Treatment Of Oral Aphthous Ulcers Research Articles

Antibacterial, anti-inflammatory and wet-adhesive poly(ionic liquid)-based oral patch for the treatment of oral ulcers with bacterial infection.

Oral aphthous ulcers are a common inflammatory efflorescence of oral mucosa, presenting as inflammation and oral mucosal damage and manifesting as pain. The moist and highly dynamic environment of the oral cavity makes the local treatment of oral aphthous ulcers challenging. Herein, a poly(ionic liquid)-based diclofenac sodium (DS)-loaded (PIL-DS) buccal tissue adhesive patch fabricated with intrinsically antimicrobial, highly wet environment adhesive properties and anti-inflammatory activities to treat oral aphthous ulcers was developed. The PIL-DS patch was prepared via polymerization of a catechol-containing ionic liquid, acrylic acid, and butyl acrylate, followed by anion exchange with DS-. The PIL-DS can adhere to wet tissues, including mucosa muscles and organs, and efficiently deliver the carried DS- at wound sites, exerting remarkable synergistic antimicrobial (bacteria and fungi) properties. Accordingly, the PIL-DS elicited dual therapeutic effects on oral aphthous ulcers with Staphylococcus aureus infection through antibacterial and anti-inflammatory activities, significantly accelerating oral aphthous ulcer healing as an oral mucosa patch. The results indicated that the PIL-DS patch, with inherently antimicrobial and wet adhesion properties, is promising for treating oral aphthous ulcers in clinical practice. STATEMENT OF SIGNIFICANCE: Oral aphthous ulcers are a common oral mucosal disease, which could lead to bacterial infection and inflammation in severe cases, especially for people with large ulcers or low immunity. However, moist oral mucosa and highly dynamic oral environment make it challenging to maintain therapeutic agents and physical barriers at the wound surface. Therefore, an innovative drug carrier with wet adhesion is urgently needed. Herein, a poly(ionic liquid)-based diclofenac sodium (DS)-loaded (PIL-DS) buccal tissue adhesive patch was developed to treat oral aphthous ulcers showing intrinsically antimicrobial and highly wet environment adhesive properties due to the presence of catechol-containing ionic liquid monomer. Additionally, the PIL-DS showed significantly therapeutic effects on oral aphthous ulcers with S. aureus infection through antibacterial and anti-inflammatory activities. We expect that our work can provide inspiration for the development of treatment for microbially infected oral ulcers.

The effectiveness of olibanum orally disintegrating tablet in the treatment of oral aphthous ulcers: A randomized, double-blind, placebo-controlled clinical trial.

Background:Boswellia serrata oleo-gum-resin (frankincense; olibanum) has anti-inflammatory, analgesic, and antimicrobial effects. This study aimed to evaluate the clinical effectiveness of frankincense extract in the treatment of oral aphthous ulcers.Materials and Methods:In a randomized, double-blind, placebo-controlled clinical trial, patients with aphthous ulcers were randomly assigned to either experimental (Frankincense extract) or placebo groups to use orally disintegrating tablets (ODT) of frankincense and placebo, respectively, four times a day for 3 days. The size of aphthous ulcers and the pain severity by visual analogue scale were recorded at days 0, 2, and 4 and compared between the groups.Results:Twenty-five patients in each group completed the study. Olibanum extract ODT significantly reduced the ulcer size on the second (P < 0.001) and fourth (P < 0.001) days as well as the pain score on the second (P = 0.002) and fourth (P < 0.001) days of the intervention compared to placebo. Furthermore, at the end of the intervention, the number of patients with complete ulcer healing and pain relief in the experimental group was significantly more than the placebo group (5 vs. 0, P = 0.02; and 11 vs. 0, P < 0.001, respectively).Conclusion:Taking olibanum extract ODTs reduces the ulcer size and pain severity and accelerates the healing process in the oral aphthous lesions.

Novel poly herbal muco-adhesive formulation for treatment of oral aphthous ulcer

Background: Oral ulcers are the most frequent lesions that cause discomfort for which the patients seek treatment for alleviating pain and facilitate early healing. Various treatment modalities from modern medicine and Ayurveda are used in the form of ointments and mouthwashes with varying efficacy. Anti-inflammatory medicines, enzymatic preparations, gamma globulins and immune suppressants have been used.Methods: Extracts of five chosen herbs, Glycyrrhiza glabra, Acacia catechu, Punica Granatum, Curcuma longa and Mentha piperita were used for preparing mucoadhesive gel for the treatment of oral aphthous ulcers of any etiology. Gel was prepared by cold method of Schmolka at M/s Pharmanza Herbals Pvt. Ltd., India. Five formulations were prepared with using different concentration of active pharmaceutical ingredient (API) extracts.Results: Formulations were analyzed for different physical and chemical properties. Preliminary trial was done with five formulations. The F5 formulation has the premier viscosity because of its higher polymer content; it is able to remain on mucous surface long enough to release its API effect. Since the uniformity, proper appearance, stability and acceptable viscosity and gel strength the F1 formulation was selected as the superior formulation which could prove ideal for treatment of oral aphthous ulcers.Conclusions: The results provide strong evidence that polyherbal gel containing extracts of Glycyrrhiza glabra, Acacia catechu, Punica granatum, Curcuma longa and Mentha piperita on the basis of their analgesic, anti-inflammatory, antioxidant, wound healing, antimicrobial and local anesthetic properties can be used as an effective and safe alternative for the management of aphthous ulcers.

Local Formula with Mucoadhesive Property: A Randomized Clinical Trial of a Therapeutic Agent for the Treatment of Oral Aphthous Ulcers

Recurrent or occasional aphthous lesions represent a painful oral condition with high prevalence. Since the etiology is still unclear and most likely related to a dysfunction in the local immune system, several treatment strategies have been proposed, including systemic agents, local agents, and laser therapy, to reduce the pain and discomfort for the patient without acting on the causes. The purpose of the present randomized study was to assess the clinical efficacy of a new topical gel with mucoadhesive property to reduce the pain and the dimension of the aphthosis lesions. Fifty patients presenting at least one minor ulcer were randomized to a control group (placebo prescription), a first test group (topical agent with laser), and a second test group (topical agent only). The healing rate, the visual analog scale (VAS) score for pain, and the diameter reduction were monitored for 10 days. Both test groups showed better results than control group, significant clinical efficacy, and a median total reduction time of 4 days with no significant adjunctive benefit from the use of laser. The clinical results are encouraging; nevertheless other studies are needed to valid this kind of treatment. The present randomized clinical study suggested that the use of topical mucoadhesive agents could represent a valid therapy for minor aphthous lesions. How to cite this article: Giammarinaro E, Cosola S, Oldoini G, et al. Local Formula with Mucoadhesive Property: A Randomized Clinical Trial of a Therapeutic Agent for the Treatment of Oral Aphthous Ulcers. J Contemp Dent Pract 2019;20(11):1249-1253.

Natural Treatment of Oral Aphthous Ulcers: A Systematic Review

Background and purpose: Due to the large number of studies on traditional and herbal treatments for oral aphthous and lack of comprehensive studies on these cases, the purpose of this research was to study and careful analysis of the effectiveness of herbal medicines used in the treatment of these lesions and reported the final outcome that one of the best study methods in these cases is a systematic review. Methods: Five electronic databases (PubMed, ISI web of science, Scopus, Cochrane and OVID) by keywords based on the PICO were searched to identify all the clinical trials with topical and systemic therapeutic interventions aimed at treating or preventing recurrence published in Persian or English that related to the effects of drugs of natural herbal origin for the treatment of recurrent aphthous stomatitis from 2010 to 2015. A structured and standardized form has been used to extract data. Title, journal, year of publication and the field of the first author and corresponding author were recorded. Standard tools of risk of bias used in the systematic review studies that has been developed by the Cochrane (Last update 2011) was applied to investigate bias in the studies. Results: In the current study a total of 33 trials were analyzed. These studies were assessed the effectiveness of 29 different herbal drugs for RAS treatment. Only five studies were assessed as being at medium risk of bias. No study had a low risk of bias. There were insufficient evidences to support or refute the use of these interventions. Conclusion: In summary, current data suggested that there was a beneficial effect in using topical treatments with plant origin for RAS and no study did not report any side effects. Though due to very weak report and disparate studies, acknowledging the fact that which herbal treatment was the best and most effective treatment was not possible.

Laser for treatment of aphthous ulcers on bacteria cultures and DNA

Low-intensity red lasers are proposed for treatment of oral aphthous ulcers based on biostimulative effects. However, effects of low-intensity lasers at fluences used in clinical protocols on DNA are controversial. The aim of this work was to evaluate the effects of low-intensity red laser on survival and induction of filamentation of Escherichia coli cells, and induction of DNA lesions in bacterial plasmids. Escherichia coli cultures were exposed to laser (660 nm, 100 mW, 25 and 45 J cm(-2)) to study bacterial survival and filamentation. Also, bacterial plasmids were exposed to laser to study DNA lesions by electrophoretic profile and action of DNA repair enzymes. Data indicate that low-intensity red laser: (i) had no effect on survival of E. coli wild type, exonuclease III and formamidopyrimidine DNA glycosylase/MutM protein but decreased the survival of endonuclease III deficient cultures; (ii) induced bacterial filamentation, (iii) there was no alteration in the electrophoretic profile of plasmids in agarose gels, (iv) there was no alteration in the electrophoretic profile of plasmids incubated with formamidopyrimidine DNA glycosylase/MutM protein and endonuclease III enzymes, but it altered the electrophoretic profile of plasmids incubated with exonuclease III. Low-intensity red laser at therapeutic fluences has an effect on the survival of E. coli endonuclease III deficient cells, induces bacterial filamentation in E. coli cultures and DNA lesions targeted by exonuclease III.

Thalidomide for the treatment of oral aphthous ulcers in patients with human immunodeficiency virus infection

Thalidomide for the treatment of oral aphthous ulcers in patients with human immunodeficiency virus infection