Episodes Of Recurrent Aphthous Stomatitis Research Articles

Role of vitamin B12 in treating recurrent aphthous stomatitis: A review.

Vitamin B12, a water-soluble vitamin, plays a vital role in the formation of hematopoietic stem cells and has been associated with oral mucosal diseases, mainly recurrent aphthous stomatitis (RAS). The latter is a debilitating condition, and B12 was proposed as a potential treatment given its role in regenerating oral mucosal tissue. There is conflicting evidence that B12 deficiency causes RAS. Five of the seven randomized controlled trials reviewed used the inactive form of B12 (cyanocobalamin) as intervention, while the other two used the active form (methylcobalamin). Of the latter two, buccal discs (500μg B12) showed significant improvement and reduced perceived pain in 77% of the subjects, and submucosal injections showed a significant difference in pain, starting from the second day. Moreover, three studies administered vitamin B12 sublingually with different dosages, which revealed that the higher dose (1000μg) achieved a significant reduction in outbreaks, number, and duration of ulcers, especially after six months. Multivitamins showed no difference in new RAS episodes and duration. Injectable B12 was compared with the oral form, and nearly 50% of the injection group reported a desired response by the eighth week. An ointment form (500μg) showed a significant reduction in pain levels after two days of treatment. Based on the available literature, we suggest that a daily dose of 1000μg of vitamin B12 sublingually for six months can be used to treat RAS. Nevertheless, this conclusion should be considered tentative due to the lack of high quality, large scale studies.

Recurrent Oral Ulcers: current and future therapeutic approaches

Recurrent Oral Ulcers: current and future therapeutic approaches

The efficacy of minocycline mouth rinses on the symptoms associated with recurrent aphthous stomatitis: a randomized, double-blind, crossover study assessing different doses of oral rinse

The aim of the study was to assess the efficacy of 2 different concentrations of minocycline mouthwashes on the symptoms of recurrent aphthous stomatitis (RAS). The 2-year study was designed as a randomized, double-blind, crossover study. Healthy patients with frequent RAS episodes received 2 sealed and computer-randomized marked kits containing minocycline mouthwashes (0.2% and 0.5% solution). The patients were asked to use 1 of the kits on the first episode of RAS, starting with the first onset of prodromal symptoms, until the symptoms resolved or up to a maximum of 10days (whichever came first). The patients were asked to use their second kit during a subsequent episode. A total of 14 patients (8 males, 6 females) completed the 2 arms of the study. The mean intensity of pain was significantly lower when the 0.5% solution was used compared with the 0.2% solution (P=.027). The difference reached the level of statistical significance as soon as the end of the second day of use (P=.032). Only minor and temporary adverse reactions were documented. We found that 0.5% minocycline mouth rinse was more effective than the 0.2% concentration, which had been suggested by our group in previous studies for the management of RAS.

Elevated serum IgE in recurrent aphthous stomatitis and associations with disease characteristics

To characterize demographic, clinical and serological parameters in recurrent aphthous stomatitis (RAS) patients and analyse their association with serum immunoglobulin E (IgE) levels. Forty-nine patients with RAS responded to a questionnaire that included demographic background, stress status, smoking habits, history and course of RAS episodes. They were also subjected to relevant laboratory tests, including determination of serum IgE levels. A familial history of RAS was reported by 47.9% of the patients, stress in the previous year by 51.1% and smoking by 18.4%. Non-Caucasian origin, familial history of RAS, stress and smoking were associated with increased severity of RAS episodes. Haematological deficiencies were observed in 18.7% of RAS patients. Average IgE levels were increased and were significantly associated ‎with younger ‎age, ‎≤12 years of schooling, ‎female gender, ‎RAS ‎episode frequency of every ‎2 weeks‎,‎ early onset of RAS episodes and elevated C reactive protein levels. Immunoglobulin E levels may be considered as part of the RAS patient's work-up. Further research is needed to identify biological mechanisms that account for the observed associations.

The efficacy of Punica granatum extract in the management of recurrent aphthous stomatitis.

Objective:Recurrent aphthous stomatitis (RAS) is a common, painful ulcerative disorder of the oral cavity with unknown etiology. No documented cure exists and topical application of medications aims to reduce pain associated with this condition. The aim of this study was to evaluate the efficacy of Punica granatum (PG) extract on the clinical management of RAS.Methods:A total of 40 patients with RAS participated in this randomized, double-blind, and placebo-controlled study. During three episodes of RAS, the efficacy of topical PG gel (10%) was evaluated. Patients were randomly assigned to use placebo gel or PG gel daily. The time of pain elimination and the time of complete healing were recorded and the pain degree was assessed and recorded by each patients in different time intervals including: Before using the oral gel (day 0), and on days 1, 3, 5, 7 after using the product. Data were analyzed using the repeated measures ANOVA, paired and independent t-test.Findings:Mean time of pain elimination showed a significant difference (P < 0.001) between PG group (3.4 ± 1.09) and placebo group (5.9 ± 0.6). The mean duration of complete healing also showed a significant difference (P < 0.001) between PG group (5.3 ± 0.81) and placebo group (8.6 ± 0.99). The visual analog scale score in PG group was significantly less than the placebo group in all time intervals (day 1 to day 7) (P < 0.001).Conclusion:The findings of this study revealed that PG extract in the form of oral gel (10%) may be beneficial in reducing RAS pain and has a positive effect in reducing the overall time period of complete healing. It was concluded that PG is an effective herbal medicine for the management of RAS.

Multivitamin therapy for recurrent aphthous stomatitis: A randomized, double-masked, placebo-controlled trial

Background Recurrent aphthous stomatitis (RAS) is a painful condition of unknown etiology, affecting more than 2.5 billion people worldwide. Vitamin deficiencies have been implicated as a possible cause. Methods The authors conducted a single-center, randomized, parallel-arm, double-masked, placebo-controlled study to examine the effect of daily multivitamin supplementation on the number and duration of RAS episodes. The authors randomly assigned 160 adults who had a validated history of at least three episodes of idiopathic minor RAS within the previous 12 months to one of two groups: the first group (n = 83) received a once-daily multivitamin containing 100 percent of the U.S. reference daily intake (RDI) of essential vitamins, and the second group (n = 77) received once-daily placebo for up to 365 days. Results The results showed no significant difference in the mean number of new RAS episodes between the multivitamin (4.19 episodes) and placebo (4.60 episodes) arms during the study period (P = .69). The mean duration of new RAS episodes also was similar for the multivitamin (8.66 days) and placebo (8.99 days) arms (P = .60). Furthermore, the authors found no differences between the two arms with regard to mouth pain, normalcy of diet or compliance with the study medication regimen. Conclusion Daily multivitamin supplementation, with the RDI of essential vitamins, did not result in a reduction in the number or duration of RAS episodes. Clinical Implications Clinicians should not recommend multi-vitamin supplementation routinely as prophylaxis for RAS. Recurrent aphthous stomatitis (RAS) is a painful condition of unknown etiology, affecting more than 2.5 billion people worldwide. Vitamin deficiencies have been implicated as a possible cause. The authors conducted a single-center, randomized, parallel-arm, double-masked, placebo-controlled study to examine the effect of daily multivitamin supplementation on the number and duration of RAS episodes. The authors randomly assigned 160 adults who had a validated history of at least three episodes of idiopathic minor RAS within the previous 12 months to one of two groups: the first group (n = 83) received a once-daily multivitamin containing 100 percent of the U.S. reference daily intake (RDI) of essential vitamins, and the second group (n = 77) received once-daily placebo for up to 365 days. The results showed no significant difference in the mean number of new RAS episodes between the multivitamin (4.19 episodes) and placebo (4.60 episodes) arms during the study period (P = .69). The mean duration of new RAS episodes also was similar for the multivitamin (8.66 days) and placebo (8.99 days) arms (P = .60). Furthermore, the authors found no differences between the two arms with regard to mouth pain, normalcy of diet or compliance with the study medication regimen. Daily multivitamin supplementation, with the RDI of essential vitamins, did not result in a reduction in the number or duration of RAS episodes.

Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is a common and painful oral mucosal disease. Possible etiologies include genetics, vitamin deficiencies, trauma, immune dysfunction, and stress. The goal of this study was to examine the relationship between the occurrence, type, and magnitude of stressful events and the onset and duration of RAS episodes. One hundred and sixty subjects with a history of RAS completed a weekly phone survey for up to 1 year, providing data on the occurrence of RAS episodes and details of any stressful events they experienced during the previous week. During RAS episodes, subjects also completed daily paper diaries that recorded incidence and duration of the RAS episode. Stressful events were quantified using the validated Recent Life Changes Questionnaire (RLCQ) and were classified as mental or physical stressors. Stressful life events were significantly associated with the onset of RAS episodes (P < 0.001), however, not with the duration of the RAS episodes. Experiencing a stressful life event increased the odds of an RAS episode by almost three times (OR = 2.72; 95% CI = 2.04-3.62). When controlled for each other, mental stressors had a larger effect (OR = 3.46, 95% CI = 2.54-4.72) than physical stressors (OR = 1.44; 95% CI = 1.04-1.99) on the occurrence of RAS episodes. RAS episodes did not occur more frequently or last longer with increasing stress severity. In patients with a history of RAS, stressful events may mediate changes involved in the initiation of new RAS episodes. Mental stressors are more strongly associated with RAS episodes than physical stressors.

Reduced dietary intake of vitamin B12 and folate in patients with recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS), commonly referred to as canker sores, is a very common and painful oral mucosal disease. Although the etiology of RAS is not well understood, a number of factors may play a role, including nutritional deficiencies. The objective of this study was to compare dietary vitamin intake in RAS patients to that of a control group. One hundred subjects, who had suffered at least three episodes of minor RAS in the previous 12 months, completed a detailed Diet History Questionnaire designed and validated by the US National Institutes of Health. DietCalc software was used to calculate daily dietary intakes of nine different vitamins in the study subjects. Daily intakes were energy-adjusted and compared to age- and gender-matched nutrient intake data on 9033 subjects from the US National Health and Nutrition Examination Survey. The study subjects had significantly lower daily intake of vitamin B12 (P < 0.0002) and folate (P < 0.0001) as compared to the controls. Our results demonstrate that patients with recurrent aphthous stomatitis are more likely to have lower dietary intakes of vitamin B12 and folate than a control group. These results support and extend previous studies indicating a link between the etiology of RAS and hematological deficiencies of vitamin B12 and folate. These findings suggest that consuming sufficient amounts of these vitamins may be a useful strategy to reduce the number and/or duration of RAS episodes.

Topical minocycline for managing symptoms of recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is a common ulcerative condition of the oral mucosa. In this study, minocycline oral rinses were compared to a placebo in patients suffering from frequent episodes of RAS. Thirty-three patients with RAS were randomly allocated to topical therapy with 0.2% minocycline or a placebo aqueous solution mouthwash. Seven patients also participated in a blind crossover study. The intensity of pain was recorded daily using a visual analogue scale. Minocycline mouthwashes resulted in significant reduction in the severity and duration of pain due to RAS. The findings in the subgroup that participated in the crossover were consistent with outcomes in the randomized study. The findings of this study show that minocycline oral rinses reduce pain in patients with RAS and may have implications for the use of minocycline in other non-infectious inflammatory ulcerative oral mucosal diseases.

Topical minocycline and tetracycline rinses in treatment of recurrent aphthous stomatitis: a randomized cross-over study

Recurrent aphthous stomatitis (RAS) is a common ulcerative condition of the oral mucosa. We assessed minocycline and tetracycline oral rinses in patients with frequent episodes of RAS in a clinical randomized crossover trial. Seventeen patients with high frequency recurrent minor RAS were randomly allocated to a cross-over topical therapy with 0.2 percent minocycline or 0.25 percent tetracycline aqueous solution mouthwash. The minimum interval between the cross-over was 30 days. The intensity of pain was recorded daily using a visual analogue scale. Minocycline mouthwashes as compared to topical tetracycline rinses resulted in significantly improved pain control, by reducing the severity and duration of pain. Topical minocycline rinse may be a potential treatment for other mucosal diseases that result in mucosal ulceration and pain.

Successful treatment of recurrent aphthous stomatitis of any origin with vitamin B12 (irrespective of its blood level)

Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal lesions seen in primary care. Over the past four years we have treated 15 RAS patients with vitamin B12. Of these, 11 patients reported a rapid and complete recovery from RAS during treatment and the other four reported pronounced reduction in the frequency and severity of RAS episodes. We suppose that a treatment with vitamin B12 can be effective for patients suffering from RAS any origin, regardless of their serum vitamin B12 level. Now we are doing double-blind, placebo-controlled, randomized clinical trial addressing the issue. It's supposed to confirm the safety and effectiveness of vitamin B12 therapy for RAS.

Aids e estomatite aftóide recidivante

O estado de imunodeficiência em pacientes HIV positivos tem sido causa de episódios severos de Estomatite Aftóide Recidivante (EAR). OBJETIVO: Este estudo objetiva estabelecer evidências da relação entre o surgimento (ou agravamento) de EAR com o estado de imunossupressão causado pelo vírus HIV, por meio da contagem de células CD4+, CD8+ e da carga viral infectante. FORMA DE ESTUDO: estudo de série. MATERIAL E MÉTODO: Noventa e quatro pacientes HIV (1)-positivos (25 mulheres e 69 homens) com EAR foram acompanhados no ambulatório de Aids da Divisão de Clínica ORL do Hospital das Clínicas da FMUSP no período de janeiro de 1998 a dezembro de 2003. A idade dos pacientes variou de 19 a 63 anos (média = 35,3 anos). RESULTADO: Os pacientes com Aids e soropositivos apresentaram, respectivamente, oito aftas e duas aftas por surto. Da mesma maneira, os pacientes portadores de úlceras do tipo major apresentaram menor contagem de células CD8+, CD4+ e relação CD4+/CD8+ e maior valor médio da carga viral do que os pacientes portadores de aftas herpetiformes e minor. Entre os portadores de aftas minor e herpetiforme não houve diferença estatística. CONCLUSÕES O aparecimento das lesões, principalmente as do tipo major, está diretamente relacionado ao estado imunitário do paciente soropositivo, acarretando déficits nutricionais e piora na qualidade de vida. Desta forma, o diagnóstico e tratamento da EAR é um desafio que não deve ser desprezado.

AIDS and recurrent aphtous stomatitis

SummaryThe immunodeficiency state in HIV infected patients has been the cause of severe episodes of Recurrent Aphthous Stomatitis (RAS). Aim: Our study aims to establish correlation between the manifestations of RAS and the immunosuppression state caused by HIV infection, through counting of CD4+ cells, CD8+ cells, CD4+:CD8+ cells ratio and viral load. Study design: series study. Material and Method: Ninety-four HIV infected patients (25 women and 69 men) with RAS were evaluated in the ENT Department of the University of Sao Paulo-Medical School from January 1998 to December 2003. The age ranged between 19 and 63 years (mean = 35.3 years). The patients were divided in two groups: AIDS group and HIV infected group. Results: The patients with AIDS and HIV infection presented, respectively, eight ulcers and two ulcers by outbreaks. Similarly, patients with major RAS presented smaller counting of cells CD8+, CD4+ and CD4+/CD8+ cells, and higher mean value of viral load than the patients with herpetiform and minor RAS. Between patients with minor and herpetiform RAS there were no statistical differences. Conclusions: The emergence of the lesions, mainly in major RAS, is directly related to the immunological state of the HIV infected patient. These patients frequently present nutritional deficits and worsening in life style. Thus, diagnosis and treatment of RAS is a challenge that should not be neglected.

Close Association of HLA-B52 and HLA-B44 Antigens in Israeli Arab Adolescents With Recurrent Aphthous Stomatitis

To investigate the incidence and clinical features of recurrent aphthous stomatitis (RAS) among Israeli Arab adolescents and to determine the HLA typing profile in affected subjects. Cross-sectional study. Junior high school in the largest Arab town in Israel. Four hundred seventy-seven Israeli Arab junior high school students filled out a questionnaire. Students who reported more than 4 episodes of RAS during the previous year were interviewed by telephone. Those whose responses were confirmed were invited to the clinic. Of these, 22 were chosen at random for HLA typing. Findings were compared with those in 117 healthy Israeli Arabs who were candidate donors of bone marrow to patients at the Institute of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tiqva. Recurrent aphthous stomatitis was confirmed in 80 subjects (16.7%). Of the 22 patients who underwent HLA typing, 7 (31.4%) had HLA-B52 antigens and 8 (36.4%) had HLA-B44 antigens; corresponding figures for the control group were 10 subjects (8.5%) (P = .007) and 9 subjects (7.7%) (P = .001), respectively. There is a close association of HLA-B52 and HLA-B44 in Israeli Arab youths with RAS. Long-term follow-up is needed to determine the relationship between RAS and Behçet disease.

Recurrent Aphthous Stomatitis

Recurrent aphthous stomatitis (RAS), often referred to as canker sore, is a chronic inflammatory disease. Frequently seen in the primary care setting, RAS affects over 50% of the population and may be observed in an otherwise apparently healthy individual. An unknown pathogenesis and absence of curative treatment make RAS a challenge to manage. Treating RAS should be patient specific and focus on reduction of pain and lesions. An awareness of literature suggesting etiologies, precipitating, and predisposing factors can assist the practitioner and patient in controlling RAS episodes. Contained in this review is a suggested course of management for patients with RAS, including present recommendations for pharmacological interventions.

Levamisole in aphthous stomatitis: evaluation of three regimens.

One hundred and twenty-four patients who had had recurrent aphthous stomatitis (RAS) for two to 53 years took part in three studies to assess the effectiveness of levamisole and determine an adequate regimen. In study 1 and the first half of study 2 both of which were double-blind, levamisole 150 mg/day (or placebo) was given on three consecutive days in every fortnight. In the second two months of study 2 and in the open trial (study 3) three-day courses were given only when an episode of RAS occurred. The drug was well tolerated. The signs and symptoms of RAS improved gradually and significantly in those treated with levamisole but not in those on placebo, and intergroup differences were also significantly in favour of the active drug. Improvement occurred earlier in study 3 than in the other two studies. Hence levamisole may prevent new episodes of RAS.

TOPICAL TRIAMCINOLONE ACETONIDE IN RECURRENT APHTHOUS STOMATITIS A Clinical Trial

The results of a double-blind clinical trial of topical triamcinolone acetonide in the treatment of recurrent aphthous stomatitis are described. The results suggest that this preparation should be used in the treatment of severe episodes of recurrent aphthous stomatitis and not for long-term management of these patients.