 240 min after dosing. The first 60 min of the recording were supervised and the remaining observations were carried out in a log diary. Discomfort recordings were made 1 h after application (after breakfast and after the evening meal and at one other time if desired) for 7 days. Patients were also asked to record number of ulcers present in their mouth and the occurrence of any new ulcers during the treatment period. Both topical HA and placebo resulted in a significant reduction in ulcer soreness following immediate application (P 0.0004). Throughout the rest of the investigation period, there were no significant differences (P>0.05) between the treatments at reducing soreness. Patients using topical HA recorded fewer ulcers on day 5 of the investigation than those in the placebo group (P<0.001). Likewise, the occurrence of new ulcers was lower in the HA-treated group on day 4 compared with placebo (P 0.047). Topical application of 0.2% HA does appear to be of benefit in the management of recurrent aphthous ulceration (RAS). Immediate application reduces discomfort but this is purely a barrier or protective mechanism from stimuli arising in the oral environment.

The efficacy of topical hyaluronic acid in the management of recurrent aphthous ulceration

The efficacy of topical hyaluronic acid in the management of recurrent aphthous ulceration

The efficacy of topical hyaluronic acid in the management of recurrent aphthous ulceration

The aim of this study was to evaluate the efficacy of a topical hyaluronic acid (HA) preparation (0.2%) in the management of recurrent aphthous ulceration (RAU). One hundred and twenty patients with RAU participated in a randomized, placebo controlled, double-blind trial to evaluate the efficacy of the topical HA and preparation. Outcome measures include soreness relief on immediate application (recorded over 60 min). Thereafter, patients completed a log diary recording soreness from the ulcers, occurrence of new ulcers and ulcer duration. Both topical HA and placebo resulted in a significant reduction in ulcer soreness following immediate application (P = 0.0004). Throughout the rest of the investigation period, there was no significant differences (P > 0.05) between the treatments for reducing soreness. Patients treated with topical HA recorded few ulcers on day 5 of the investigation than those treated with placebo (P < 0.001). Likewise, the occurrence of new ulcers was lower in the HA treated group on day 4 when compared with placebo (P = 0.047). Topical HA (0.2%) may be of benefit in the management of RAU. Immediate reduction of symptoms appears to be a barrier effect.

Thalidomide in the concurrent management of recurrent aphthous ulcerations and Kaposi sarcoma in HIV patients with severe immunosuppression

Thalidomide is a complex immunomodulatory and antiangiogenic agent whose role in oncology practice is as yet not fully clear. We present an unusual case documenting the use of thalidomide in the concurrent management of recurrent aphthous ulceration and kaposi sarcoma in a patient with severe immmunosuppression.

Recurrent aphthous ulceration in children--a review.

The clinical presentation or recurrent aphthous ulceration in children is described together with current views on the aetiology and pathogenesis of the disease. Factors that predispose to this type of oral ulceration are discussed and a rational approach to the management of recurrent aphthous ulceration in children is proposed.

Chlorhexidine gluconate (corsodyl) mouthwash

When we reviewed chlorhexidine dental gel (Corsodyl - ICI) in the Bulletin1 we criticised the lack of evidence for its long-term efficacy for the treatment of chronic periodontal disease and suggested that it should not be used for this purpose. Now a chlorhexidine gluconate 0.2% mouthwash ‘Corsodyl’ (ICI) is being promoted as an aid in treatment and prevention of gingivitis, in the management of recurrent aphthous ulceration and oral candidiasis and to promote gingival healing following periodontal surgery.2 The pharmacology of this antiseptic was reviewed in a previous article on the gel.1