Aphthous Research Articles

Recurrent aphthous stomatitis and neoplasms of the mouth and pharynx: a two-sample Mendelian randomization study

BackgroundThe association between recurrent aphthous stomatitis (RAS) and neoplasms of the mouth and pharynx (NOMAP) has been reported in some previous observational studies. However, causality is still confused. Our research aims to explore the relationship between RAS and NOMAP through a Mendelian randomization (MR) analysis and to explore whether RAS can serve as a risk factor for NOMAP to provide a reference for the clinical strategy.MethodsAn exposure dataset for RAS were collected from a published study based on the UK Biobank (UKB). Outcome datasets included Genome-wide association studies (GWAS) summary statistics of NOMAP from the FinnGen datasets. The core method was inverse variance weighting (IVW). The Bonferroni correction, MR-Egger, weighted median, weighted mode, Cochcan’s Q test, MR-PRESSO, and leave-one-out methods served as complementary methods.ResultsWe found no significant evidence of causal relationships between RAS and NOMAP. After applying the Bonferroni correction, the corrected P was equal to 0.00625 (0.05/1/8). The IVW method provided the sole evidence for RAS on Benign neoplasm of floor of mouth (BNFM) (OR = 2.509, 95% CI: 1.296–4.857, P = 0.006), but the subsequent MR-Egger regression method showed that this result may be due to horizontal pleiotropy (P = 0.035). The Cochran Q-test, MR-Egger regression, and MR-PRESSO did not reveal any heterogeneity or directional pleiotropy for the other outcomes.ConclusionsIn conclusion, this is the first MR analysis to investigate the relationship between RAS and NOMAP. Our research confirmed at the genetic level that no causal association has been identified between RAS and NOMAP, therefore facilitating a logical therapeutic perspective and the development of clinical therapies for them.

Attempts to identify the molecular cause of autoinflammatory recurrent fever

Systemic autoinflammatory diseases caused by dysregulation of the innate immunity are a known cause of recurrent fevers. We present the molecular diagnosis results of 12 children with recurrent fever, analyzing the correlation between molecular findings and clinical symptoms. No pathogenic variants confirming autoinflammatory disease were found. One child was diagnosed with SRP54 deficiency, linked to congenital neutropenia with a cyclic pattern. Variants of uncertain significance were found in 6 patients in genes associated with autoinflammatory disorders, though two lacked clinical correlation. Variants of uncertain significance in the NLRC4 gene were detected in 2 patients with periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome, in the PLSG2 gene in 1 child with systemic juvenile idiopathic arthritis, and in the MEFV gene in 1 patient with syndrome of uncertain recurrent fever. COVID-19 was identified as a triggering factor in 54.5% of cases. Further research is needed to clarify the role of genetic variants and environmental factors in recurrent fevers.

Recurrent Aphthous Stomatitis and Sleep Quality Factors: A Comprehensive Analysis

Recurrent Aphthous Stomatitis and Sleep Quality Factors: A Comprehensive Analysis

OA08 Ocrelizumab in pregnancy in a patient with juvenile onset systemic lupus erythematosus

Abstract Introduction Juvenile-onset systemic lupus erythematosus (jSLE) is a multisystem autoimmune disease that results in increased disease activity compared to adult-onset SLE. jSLE in pregnancy results in a greater incidence of disease flares as well as adverse pregnancy outcomes. Management of SLE in pregnancy is particularly difficult due to lack of safety data for immunosuppressant medications and is therefore limited. Ocrelizumab is a humanised monoclonal antibody that selectively targets CD20 B cells and is approved for the treatment of multiple sclerosis. Despite never being trialled in a patient with active SLE in pregnancy, this case demonstrates its use with a successful outcome. Case description An 18-year-old female was diagnosed at age 14 with juvenile onset systemic lupus erythematosus with the presence of a photosensitive malar rash, arthralgia, alopecia, aphthous ulcers and headache. At the time of diagnosis her investigations revealed ANA 1:5120 with homogenous pattern, high dsDNA, low C3 and C4, thrombocytopenia, antibodies to Smith, Ro, RNP, anti-Rib-P, strongly positive lupus anticoagulant antibodies and low titre anti-cardiolipin IgG and IgM. Previous treatment included methotrexate, mycophenolate mofetil and cyclosporin which were discontinued either due to patient choice, inefficacy or adverse reaction. Azathioprine was contraindicated due to low TMPT. Rituximab was trialled and although effective had to be stopped due to adverse reaction. Unfortunately, she experienced a primigravida pregnancy loss at 15-20 weeks secondary to active SLE and pre-eclampsia. Shortly after this, she developed a rare case of anti-fascin antibody neuropathy and was treated with ocrelizumab. Six months later during her second pregnancy, she was treated with hydroxychloroquine 400 mg, aspirin 150 mg, folic acid 5 mg and low molecular weight heparin prophylaxis which were continued throughout the pregnancy. Due to concerns of active lupus at 13 weeks due to facial rash and fatigue, prednisolone was commenced at 10 mg daily and continued. After careful consideration, Ocrelizumab was given in the second trimester at 17 and 19 weeks’ gestation. Following this, symptoms remained under control and disease activity was low with normal C3/C4 and dsDNA levels without significant proteinuria. A newborn baby was delivered at 38 weeks by caesarean section without complication or foetal abnormalities. Both the mother and baby remain under close follow- up but have not demonstrated adverse outcomes at 3 months postpartum. Discussion This case demonstrates the use of Ocrelizumab in the second trimester of a high-risk pregnancy complicated by active jSLE. At present, there is no license for use of Ocrelizumab in SLE and no safety data on its use in pregnancy. However, there was a good outcome for this patient which resulted in no antenatal or postpartum complications and the successful birth of a healthy newborn without foetal abnormalities. Ocrelizumab is used for the treatment of early relapsing-remitting multiple sclerosis (RRMS) and is increasingly used by neurologists in women of childbearing age despite being unlicensed for use in pregnancy. Concerns of its use in pregnancy surround B cell depletion in the neonate which while tends to be transient, causes significant concern regarding long term immunological development and response to vaccination. B cell depleting therapies are widely used in the context of active and refractory SLE and therefore use of Ocrelizumab has been evaluated in cases of SLE in two phase III clinical trials. The first study examined the efficacy of Ocrelizumab in SLE without renal involvement (BEGIN) and the second recruited patients with lupus nephritis (BELONG). The BEGIN study was terminated early due to lack of response and the BELONG study was terminated due to a significant increase in serious infections (in the Ocrelizumab plus mycophenolate treatment group). However, results on disease activity were positive with complete renal response being achieved non-statistically more frequently in the Ocrelizumab treated patients versus placebo. Real world evidence shows the importance of achieving disease control in SLE around pregnancy to prevent adverse outcomes. The decision for the use of Ocrelizumab therefore needs to be balanced carefully against potential harm to the baby either from direct foetal exposure to the drug, or from gestation in an immunocompromised mother. Key learning points • Pre-pregnancy counselling is of paramount importance in severe cases of active SLE and when possible, pregnancy should be postponed in these instances until disease activity is stabilised with contraception counselling offered to those on teratogenic immunosuppressive agents. • A multidisciplinary approach to the management of complex SLE in pregnancy in essential with obstetrician, midwife, maternal medicine physician and rheumatologist input. • The benefit of potentially life-saving immunosuppressive treatment should be carefully balanced against the poor outcomes of active SLE in pregnancy and decisions should be made on a case-by-case basis.

Cholisal® in the complex treatment of oral mucosa and periodontium inflammatory diseases in children: A review

The problem of inflammatory diseases of the oral mucosa and periodontium in children remains relevant. The article presents the etiology, clinical presentation, and treatment methods of the most common diseases in children, such as acute herpetic stomatitis, chronic recurrent aphthous stomatitis, and chronic catarrhal gingivitis. Cholisal® dental gel with analgesic, anti-inflammatory, and antimicrobial effects is addressed as part of the complex local treatment.

In-Human Clinical Experience with Direct Stick Embolization of Low-Flow Vascular Malformations Using an mTOR Inhibitor

BackgroundWhile direct stick embolization (DSE) of low-flow vascular malformations (LFVMs) with off-label embolotherapeutic compounds is the current mainstay of therapy, systemic oral mTOR inhibition has evolved into an important adjunctive therapy that is associated with frequent blood draws, systemic toxicity, and rebound signs/symptoms upon cessation. We, herein, report our experience with in-human DSE of LFVMs with an mTOR inhibitor for direct, intralesional targeting of the culprit mutated pathway without repeated systemic exposure. MethodsSince 2020, 33 procedures involving DSE were performed in 25 patients with LFVMs using a patented formulation and technique involving the intravenously compatible mTOR inhibitor Yale-OCR7737, used as a liquid compound in a collagen matrix emulsion for added viscosity and intralesional residence. Data was prospectively maintained and retrospectively reviewed for technical success (successful catheterization of the lesion and intralesional delivery of compound); clinical success (improvement in signs/symptoms with radiologically documented reduction in flow and/or volume of treated lesion); complications; side effects; and re-interventions. ResultsFrom 2020 to 2023, 33 procedures involving DSE were performed using Yale-OCR7737 in 25 patients (10[40%] men; 15[60%] women; mean age: 28 years [range 1 -70 years]) with LFMVs involving the head/neck (48%) and limbs (40%); 88% were non-syndromic while 12% had Klippel-Trenaunay Syndrome; 68% exhibited venous malformations, while 32% had lymphatic malformations. Technical and clinical success were 100%. Mean DSE sessions per patient was 1.4 (range 1 to 5). Localized intravascular coagulopathy was present after 16 (49%) DSE procedures; D-dimer improved post-DSE in 7 cases. No perioperative or delayed complications occurred. Side-effects were 7 (21%) cases of self-limited, transient oral aphthous ulcers. ConclusionsOur findings suggest that DSE of LFVMs with mTOR inhibitors (Yale-OCR7737) may be safe and effective. This may represent the new embolotherapeutic frontier in the endovascular treatment of LFMVs.

Formulation and Evaluation of Jatropha curcas Latex Based Gel for the Treatment of Canker Sores

Formulation and Evaluation of Jatropha curcas Latex Based Gel for the Treatment of Canker Sores

PFAPA syndrome: a case report of a challenging diagnosis

Introduction: PFAPA syndrome (Periodic Fever, Aphthous stomatitis, Pharyngitis, and Adenitis) is the most common cause of periodic fever in childhood. Typically, it occurs in children up to five years old and is characterized by sudden and recurrent episodes of high-spiking fever accompanied by at least one of the other eponymous features. This case report enhances the importance of its recognition, to prevent unnecessary tests and/or treatments. Case description: We present a case of a four-year-old boy, with no relevant background, observed multiple times in primary and secondary care settings due to fever. His parents reported monthly episodes of high fever, usually along with pharyngitis, oral aphthosis, and/or cervical adenitis. He was completely asymptomatic between crises and showed normal growth and psychomotor development. Several oropharyngeal and nasal swab tests were performed, with negative results. After some investigation and articulation with his pediatrician, a diagnosis of PFAPA syndrome was made and he started oral corticosteroids, a single dose on the first day of every episode, obtaining fast and complete symptomatic relief. Comment: PFAPA syndrome diagnosis is challenging, and its process can trigger anxiety in the patient, his family, and even in healthcare professionals. However, this relatively common and benign condition tends to be self-limited, usually with spontaneous resolution before adolescence. Its recognition by the medical community is essential, particularly in primary care settings since family physicians are usually the first point of medical contact within the healthcare system. This case report enhances the family physician’s core competence to manage illness with nonspecific presentations and the importance of the interface with other specialties to provide the best care to the community.

Vascular thrombosis and relapse-associated factors in Behcet's syndrome: a comprehensive analysis of 136 patients

Abstract Background Vascular thrombosis in Behçet syndrome (BS) is frequent and associated with high morbidity and mortality rates. Purpose To investigate BS patients presenting with a thrombotic event (TE) and identify the factors associated with relapse. Methods We retrospectively conducted a single-center, descriptive, and analytic study, from 2000 to 2022, enrolling all BS patients presenting TE, including venous thrombosis (VT) and/or arterial thrombosis (AT). Results TE was observed in 136/531 patients (25%), mostly men (83%), aged 29 ± 9 years (11-50) at BS onset. TE was the initial presentation of BS (32%) or occurred after a median of 4 years [0;25]. It included VT (92.5%), AT (18%), and both (13%). VT mostly consisted of DVT in the lower extremities (60%), vena cava (30%), and cerebral (15%) veins. It involved one (55%), two (27%), and multiple (16%) veins (Figure 1). AT mainly affected the pulmonary (42%), femoral (21%), coronary (17%), cerebral (8%) arteries, and aorta (8%). Arterial aneurysms were common (18%), especially in the pulmonary arteries (11%). Intracardiac thrombosis was also visualized (10%). Noncardiovascular manifestations mainly included aphthous ulcers (96%), pseudofolliculitis (36%), ocular lesions (41%), and arthralgias (22%). Hemostasis parameters were within normal ranges. Patients were treated with colchicine (98%), corticoids (98%), and immunosuppressants (80%). Anticoagulation and anti-platelet aggregation were administered in 90% and 15% of the cases, respectively. Six patients underwent vascular surgery. Post-thrombotic syndrome was noted in 14% of the patients. Relapse was common (25%), mainly occurring in men (81%), of younger age (24 ± 6) at first TE. Relapse consisted of one (55%), two (32%), or multiple episodes (13%). It occurred in the same vascular system initially affected (69%), a different one (12%), and both at the same time (19%). Multivariable analysis revealed TE at onset (OR= 2.99, 95% CI[1.14 ; 7.82], p=0.02), arterial thrombosis (OR= 2.91, 95% CI[1.10 ; 8.40], p=0.04), and arterial aneurysms (OR= 2.58, 95% CI [1.09 ; 8.45], p=0.02) as factors significantly associated with TE relapse (Figure 2). Conclusion Our study highlights several particularities of TE in BS, with TE at onset, arterial thrombosis, and arterial aneurysms emerging as significant relapse factors.

The condition of the oral mucosa in somatic pathology

Lesions of the oral mucosa (SOPR) are often the primary pronounced clinical symptom of somatic diseases. It is possible to find out which pathogenetic mechanisms and links of somatic pathology create conditions for the implementation of risk factors, the implementation and development of structural and functional disorders in the oral mucosa, with the aim of targeted therapeutic effects on changes in the SOPR and the general condition of the body as a whole. The purpose of the study was to establish the structure of diseases of the oral mucosa depending on gender and age in patients with various somatic pathology. Materials and methods: A survey was conducted of 164 patients who sought advice from the Dental Hospital of Khabarovsk. Between the ages of 18 and 89. The average age of patients was (55.7 ± 1.38) years. All the subjects were divided into 4 groups depending on their age and the presence of diseases of internal organs. The comparison group included 30 somatically preserved patients of similar age and gender, by random sampling. Results: It was found that with pathology of the oral mucosa, women out of the total number of cases were 2.5 times more than men. The greatest number of patients’ complaints about the diseases of COPD was in the age group of 60-74 years, unlike other age groups: 18-44 years by 1.8 times; 45–59 years by 1.2 times; 75–89 years by 2.7 times, respectively. Most diseases of the oral mucosa are manifested in the presence of systemic pathology. Somatic diseases were detected in 62.2 % of patients with COPD. Pathology of internal organs and systems affects 70.42 % of patients with lichen planus, 50 % of patients with leukoplakia, 80 % of patients with candidiasis, 26.32 % of patients with chronic aphthous stomatitis and 79.17 % of patients with glossitis. Diseases of the gastrointestinal tract are 1.2 and 2.8 times more dominant in the structure of the lesions of the SOPR compared to the pathology of the cardiovascular and endocrine system. Findings: The revealed pattern of manifestations of pathological changes in the oral mucosa against the background of somatic pathology is of great diagnostic importance not only for dentists of various profiles, but also for clinicians of specialized departments, since ultimately all this affects the timeliness and quality of medical and diagnostic care for this category of patients.

Three cases of autoinflammatory disease with novel NLRC4 mutations, and the first mutation reported in the CARD domain of NLRC4 associated with autoinflammatory infantile enterocolitis (AIFEC)

BackgroundGain of function (GOF) mutations in NOD-like receptor family CARD-containing 4 protein (NLRC4) gene induce a wide spectrum of autoinflammatory phenotypes. Currently, we categorize them into four groups: familial cold autoinflammatory syndrome (FCAS)4, autoinflammatory infantile enterocolitis (AIFEC), NLRC4-macrophage associated syndrome (MAS), and neonatal-onset multisystem inflammatory disease (NOMID). The rarity and complexity of the disease necessitate the description of new cases and a reexamination of our understanding of the condition.Case presentationsWe present three patients with NLRC4-GOF mutations and AIFEC phenotypes. The first patient is an infant girl with periodic fever, seizure, high inflammatory markers, and an episode of macrophage associated syndrome (MAS). History of recurrent fever episodes since childhood was reported in mother and maternal grandmother. A heterozygous mutation was found in CARD domain of NLRC4: c.A91C: p.Asn31His. The second patient is an adolescent boy with periodic fever, diarrhea, aphthous stomatitis, seizure, and central nervous system (CNS) vasculitis. A heterozygous mutation was found in NLRC4 gene: c.1202T > C. p. Val401Ala. The third patient is a child with chronic diarrhea and elevated inflammatory markers. We found a heterozygous mutation in NLRC4 gene: c.390delG: p.S132Afs*21. All mutations have been reported for the first time as NLRC4 mutations associated with autoinflammation. We introduced novel mutations in the CARD domain and between CARD and NBD domain in the first and third cases, respectively. All three children are under remission following treatment.ConclusionsNLRC4-GOF mutations can be associated with autoinflammation with diverse symptoms. Given the rarity of the disease and the possibility of new mutations being identified, the existence of a phenotype/genotype correlation has yet to be thoroughly investigated. The variety in manifestations and severity spectrum mandates a variety of treatments. Adalimumab has shown favorable outcomes in our AIFEC cases.

Comorbidity of inflammatory bowel diseases and periodontal pathology

Inflammatory bowel diseases, which include Crohn’s disease and ulcerative colitis, are a global disease of the 21st century. Periodontitis is the sixth most common disease in the world (second among dental pathologies after caries) and the leading cause of tooth loss in adults. At the beginning of the 21st century, the concept of “periodontal medicine” was formed, within the framework of which the bidirectional connection of periodontal pathology with systemic diseases of the body is considered. Extraintestinal manifestations of inflammatory bowel disease are associated with the generalized nature of the inflammatory response. In clinical guidelines, only aphthous stomatitis is described as a systemic manifestation of Crohn’s disease and ulcerative colitis from the oral cavity. Periodontitis is considered a less representative non-specific oral manifestation of inflammatory bowel disease. We searched the Pubmed and Scopus information databases for articles published before 02/15/2024 that examined the relationship between inflammatory bowel disease and periodontal pathology. The results of clinical studies, their synthesis in systematic reviews and meta-analyses, indicate a bidirectional relationship between Crohn’s disease and ulcerative colitis with periodontal pathology. The most likely mechanism is associated with a change in the microbiocenosis of the oral cavity and a further change in the intestinal microbiome due to oral intake of periodontal organisms, which leads to impaired intestinal permeability and the development of immune reactions that play a key role in the development of periodontal diseases and inflammatory bowel diseases.

Histological assessment of the effect of ginger on the healing of chemically-induced aphthous ulceration in rabbits

Background: An aphthous ulcer is a painful and recurrent oral mucosal inflammation that is retractable to treatments and resistant to healing. Conventional treatments include a variety of antiseptic, anti-inflammatory, and analgesic therapies, yet their efficacy remains inconsistent. Aim: The present study was conducted in order to evaluate the effects of ginger powder on the healing of chemically-induced aphthous ulcers in rabbits. Methodology: Twelve healthy rabbits were divided into control and ginger-treatment groups. Aphthous ulcers were induced in both groups. The treatment group received ginger powder topically in the socket every 24 h, for 7 days. Subsequently, all animals were sacrificed, and specimens were collected for macroscopic and histological examination. Results: Histological analysis of the ulcer sites on days 3 and 7 post-induction revealed that ginger-treated ulcers exhibited enhanced healing, as evidenced by increased collagen deposition, fibroblast proliferation, and re-epithelialization. Macroscopic observations also confirmed a faster regression of necrotic tissue and a reduced ulcer size in the ginger-treated group (as compared to the control group). Histological analysis has indicated significant differences in inflammation and blood vessel congestion between the two groups, particularly on day 7. Conclusion: The findings of this study reveal that locally applied ginger can enhance the healing in chemically-induced aphthous ulcers in rabbits, which may support its use in clinical practice.

Novel Serum Markers that Distinguish Behcet’s Disease from Idiopathic Recurrent Aphthous Stomatitis

ABSTRACT Background Behcet’s disease (BD) is a rare and recurrent autoinflammatory disorder characterized by systemic vasculitis, frequently manifested as recurrent aphthous stomatitis (RAS). We aim to identify specific serum proteins to discriminate between BD and idiopathicRAS. Method Peripheral blood was collected from 12 BD patients, 12 idiopathic RAS patients, and 21 healthy volunteers. The serum samples underwent Tandem Mass Tag-based mass spectrometry analysis. Differentially expressed proteins (DEPs) were identified for KEGG pathway enrichment, Gene Ontology (GO), and protein-protein interaction (PPI) analyses. ELISA was utilized to verify two BD-specific DEPs in another cohort consisting of 18 BD patients, 18 idiopathic RAS patients, and 18 controls. Results Compared with RAS serum, BD serum showed 242 DEPs. 49 proteins were differentially expressed in BD but not RAS serum compared to healthy controls. KEGG pathway and GO analyses revealed that DEPs in BD and RAS have similar biological functions and cellular distributions, featuring a significant association with pathways regulating blood coagulation and immune response. When comparing DEPs between BD and RAS, several keratins emerged as markers that distinguish RAS from BD. We also identified multiple DEPs in BD but not RAS patients. PPI analysis uncovered that lipoprotein metabolism regulators serve as hub proteins, indicating their potentially essential roles in BD pathology. In addition, ELISA results confirmed the elevated LRG1 and SOD3 levels in BD, but not RAS patients, compared to healthy donors. Conclusion Our data uncovered novel serum proteins that distinguish BD from RAS, which may potentially be useful in BD diagnosis and treatment.

Correlation between dental symptoms and functional and clinical manifestations of Crohn's disease and ulcerative colitis

Objective. To analyze the correlation between dental symptoms and clinical and functional manifestations of Crohn's disease (CD) and ulcerative colitis (UC). Materials and methods. A prospective, observational, longitudinal clinical study of 70 patients with verified inflammatory bowel diseases, i.e. Crohn's disease and ulcerative colitis, has been performed. For an in-depth assessment of the oral mucosa (OM) and red lip border (RLB) condition in patients with these systemic diseases, a complete dental examination has been carried out. The validated questionnaire "7´7" was used to objectify the symptoms of functional gastric dyspepsia. Results. In patients with the main clinical manifestations of the gastrointestinal tract impairments in CD and UC, extraintestinal dental manifestations in the form of meteorological cheilitis (16 and 9, respectively; p = 0.081), glossitis (15 and 11, respectively; p = 0.323), onset of recurrent aphthous stomatitis (17 and 11; p = 0.144), chronic mechanical trauma of oral mucosa (14 and 11; p = 0.455), and the presence of scalloped tongue (28 and 21, p = 0.068) were diagnosed. At the same time, the incidence of associated pathologies of OM and RLB was significantly higher in patients with CD (p0.05) than in patients with UC. Clinical examination of patients revealed predominance of flatulence symptoms in patients with CD and UC in 74.3 and 77.1 % of cases, respectively (р = 0.771). Patients with CD prevailed in the number of dyspeptic disorders and their variability but statistically significant differences were determined only for the symptom 'abdominal pain decreasing after bowel emptying'. The correlation between the frequency of dyspeptic disorders in patients and characteristic changes in the clinical state of RLB and OM was revealed. For the CD and UC groups Chuprov conjugacy coefficients were statistically significant (ChC=0.36, ChC=0.28 respectively). In patients with CD clinically apparent changes in the RLB and OM associated with various dyspeptic disorders were manifested more often than in patients with UC. Conclusion. The conducted study has shown that in patients with CD and UC there is a correlation between the frequency and severity of the main functional and clinical symptoms/syndromes (in the form of edema, hyperemia, pitting edema of the ОМ (in fact) and the RLB) and dyspeptic disorders, this correlation being stronger in Crohn's disease (p = 0.031 vs p = 0.046).

The Effect of Honey Supplementation On Aphthous Ulcers In Egyptian Children..

The Effect of Honey Supplementation On Aphthous Ulcers In Egyptian Children..

Comparison of Two Oral Pastes Containing Triamcinolone and Rhus Coriaria L. for Treating Minor Aphthous Lesions

BackgroundRecurrent aphthous stomatitis (RAS) is a common oral mucosal lesion. Herbal medicine has been explored to treat this condition. This study compared the effectiveness of two oral pastes containing Triamcinolone and Sumac, for the healing, size, and symptomatology of RAS. MethodsThis triple-blind randomized clinical trial included 60 patients with minor aphthous ulcers. Participants were informed about the study and provided consent. Exclusion criteria consisted of specific medical conditions and medication use. The patients were divided into three groups and received either Sumac adhesive gel, Triadent oral paste, or a placebo. Ulcer size was measured before and after treatment. The medication was prepared using carboxymethylcellulose-based gel and Sumac powder extract. The study was triple-blinded, and the groups were labelled as A, B, and C. Data analysis was performed using SPSS version 22, employing repeated measurement, student t test, Kolmogorov–Smirnoff, and one-way ANOVA for quantitative data. Statistical significance was set at P ≤ .05. ResultsA clinical trial involving 59 participants compared the Sumac, Triadent, and placebo groups. The Sumac group exhibited the shortest healing time, significantly reduced lesion size, and lower Visual Analog Scale scores. Triadent took the longest time to heal ulcers. ANOVA test indicated no significant difference in age and gender distribution. ConclusionThis clinical trial evaluated two oral pastes for treating aphthous ulcers and found that the Sumac group achieved faster healing and reduced lesion size compared to the Triadent and control groups. Sumac shows promise as a treatment option, but further studies are necessary to confirm its efficacy and safety. These favourable results support the use of herbal treatments and suggest their potential for broader utilization in managing diseases such as RAS.

Diagnosing celiac disease in children using oral manifestations

PurposeCeliac disease (CD) may be frequently undiagnosed due to the absence of characteristic gastroenterologic symptoms in many CD patients. Our objective was to diagnose CD by utilizing documented oral manifestations such as Recurrent Aphthous Stomatitis (RAS) and Molar-Incisor Hypomineralization (MIH).MethodsThe study comprised sixty children who presented with complaints of RAS lesions. The MIH group consisted of 40 children, while the control group comprised 20 children without MIH lesions, ranging in age from 7 to 13 years. After the dental examination, all children were given a questionnaire to assess whether they had any previous history of general symptoms related to CD. Following that, diagnostic testing for celiac disease were conducted, including serological tests such as Tissue transglutaminase IgA (tTG-IgA), Endomysium Antibody (EMA), and Total IgA, as well as genetic tests for HLA-DQ2 and HLA-DQ8.ResultsThe statistical analysis, conducted using Fisher’s Exact, Yates’ Continuity Correction, Fisher Freeman Halton, and Student’s t tests, revealed no significant differences between the groups (p < 0.05). Within the MIH group, 3 children exhibited border tTG-IgA values, while another 3 had positive tTG-IgA results. Two of these 6 children had also positive EMA and HLA results. Following a biopsy procedure, these two children were ultimately diagnosed with celiac disease (CD).ConclusionsIn this study, while children initially presented to the clinic with complaints of recurrent aphthous stomatitis (RAS), 2 children (5% of the MIH group) were diagnosed with CD shortly after the onset of MIH lesions. CD enhanced the likelihood of observing some oral manifestations particularly recurrent aphtous stomatitis and developmental enamel defects. We recommend that dentists be cautious about diagnosing CD when RAS lesions and DEDs and/or MIH lesions are present, whether or not other indications of this systemic disease exist.

Aphthous stomatitis - computational biology suggests external biotic stimulus and immunogenic cell death involved

BackgroundThe exact cause of recurrent aphthous stomatitis is still unknown, making it a challenge to develop effective treatments. This study employs computational biology to investigate the molecular basis of recurrent aphthous stomatitis, aiming to identify the nature of the stimuli triggering these ulcers and the type of cell death involved.MethodsTo understand the molecular underpinnings of recurrent aphthous stomatitis, we used the Génie tool for gene identification, targeting those associated with cell death in recurrent aphthous stomatitis. The ToppGene Suite was employed for functional enrichment analysis. We also used Reactome and InteractiVenn for protein integration and prioritization against a PANoptosis gene list, enabling the construction of a protein-protein interaction network to pinpoint key proteins in recurrent aphthous stomatitis pathogenesis.ResultsThe study’s computational approach identified 1,375 protein-coding genes linked to recurrent aphthous stomatitis. Critical among these were proteins responsive to bacterial stimuli, especially high mobility group protein B1 (HMGB1), toll-like receptor 2 (TLR2), and toll-like receptor 4 (TLR4). The enrichment analysis suggested an external biotic factor, likely bacterial, as a triggering agent in recurrent aphthous stomatitis. The protein interaction network highlighted the roles of tumor necrosis factor (TNF), NF-kappa-B essential modulator (IKBKG), and tumor necrosis factor receptor superfamily member 1A (TNFRSF1A), indicating an immunogenic cell death mechanism, potentially PANoptosis, in recurrent aphthous stomatitis.ConclusionThe findings propose that bacterial stimuli could trigger recurrent aphthous stomatitis through a PANoptosis-related cell death pathway. This new understanding of recurrent aphthous stomatitis pathogenesis underscores the significance of oral microbiota in the condition. Future experimental validation and therapeutic strategy development based on these findings are necessary.

Psychological problems and their impact on oral mucosal disease patients’ quality of life: A cross-sectional study in the Chinese population

ObjectivesWe aimed to investigate the presence of common psychological factors (i.e., stress, depression, anxiety) and their impact on the Oral health-related quality of life (OHRQoL) in patients diagnosed with four oral mucosal diseases (OMDs): recurrent aphthous ulcers (RAU), oral lichen planus (OLP), oral leukoplakia (OLK), and oral submucous fibrosis (OSF). MethodsA total of 229 patients with clinically diagnosed OMDs were enrolled in this study, consisting of 55 RAU, 68 OLK, 50 OLP, and 56 OSF patients. The patients were statistically analyzed for psychological problems and OHRQoL using the Visual Analog Scale (VAS)､ the 5-item Oral Health Impact Profile (OHIP-5) and the Depression Anxiety Stress Scale-21 (DASS-21) scales. ResultsThere were 229 valid questionnaires collected, consisting of 83 females and 146 males with a mean age of 45.24 (SD = 11.88) years. Multiple regressions between DASS-21 scores and OHIP-5 scores revealed generally negative impacts of psychological problems on OHRQoL, with depression on OLP (β = 0.47), OLK (β = 0.65) and OSF (β = 0.38), stress on RAU (β = 0.29), OLP (β = 0.72), OLK (β = 0.38) and OSF (β = 0.60), and anxiety on OLP (β = 0.33), OLK (β = 0.49) and OSF (β = 0.51). ConclusionsPsychological problems like depression, stress, and anxiety were found to be prevalent in OMDs patients and adversely affected their OHRQoL. The results support the biopsychosocial medical model in the treatment of OMDs patients. Clinical significanceThe present study reinforced the crucial roles of psychological factors in impacting OMDs patients' OHRQoL. Therefore, it is necessary to monitor patients’ psychological status and OHRQoL using questionnaires like DASS-21 and OHIP-5. Followed by psychological interventions, the treatment is expected to be enhanced.