Minor Aphthous Ulcers Research Articles

Clinical Evaluation of 660 nm Diode Laser Therapy on the Pain, Size and Functional Disorders of Recurrent Aphthous Stomatitis.

BACKGROUND:Minor recurrent aphthous stomatitis (MiRAS) is one of the most common, recurrent, and painful mucosal pathological condition. It is characterised by round or shallow oval ulcers, less than 10 mm in diameter, surrounded by a thin erythematous halo. It involves non-keratinized mucosa such as the labial and buccal mucosa, the ventral surface or borders of the tongue and the floor of the mouth, but it is uncommon to occur on the keratinised mucosa. It heals spontaneously within 10-14 days without scarring. There is no curative remedy to prevent its recurrence; also, available modalities only reduce the symptoms and severity of the lesion.AIM:Since these lesions may be extremely painful, we decided to estimate the pain-relieving and healing properties of low energy level laser therapy using diode laser 660 nm on MiRAS.MATERIAL AND METHODS:Twenty healthy patients suffering from minor aphthous ulcers were randomly selected from the Out-Patient Clinic of Oral Medicine Department, Faculty of Dentistry, Alexandria University. They were equally divided into two groups, study group who received 660 nm diode laser irradiation while the control group received placebo (sodium bicarbonate rinse). The visual analogue scale, size reduction, effectiveness indices and functional disorders were compared between the groups.RESULTS:Both groups presented a statistically significant difference from baseline to follow up periods. But, diode laser 660 nm treatment showed more remarkable improvements in reduction of healing time, pain and lesion size.CONCLUSION:We concluded that diode laser 660 nm should be further considered as an effective alternative therapeutic regimen to patients who suffer from recurrent aphthous stomatitis.

Expression of endocan and vascular endothelial growth factor in recurrent minor aphthous ulcers.

BackgroundRecurrent aphthous ulcers (RAU) are common painful inflammatory lesions of the mucous lining of the mouth. Endocan, previously identified as endothelial cell specific molecule-1, is implicated as a vital player in the regulation of several inflammatory processes. A number of inflammatory cytokines and pro-angiogenic growth factors including VEGF upregulate endothelial cells synthesis and expression of endocan.Material and MethodsClinical scores of pain and ulcer size as well as level of endocan and VEGF were determined in swaps from aphthous ulcer and contra lateral normal mucosa in 30 patients (nine males and twenty one females) with age ranging from 18 to 45 years and mean age is 31.5 years.ResultsIn the early days of ulcer development, ulcer showed statistically significantly higher mean endocan (8.2 ±5.3) and VEGF levels (1220.7 ±294.6) than control healthy mucosal site (1.1 ±0.5) and (518.6 ± 61.7) respectively. An increase in endocan is associated with an increase in pain score and vice versa. A statistically significant positive correlation were also found between endocan and VEGF levels.ConclusionsEndocan and VEGF are strongly associated with the destructive phase of minor aphthous ulcers especially Endocan which was positively correlated with pain severity. Key words:Endocan, ESM-1, VEGF, Recurrent Apthous Ulcer.

A Randomized, Double-Blind, Placebo-Controlled Trial on Clinical Efficacy of Topical Agents in Reducing Pain and Frequency of Recurrent Aphthous Ulcers.

Introduction:Recurrent Aphthous Ulcers (RAU) is one of the most common oral ulcerative Disease of the oral mucosa with high recurrence rate. Standard topical treatment options provide symptomatic relief with few have been found to be effective in treating or relieving the symptoms.Aim:The study aimed to evaluate the clinical efficacy of various topical agents in order to find the better treatment modality so as to decrease the number, size, exudate level and discomfort associated with pain with RAU.Materials and methods:The patients diagnosed with minor recurrent aphthous ulcers fulfilling the inclusion and exclusion criteria were enrolled. All the baseline parameters were measured by the principal investigator. The treatment modality was assigned by generating a randomization list by computer software, double-blinded in consecutively numbered sealed envelopes. The topical treatment modalities that were included: 5% Amlexanox, 0.1% Triamcinolone Acetonide, 20% Benzocaine gel, 100 mg Doxycycline hyclatemixed with denture adhesive and normal saline (20:2:1); The study was placebo controlled in which placebo gel 10 gm was used. The size, no of ulcers, pain, erythema and exudate level were measured by the principal investigator at days 1, 4, 8 and 10. All quantitative variables were estimated using measures of central tendency (mean, median) and measures of dispersion (standard deviation). Qualitative or categorical variables were described as frequencies or proportions. Proportions were compared using Post Hoc Test and N Par Tests. Effectiveness was checked using p-value (< 0.005).Results:It was observed that 0.1% Triamcinolone Acetonide and 5% Amlexanox proven to be more efficacious in the reduction of size, Number, Pain, Erythema and Exudate Levels at day 8, (p = .000*) and at day 10 (p =. 000*) as compared to single application of 100 mg Doxycycline Hyclate, 20% Benzocaine gel and the placebo, which was statistically significant. VAS scale was significant for 100 mg Doxycycline Hyclate and 20% Benzocaine gel.Conclusion:The selected topical treatment modality can deliver cheap, effective and safe drug therapy which benefits the patient in refining their regular activities and everyday events of life.

Effect of Herbal Echinacea on Recurrent Minor Oral Aphthous Ulcer.

Background:The oral aphthous is a common oral ulcer with intense pain and there is no treatment for it, yet. Echinacea is an herbal medicine that moderated the immune system.Objective:The aim of this study was to investigate the effects of Echinacea on the treatment of aphthous ulcer.Methods:50 patients with minor aphthous participated in our study. 25 patients take 3 tablets in a day for five weeks (case group) and 25 patients didn’t take any tablets (control group). The patients were monitored for one month before taking the tablets for six months. During this period, the number of lesions, complete improvement of ulcers, recurrence rate and intensity of pain were considered in each month. Finally, the Friedman and ANOVA tests used to analyze the obtained data.Result:Our study showed a significant difference between a number of lesions during six-month in case and control groups (p>0.001). In this way, we observed that the number of lesions was decreased significantly after six months in the case group. Hence, ANOVA analysis showed a significant decrease between each month for the intensity of pain (p=0.025), complete improvement (p<0.001) and recurrence rate (p=0.026).Conclusion:In conclusion, we showed that Echinacea tablets as an herbal medicine have positive effects on a number of lesions, intensity of pain, complete improvement and recurrence rate in patients with recurrent minor aphthous ulcers.

Comparative prospective randomized open label trial of synbiotic (bifilac) as an add on therapy with standard treatment in patients with aphthous ulcer

Background: To trial the safety, efficacy and rapidity of response to a lozenges containing synbiotic in patients with minor aphthous ulcer.Methods: A total of 60 patients were enrolled for the trial after obtaining IEC approval and randomly allocated into two groups. Control “Group A” was administered with conventional treatment i.e., zytee and B complex for 2 weeks and trial “Group B” was administered with Bifilac along with conventional treatment for 2 weeks. The results of this trial were analyzed both subjectively and objectively.Results: Comparing with control group, where standard treatment was used with analgesics and B-complex, the trial group showed a quick relief of pain and helped in reducing mean size of ulcer.Conclusions: This trial was done with synbiotic lozenges in minor aphthous ulcers and it proved to be better alternative for them. Moreover, synbiotics have no adverse effects.

Association of oral manifestations in ulcerative colitis: A pilot study.

Background:Ulcerative colitis (UC) is a chronic tissue destructive inflammatory bowel disease (IBD) of autoimmune origin characterized by predominant bowel symptoms such as abdominal pain, diarrhea and relapsing and remitting rectal bleeding, leading to loss of weight. Extraintestinal manifestations, including involvement of the oral cavity, may also occur. Oral involvement during IBD includes aphthous ulcers, pyostomatitis vegetans (PV) and lichen planus (LP).Objectives:The purpose of this study was to document the oral manifestations in UC patients and also to evaluate whether oral manifestation can predict relapse and remission of UC.Materials and Methods:Fifteen patients (8 men and 7 women) diagnosed for UC, in clinics of gastroenterology (with disease duration 5–15 years), with equal age- and sex-matched healthy controls were included in the study. All study participants were subjected to intraoral examination to evaluate for oral manifestation. The same patients were also asked a series of questions in the form of questionnaire to evaluate possible association between occurrence of oral manifestations and relapse of UC episode.Results:PV, minor aphthous ulcer, LP, halitosis, dysgeusia, dry mouth, tongue coating, gingivitis and periodontitis were documented as oral manifestations in UC. PV, minor aphthous ulcer and LP exhibited relapse and remission with the severity of UC.Conclusion:Our study revealed numerous and varied intraoral manifestations among the patients with UC. The previous episodes of oral manifestations were also similar and reported exacerbation of oral manifestations during relapses. Thus, oral manifestations can be used as an indicator of relapse in UC.

Comparative evaluation of the efficacy of topical amlexanox 5% oral paste and triamcinolone acetonide 0.1% oral paste in the treatment of Recurrent Aphthous Stomatitis (RAS)

Background: A double-blind randomized control trial was conducted to compare the clinical efficacy of topical triamcinolone acetonide 0.1% and amlexanox 5% in recurrent apthous stomatitis (minor). Materials and Methods: Forty adult patients were assessed for erythema, ulcer size, pain scores, and ulcer healing on three evaluation visits within 24 h of ulcer formation, third day, and fifth day. All participants were monitored for compliance with treatment protocols of four times daily application of calibrated quantity of medication. Results and Discussion: Ninety percent of controls when compared with 65% of the participants in the amlexanox group showed complete improvement of peri-ulcer erythema. Pain reduction was marked from the first to the fifth day (F = 15.249, P = 0.000). The control participants showed 90% reduction in pain in comparison to 70% in the amlexanox group. The mean ulcer size was shown to reduce from the first to fifth day in both groups (F = 18.611, P = 0.000). Completely healed ulcers were seen in 70% of the participants in the control group compared with 75% of the participants in the amlexanox group. Conclusion: The data suggest that the clinical efficacy of topical amlexanox 5% is comparable to topical 0.1% triamcinolone acetonide and may be considered a substitute except in pain control, which was marginally less for the treatment for recurrent apthous stomatitis (minor).

Clinical Short-term Effects of Nd:YAG Laser and CO2 Laser on Minor Aphthous Ulcer

Clinical Short-term Effects of Nd:YAG Laser and CO2 Laser on Minor Aphthous Ulcer

Comparison of the Effect of Salvizan Gel with Teriadent in Patients with Minor Aphthous Ulcers

Comparison of the Effect of Salvizan Gel with Teriadent in Patients with Minor Aphthous Ulcers

Prevalence of aphthous and aphthous like ulcers and their relation to precipitating factors among a sample of Egyptian Population

Introduction: Recurrent aphthous ulcer is one of the most common oral diseases worldwide. The prevalence ranges from 2% to 66% in different populations. Detection of the prevalence of oral ulcerations in the general population is very important as the ulcers have significant negative effects on the oral health, irrespective to the etiology. Moreover, many syndromes were known to be associated with recurrent aphthous ulcers. Aim: the present study was performed to detect RAU prevalence among a sample of Egyptian population and to find out its incidence in relation to the precipitating factors.Subjects & Methods: The present study was performed on a total of 4362 subjects, 1874 males and 2488 females. The subjects were recruited from the outpatient clinic of Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University. For patients with RAU, the diagnostic sheets were provided. Data obtained from the questionnaire was analyzed using software SPSS 16.0 for windowsResults: There were 50/4362 cases with aphthous ulcer giving a prevalence of 1.15%. Ten cases (20.0%) had major aphthous ulcer while 40 cases (80.0%) had minor aphthous ulcer and no herpetiform aphthous ulcers were reported. Conclusions: The present study shed the light on the prevalence of recurrent aphthous ulcers and also pointed to the importance of a thorough history taking to identify the main risk factors of the ulceration and then to get the needed preventive measures.

Anti-Inflammatory Effect of Sage (Salvia Officinalis) Extracts ABSTRACT on Oral Health

The aim of the study is to show the anti-inflammatory effect of sage ( Salvia officinalis ) extract as mouthwash on treating the infect- ed gums (gingivitis) and mouth ulcers (minor aphthous ulceration). Methods and materials : sixty (60) patients (50% female and 50% male) 30 patients had RAU (minor aphthous ulceration) according to clinical presentation and 30 patients had gingivitis according to gingival index of loe and Silness. Sage mouthwash was extracted from the plant Salvia officinalis . The patients of the study group were demonstrated to how they made the mouth wash. Patients with minor aphthous ulceration of study and control group were included in the post-treatment daily observations of the ulcer on [first, third and sixth day] and we looked for pain relief, reduction of intensity of pain, reduction in size of ulcers, and complete healing. Results: Analysis of gingival scores by gingival index of loe and silness of sage mouthwash individually showed a statistically highly significant improvement and healing of gingivitis (decreased mean value) from the first day to the sixth day. Analysis of gingival scores by gingival index of loe and silness of normal saline mouthwash showed a statistically significant results from the first day to the sixth day but there was no complete healing. Minor aphthous signs and symptoms of the study group in comparison with control group showed a statistically significant improvement in daily observations. Conclusions: Sage extract was found to be effective as anti-inflammatory product against gingival inflammation and mouth ulcers and present study confirmed the efficacy of the plant.

Relative Efficacy of Quercetin Compared with Benzydamine Hydrochloride in Minor Aphthae: A Prospective, Parallel, Double Blind, Active Control, Preliminary Study

Background and Objectives Recurrent aphthous stomatitis is an inflammatory condition present since ancient era wherein numerous treatment modalities have been tried. But complete eradication of the disease has not been possible and hence newer agents are being introduced. One such agent is a flavonoid named quercetin with proven antioxidant, anti-inflammatory, and ulcer healing properties. Methods 40 patients with minor aphthous ulcers were divided equally into two groups: A and B. Group A patients were advised to apply quercetin gel and Group B patients were advised to take benzydamine hydrochloride mouth wash. Clinical evaluation including assessment of ulcer size and pain score and questionnaire about the acceptability of both the drugs in terms of taste and ease of application was carried out. Each criterion was compared and statistically analyzed. Results There was statistically significant reduction in the mean score of pain sensation and ulcer area in both the groups. Quercetin showed statistically highly significant ulcer size reduction as compared to benzydamine hydrochloride. Conclusion From the present study, it is evident that quercetin is safe, well tolerated, and effective therapy which promotes complete ulcer healing in a short duration of time.

Aphtes et ulcérations buccales

Aphthous ulcers are painful ulcerations located on the mucous membrane, generally in the mouth, less often in the genital area. Three clinical forms of aphthous ulcers have been described: minor aphthous ulcers, herpetiform aphthous ulcers and major aphthous ulcers. Many other conditions presenting with oral bullous or vesiculous lesions orulcerations and erosions can be mistaken for aphthous ulcers. Currently, treatment of aphthous ulcers is palliative and symptomatic. Topical treatments (topical anesthetics, topical steroids and sucralfate) are the first line therapy. Recurrent aphthous stomatitis (RAS) is defined by the recurrence of oral aphthous ulcers at least 4 times per year. RAS is often idiopathic but can be associated with gastro-intestinal diseases (i.e. celiac disease, inflammatory bowel diseases), nutritional deficiencies (iron, folates...), immune disorders (HIV infection, neutropenia) and rare syndromes. Behçet's disease is a chronic, inflammatory, disease whose main clinical feature is recurrent bipolar aphthosis. Colchicine associated with topical treatments constitutes a suitable treatment of most RAS. Thalidomide is the most effective treatment of RAS but its use is limited by frequent adverse effects. Oral ulcers can be related to a wide range of conditions that constitute the differential diagnoses of aphthous ulcers. Oral ulcers are classified into three main groups: acute ulcers with abrupt onset and short duration, recurrent ulcers (mainly due to postherpetic erythema multiforme) and chronic ulcers (with slow onset and insidious progression). Acute oral ulcers are due to trauma, bacterial infections (including acute necrotizing ulcerative gingivitis), deep fungal infection, gastro-intestinal (namely inflammatory bowel disease) or systemic diseases. Chronic oral ulcers may be drug-induced, or due to benign or malignant tumors. Every oral solitary chronic ulcer should be biopsied to rule out squamous cell carcinoma. A solitary palatal ulcer can be related with necrotizing sialometaplasia.

Short-Term Efficacy of Pudilan Keyanning Toothpaste in Treatment of Minor Recurrent Aphthous Ulcers.

Aim. To examine the potential of Pudilan Keyanning toothpaste (PKT) to treat minor aphthous ulcers (MiAU). Method. A double-blind clinical trial was conducted in which 80 volunteers were randomly assigned to the PKT group (N = 40) or the control group (N = 40). The control group used a placebo toothpaste containing no Pudilan extract. At baseline, after 3 days, and after 6 days the following parameters were recorded for the target ulcers: healing rate, healing period, pain (visual analogue scale, VAS), areas of the target ulcerated lesions, degree of exudation, and hyperemia. Results. At the end of the study, the healing rate in the PKT group was 80%, compared to 50% in the control group (p < 0.05). At day 6, the VAS scores, ulcer area, degree of exudation, and hyperemia were significantly different between the two groups, with better performance observed in the PKT group (p < 0.05). Conclusion. PKT toothpaste appears to promote effective healing of MiAU.

Low-level laser therapy versus 5% amlexanox: a comparison of treatment effects in a cohort of patients with minor aphthous ulcers

The aim of the study was to compare the treatment effects of 5% amlexanox and low-level laser therapy (LLLT) in a cohort of patients who experienced minor aphthous stomatitis. A clinical trial was performed between 2012 and 2014 on 50 participants having minor aphthous ulcers. Group A participants were treated with amlexanox oral paste (lexanox 5% oral paste), and group B participants were treated with LLLT. Pain scores and sizes of ulcers were measured on the first, third, and seventh days of treatment in both groups. Data were analyzed using paired t test and independent t test. No significant difference was observed between the two groups with respect to pain level on the first and seventh days of treatment. Both amlexanox and LLLT were equally effective in relieving pain associated with minor aphthous stomatitis. Both groups showed significant reduction in ulcer sizes and in pain scores.

English

AIMS AND OBJECTIVES: To study the various etiological factors, the relation between haematinic deficiencies and recurrent aphthous stomatitis (RAS). MATERIALS AND METHODS: It was a prospective study to find out the aetiopathogenesis of RAS. A detailed history of 50 patients with RAS was taken with emphasis on etiological factors causing RAS such as age, stress, sleep, menstruation, trauma, constipation, smoking, drugs / food allergy and haematinic deficiencies. Diagnosis was based on history and clinical examination. Hemoglobin percentage, serum vitamin B12 & folic acid levels were seen for in blood. RESULTS AND OBSERVATION: We have evaluated 50 patients with RAS. Maximum numbers of patients were seen in the age group of 20 – 39 (68%). In our study 47 patients (94%) presented with minor aphthous ulcers and 3 patients (6%) with major ulcers. 64% of patients were from middle socioeconomic group, 70% of RAS was associated with anemia, 46% of stress related, 30% gave history of lack of sleep, 20% of female patients developed RAS during menstruation. Vitamin B12 deficiency (20%), trauma (22%), and 6% was associated with smoking, constipation and food allergy, 8% were found to be associated with alcohol. CONCLUSION: Recurrent Aphthous Stomatitis is a very common disease with several precipitating factors. Multiple combined etiological factors like lack of sleep, minor trauma to oral mucosa in susceptible individuals, menstruation, constipation, food allergies, vitamin B12 and folic acid deficiency etc. caused RAS. This data may be helpful in future studies regarding the aetiopathogenisis of RAS and to bring out better treatment or preventive options.

A comparative study of vitamin D serum levels in patients with recurrent aphthous stomatitis

BackgroundRecurrent aphthous stomatitis (RAS) is characterized by recurrent, painful, shallow, round or oval oral ulcers surrounded by inflammatory halos. Aim of the workTo investigate the status of vitamin D in RAS patients and the relationship between vitamin D levels and the severity of RAS. Patients and methodsIn this cross sectional study 46 patients with idiopathic minor RAS (MIRAS), and 49 age and sex matched healthy controls were included. Patients with at least 3 minor aphthous oral ulcers in a year without any known cause for RAS were determined as idiopathic minor recurrent aphthous stomatitis. The severity of RAS was assessed by the number of oral aphthous ulcers in each attack and the frequency of attacks. 25-Hydroxy vitamin D [25(OH) D] levels were measured by the Enzyme-Linked Immunosorbent Assay (ELISA) method in patients and control groups. ResultsThe mean 25(OH) D level in the MIRAS group was lower than the control group (12.1±7.7ng/dl vs. 27.4±9.7ng/dl, p=0.0001). Insufficiency and deficiency of 25(OH) D in the recurrent aphthous stomatitis groups were more common than those in the control group (Vitamin D sufficient, Vitamin D insufficient and Vitamin D deficient (p<0.0001 for all the cases)). No correlation was found between the serum levels of 25(OH) D and the duration of RAS, the number of oral aphthous ulcers in each attack, and the frequency of attacks (p<0.05 for all the cases). ConclusionsOur study suggests that deficiency of vitamin D may be a trigger factor for RAS.

Efficacy of honey in comparison to topical corticosteroid for treatment of recurrent minor aphthous ulceration: a randomized, blind, controlled, parallel, double-center clinical trial.

Recurrent aphthous ulceration represents a very common mucosal disorder that general dentists may encounter on a daily basis, and for which there is no curative treatment. The best treatment that can be achieved is to avoid local traumatic precipitants, lessen the pain and duration of ulceration by suppressing the local immune response, and prevent secondary infection. The objective of this study was to clinically determine the efficacy of honey as a topical treatment of recurrent minor aphthous ulceration in a Saudi cohort. A randomized, blind, controlled, parallel, double-center clinical trial was carried out. Honey was applied by patients four times a day for 5 days. Clinical parameters (ulcer size, pain scale, and degree of erythema and healing) were recorded both at baseline and during the follow-up period. There were 94 subjects, with 180 minor recurrent aphthous ulcerations. The ulcers were distributed as 67, 57, and 56 ulcers for honey, topical corticosteroid, and Orabase treatment, respectively. There was a statistically significant difference between the honey group and the other two groups in terms of reduction of ulcer size, days of pain, and degree of erythema. No side effects were reported in any group. Honey was found to be effective and safe in reducing minor aphthous ulcer pain, size, and erythema in a Saudi cohort.

Assessment of immediate pain relief with laser treatment in recurrent aphthous stomatitis

To compare immediate pain relief, healing time between minor recurrent aphthous ulcers treated with a single session of carbon dioxide (CO2) laser and a placebo. A prospective clinical study was performed on 25 patients with minor recurrent aphthous stomatitis. Pretreatment pain levels were recorded using a numerical rating scale. Ulcers were randomized to either receive treatment or placebo. Pain levels were assessed immediately after treatment and after 24 h. Healing was assessed on days 3 and 4, and once every 2 days thereafter for 2 weeks. Mean pain scores in the laser group were significantly reduced immediately after treatment (0.68 ± 0.6) compared with pretreatment (8.48 ± 0.71; P < .001). In contrast, the placebo group showed little difference in pain scores between pretreatment (8.08 ± 0.70) and immediately after treatment (7.96 ± 0.84). In the laser group, significant improvements in healing times were observed (4.08 ± 0.81 vs. 7.84 ± 0.90 days; P < .001). CO2 laser therapy in recurrent aphthous stomatitis (RAS) provides immediate pain relief sustained over 24 h, along with accelerated healing time.

A clinical evaluation of 5% amlexanox oral paste in the treatment of minor recurrent aphthous ulcers and comparison with the placebo paste: A randomized, vehicle controlled, parallel, single center clinical trial

The primary objective of the following study is to determine and secondary objective is to compare the efficacy and safety of 5% amlexanox oral paste in the treatment of recurrent minor aphthous ulcers and also to evaluate the recurrence rate of aphthous ulcers over a period of 1 year. The present study was conducted on 100 patients diagnosed to have recurrent minor aphthous ulcers of which, 50 patients were advised to apply 5% amlexanox oral paste directly on the ulcer 4 times a day for 6 days and the other 50 patients were given placebo paste for the same duration. The baseline parameters were recorded on the first visit which includes ulcer size, pain, erythema and exudation. Efficacy and safety evaluations were made on the 4 th day and 6 th day. In total 30 patients with increased frequency of ulcers were advised to use 5% amlexanox paste for one whole year and the number of ulcers per month was recorded to evaluate any decrease in the recurrence rate. Male patients dominated the study with 73 males and 27 females. The mean age of the total sample was 26.6 years. The amlexanox group showed marked reduction in ulcer size (P < 0.001), significant reduction in the visual analog scale scores of pain (P < 0.001), significant lower scores of erythema and exudation (P < 0.001) when compared to the placebo group on the 6 th day of follow-up. The incidence of recurrence of ulcers was significantly reduced up to the 6 th month, but thereafter recurrence rate slowly increased. Almost 5% of Amlexanox oral paste is clinically beneficial in reducing the pain, erythema, exudation and size of the ulcer over a period of 6 days. There was no definite conclusion drawn with respect to its effect on the recurrence rate of aphthous ulcers over a period of 1 year.