Treatment Of Recurrent Aphthous Ulcers Research Articles

New Progress in the Integrated Treatment of Traditional Chinese and Western Medicine for Recurrent Aphthous Ulcer in the Oral Cavity

Recurrent aphthous ulcer in the oral cavity is a common oral mucosal disease with periodic, recurrent, and self-limiting characteristics. This article aims to explore the new progress of integrated traditional Chinese and Western medicine in the treatment of recurrent aphthous ulcers in the oral cavity. Through a comprehensive analysis of relevant research, the advantages and mechanisms of integrated traditional Chinese and Western medicine in improving efficacy, reducing symptoms, and reducing recurrence rates are elaborated, providing reference for clinical treatment.

Efficacy and safety of total glucosides of paeony in the treatment of recurrent aphthous ulcers: a single-center, double-blind, randomized, placebo-controlled clinical trial.

Introduction: There has been a lack of treatments available to lower the frequency of recurrent aphthous ulcers (RAUs) until now. Total glucosides of paeony (TGP) is a botanical drug extracted from the dried roots of Paeonia lactiflora Pall. [Ranunculaceae; Paeoniae Radix Alba]. This study aims to evaluate the efficacy and safety of TGP in the treatment of RAU. Methods: This study was registered with the Chinese Clinical Trial Registry (ChiCTR1900025623). Patients were randomly assigned to the TGP or placebo group and treated with 1.8g/day for 24weeks. Participants were observed for a total of 36weeks and were asked to record ulcer severity, medication, and adverse reactions in the form of diaries or apps every day. The primary outcome was the monthly ulcer-free interval. Results: A total of 79 individuals were enrolled, with 40 assigned to the TGP group and 39 to the placebo group. The dropout rate was 18.18%. In the TGP group, the monthly ulcer-free interval was significantly longer than baseline (median, 9.6days) since weeks 13-24 (median, 18.5days) (p < 0.05), and after discontinuation, it was further prolonged (median, 24.7days) than in weeks 13-24 (p < 0.05). In addition, the monthly ulcer-free interval was longer in the TGP group than in the placebo group (median, 15.9days) at weeks 25-36 (p < 0.001). There were better improvements in the monthly number of ulcers and monthly area of ulcers, and visual analog scoring in the TGP group at weeks 25-36 (p < 0.001). Conclusion: TGP had a good long-term therapeutic effect on RAU with frequent occurrence. Systematic Review Registration: www.chictr.org.cn, identifier ChiCTR1900025623.

Formulation and Evaluation of Prednisolone Sodium Metazoate-Loaded Mucoadhesive Quatsomal Gel for Local Treatment of Recurrent Aphthous Ulcers: Optimization, In Vitro, Ex Vivo, and In Vivo Studies.

This study aims to formulate a buccal mucoadhesive gel containing prednisolone sodium metazoate-loaded quatsomes for efficient localized therapy of recurrent aphthous ulcers. Quatsomes were prepared using a varied concentration of quaternary ammonium surfactants (QAS) and cholesterol (CHO). A 23 factorial design was conducted to address the impact of independent variables QAS type (X1), QAS to CHO molar ratio (X2), and sonication time (X3). The dependent variables were particle size (PS; Y1), polydispersity index (PDI; Y2), zeta potential (ZP; Y3), entrapment efficiency percent (EE%; Y4) and percent of drug released after 6 h (Q6%: Y5). Then, the selected quatsomes formula was incorporated into different gel bases to prepare an optimized mucoadhesive gel to be evaluated via in vivo study. The PS of the developed quatsomes ranged from 69.47 ± 0.41 to 113.28 ± 0.79 nm, the PDI from 0.207 ± 0.004 to 0.328 ± 0.004, ZP from 45.15 ± 0.19 to 68.1 ± 0.54 mV, EE% from 79.62 ± 1.44 to 98.60% ± 1.22 and Q6% from 58.39 ± 1.75 to 94.42% ± 2.15. The quatsomal mucoadhesive gel showed rapid recovery of ulcers, which was confirmed by the histological study and the evaluation of inflammatory biomarkers. These results assured the capability of the developed quatsomal mucoadhesive gel to be a promising formulation for treating buccal diseases.

Assessment of the Effectiveness of Aloe vera Versus Amlexanox in the Treatment of Recurrent Aphthous Ulcers: A Three-Arm Placebo-Controlled Randomized Clinical Trial.

Background Recurrent aphthous ulcers are one of the most common lesions of the oral mucosa. Most currently available treatment methods aim to relieve symptoms, speed up healing and prevent ulcer recurrence. The current study aimed to compare the effectiveness of Aloe vera gel with that of amlexanox 5% oral paste in the treatment of recurrent small-type aphthous ulcers. Materials and Methods The study was conducted on 60 patients (27 males and 33 females) attending the Department of Oral Medicine at the Faculty of Dentistry at Damascus University. The sample age ranged between 15 to 25 years, with an average age of 20.3 ± 2.4 years. Patients were diagnosed with recurrent aphthous ulcers of the small type. The sample was divided into three groups with equal numbers of patients (n=20 for each group) according to the provided drug: Aloe vera, amlexanox, and the placebo groups. Patients' ulcer size was measured on day 0 of treatment, and the ulcer size reduction was assessed on day 3 and day 5. The pain was also recorded at the first visit, and then pain reduction was assessed during follow-up visits. Results The mean ulcer size on the fifth day of treatment was 1.85 mm2, 4.05 mm2, and 6.20 mm2 in the Aloe vera, the amlexanox, and the placebo groups, respectively. The differences between groups were significant (p=0.003). The mean pain on the fifth day was 0.80 cm, 1.60 cm, and 3.20 cm in the Aloe vera, the amlexanox, and the placebo groups, respectively. The differences between groups were significant (p=0.026). Conclusions Within the limits of the current trial, both treatment groups proved effective in accelerating ulcer healing with the superiority of Aloe vera compared to amlexanox, as it achieved a greater reduction in ulcer size and pain when assessed on the fifth day of treatment.

The Effect of Duration of Laser Radiation with the Same Dose in the Treatment of Recurrent Aphthous Stomatitis

Introduction: Recurring aphthous ulcers is a common and painful ulcer in the oral area. The aim of this study was to evaluate the impact of length of radiation in the same dose for the treatment of recurrent aphthous stomatitis. To date no similar study is available.&#x0D; Materials &amp; Methods: In this double-blinded clinical trial, 30 patients with minor aphthous ulcer that were referred to Oral medicine department of Islamic Azad university were selected according to convenience sampling and inclusion exclusion criteria and were randomly divided into two similar groups. Low level laser therapy with diode 660nm was used in group A with 200 mW and 20 seconds setting and in group B with 20 mW and 200 seconds setting in two sessions on the first and third days were used. The time of clinical healing and the pain intensity as VAS were recorded. Data were analyzed by Independent t-test and Mann-Whitney test (p value &lt; 0.05).&#x0D; Results: The pain intensity from first day after the laser until the seventh day in group B was significantly less than group A (p value &lt; 0.001). The mean size of lesion was significantly lower in the third day (p value = 0.03), fifth (p value &lt; 0.001) and seventh (p value = 0.001). The mean clinical healing time in group B was significantly lower than group A (p value &lt; 0.001).&#x0D; Conclusion: According to this study's findings, longer time of irradiation in lower output power of 660 nm diode laser was suggested for treatment of recurrent aphthous ulcer.

Application of soft tissue laser in the management of recurrent apthous stomatitis

Apthous ulcers are relatively common pathology and are very painful, so in order to facilitate the relief in pain and healing of these ulcers application of LLT has been done in the present study. The purpose of this study was to assess the efficacy of Low Level Laser Therapy in the treatment of recurrent aphthous ulcers. 30 patients of both sexes and all age groups with two recurrent aphthous ulcers were included in the study. One ulcer in each subject was subjected to Low Level Laser Therapy as study group and one ulcer in each subject was considered for the Sham Control group. The Student’s t-test was used for statistical evaluation of the data. The study group (LLLT) showed a statistically significant reduction in pain as compared to the sham controlled group. Complete resolution of the ulcers in the study group was observed to be 4.7 ± 1.2 days and control group was 8.4 ± 2.6 days. On comparison with the sham group, the complete healing time for the study group (LLLT) was found to be highly significant, with a p value of &lt;0.001.

Efficacy and Safety of Total Glucosides of Paeony in the Treatment of Recurrent Aphthous Ulcers: A Single-Center, Double-Blind, Randomized, Placebo-Controlled Clinical Trial

Efficacy and Safety of Total Glucosides of Paeony in the Treatment of Recurrent Aphthous Ulcers: A Single-Center, Double-Blind, Randomized, Placebo-Controlled Clinical Trial

Dissolvable and layered microneedles composed of hyaluronate/rbFGF/CPC effectively improve the treatment effect on recurrent aphthous ulcers

The rbFGF/CPC-loaded MN patch was prepared via a two-step casting method and applied for the treatment of recurrent aphthous ulcers.

The Clinical Use of Curcumin for the Treatment of Recurrent Aphthous Stomatitis: A Systematic Review of Clinical Trials.

Recurrent aphthous stomatitis (RAS) lesions are inflammatory painful oral ulcers with uncertain etiology. Curcumin acts as an effective anti-inflammatory and antibacterial agent in the treatment of various oral diseases. This systematic review aimed to assess the effects of curcumin on RAS. A systematic search of the medical databases, PubMed, Scopus, ISI, Science Direct, and Google Scholar was performed up to March 30, 2020, to identify clinical trials assessing the effect of curcumin on aphthous ulcers. Nine studies comprising of 469 participants met all criteria and were analyzed. Treatment with curcumin significantly reduced aphthous ulcer size (seven studies), pain intensity (eight studies), number of aphthous ulcers (three studies), erythematous halo (one study), and erythema and exudate of the aphthous (one study). In four studies, the effect of curcumin on aphthous ulcer was assessed in comparison to the effects of the standard medication, triamcinolone. In all of these studies, curcumin had similar beneficial effects on the aphthous ulcer as measured by ulcer size, number, and pain. Only three studies were categorized as high quality using the Jadad scale. Within the limitations of this review, it can be concluded that curcumin may have a beneficial role in the treatment of recurrent aphthous ulcers. However, more randomized clinical trials are needed to validate these findings.

A comprehensive review of therapeutic agents used in the treatment of recurrent aphthous ulcer and oral ulcers in Bechet’s syndrome

Introduction: Recurrent aphthous ulcer (RAU) is a common oral disease characterized by ulcers with an erythematous halo, affecting 5–25% of the general population. The underlying etiology is not clear, but several factors are believed to be responsible for the pathogenesis of the disease including stress, hormones, genetic factors etc. Behcet'ssyndrome is a multisystem disorder involving vasculitis of small and medium-sized vessels and inflammation of the epithelium, characterized by recurring oral and genital ulcers with eye lesions. Aim:The objectives of this paper were to compare different treatment options available for the patients suffering from RAU and major refractory oral aphthae without any systemic disease or any syndromes except Bechet’s, associated with RAU published in the review of RAU, point out drugs and therapies along with their dosages that may be used in the first line of treatment (topical) and second line of treatment (systemic). Materials and Methods: Pub Med search (full text and abstracts) with drugs belonging to several categories like anesthetics; antibiotics and antiseptics, corticosteroids, anti-inflammatory and antiallergic drugs hemorrheologic agents, zinc substitutes, immunomodulatory agents and chemical cauterizing agents was done. Pub Med search term “Behcet's trial oral” was used and only those publications that described clinical trial with drugs on patients with Behcet’s disease involving oral lesions were selected. Result:Total 62 articles were analyzed to extract the data regarding different therapeutic agents used in the treatment of Recurrent aphthous ulcer and oral ulcers in Bechet’s syndrome. The drugs most commonly used were lidocaine, benzocaine, tetracycline, chlorehexidine amlexenox and dexamethasone topically and prednisolone, levamisole and thalidomide systemically as a single therapy or in combination. The impact of immunomodulators and LASER in comparison with topical drugs also was assessed. C

Comparative study of the antioxidant effects of lavender and flax oils in recurrent aphthous ulceration treatment

Background: Recurrent aphthous ulceration (RAU) is an inflammatory condition of unknown etiology characterized by painful recurrent (single or multiple) ulcerations of the oral mucosa. It is one of the most common and poorly understood mucosal disorders. It occurs more frequently in times of stress. Local and systemic conditions, genetic, immunologic, microbial factors, and oxidative stress may play a role in the pathogenesis of RAU. The objective of this study was to evaluate the free radical metabolism and antioxidant activity of RAU patients treated by lavender or flax oil paint.&#x0D; Materials and Methods: Sixty-six RAU patients were enrolled in this prospective randomized double-blind placebo-controlled study. Analysis of the plasma levels of malondialdehyde (MDA), glutathione (GSH), Nitric oxide (NO), myeloperoxidase (MPO), Vit. E, Vit. C, and Trolox equivalent antioxidant capacity (TEAC) were determined. The ulcer size, healing time, and healing process were correlated to the plasma levels of the studied parameters for the assessment of the antioxidant mechanism of action of lavender and flax oil paint in the treatment of RAU.&#x0D; Results: Statistical analysis showed that lavender antioxidant action was higher than flax oil paint compared to placebo. The decreased oxidative stress and the damage caused by free radicals was significant in the lavender group than both flax group and placebo (P&lt;0.001).&#x0D; Conclusion: This study proves the significant antioxidant mechanism of both lavender and flax in the treatment of RAU patients.&#x0D; Keywords: Recurrent aphthous ulceration (RAU), oxidative stress, antioxidants, lavender, flax

Hyaluronic acid versus dexamethasone for the treatment of recurrent aphthous stomatitis in children: efficacy and safety analysis.

The objective of this study was to compare the safety and efficacy of 0.2% hyaluronic acid (HA) topical gel and dexamethasone topical ointment in the treatment of recurrent aphthous ulcers (RAU) in children. This retrospective observational study included 104 patients who had more than two episodes of oral aphthous ulcers per year and were treated with HA (n=52) or dexamethasone (n=52) from August 15, 2014 to September 3, 2018. Therapy efficacy was evaluated based on the ulcer size and pain score before versus 7 days after either therapy. The paired t-test, chi-squared test, and independent t-test were utilized for statistical analyses. There was no significant difference in ulcer size or pain score between the HA and dexamethasone groups, on day 1 or day 7. Both treatments were tolerated well and no side effects were reported. No significant differences in body temperature, respiration rate, pulse, or systolic/diastolic blood pressure were observed between the start (day 1) and end of treatment (day 7), for either treatment. HA and dexamethasone showed similar efficacy in reducing ulcer size and pain scores, and were tolerated equally well in children with RAU. Future high-quality studies with larger numbers of patients are needed to confirm our findings.

Doxycycline: An option in the treatment of ulcerated oral lesions?

In addition to its antimicrobial effect, doxycycline has potent anti-inflammatory activity. In view of these pharmacological characteristics, its use in the management of inflammatory, autoimmune and granulomatous diseases has been proposed. The objective of this study was to investigate, through a systematic literature review, the effect of doxycycline on pain and healing of ulcerated lesions of the mouth. An electronic search was performed in accordance with PRISMA guidelines in PubMed, Cochrane Central Register, Web of Science, Bireme/LILACS and Scopus databases. Controlled, randomized clinical trials were selected. The concentration of doxycycline, frequency of application, pain relief and clinical remission of the lesions were analysed. According to the inclusion criteria, five articles were selected. In four of these studies, doxycycline was used in the treatment of aphthous stomatitis, and in one study, it was used in the treatment of herpes labialis. In all studies, the drug was used topically, both as a hydrogel and as a crushed tablet (along with a prosthetic adhesive). The groups treated with doxycycline showed faster healing of lesions and lower pain scores compared to placebo. The present study suggests that topical doxycycline has a positive effect on the treatment of recurrent aphthous ulceration and herpes labialis. Experimental animal studies and double-blind randomized clinical trials should be performed on other oral lesions, such as traumatic ulcers and mucositis.

The Efficacy of Essential Oils (Lavender Oil and Flaxseed Oil) in Treatment of Recurrent Aphthous Ulceration

RAS is a common oral disease, with an estimated prevalence of 25%. Topical treatment with corticosteroids, antibiotics, and analgesics are highly recommended for patients with RAS. However, longer treatment may cause fungal infection and drug resistance. Alternative safe treatments are highly favorable.

A pilot study on the use of biolase in the treatment of recurrent aphthous ulcer

Recurrent Aphthous Ulcer (RAU) is a common oral pathology that produces pain which affects the lifestyle of the patient. Its aetiology and pathogenesis still remain unclear. A considerable number of treatments are available with the main goal directed towards pain relief. Previous studies on RAU treatment using low level laser therapy (LLLT) show immediate pain relief after application. Aim: This study aims to evaluate and compare treatment effectiveness in relieving pain provided by Waterlase (BIOLASE) LLLT and conventional topical corticosteroid using Triamcinolone Acetonide 0.1% dental paste. Methods: Thirty (30) volunteered patients of age between 18-27 years old were divided into two groups. Each group consists of 15 patients with 7 males and 8 females. Group 1 patients were treated by using LLLT while group 2 patients were treated by using triamcinolone acetonide 0.1%. The patient’s details, pain intensity and clinical photographs were recorded in a specially prepared case sheet. Mann-Whitney U test was used to compare significance in pain reduction provided by both methods of treatment. Results: Both groups showed significant pain reduction immediately, day 3 and day 7. Higher reduction in pain intensity was observed immediately (p=0.001) and 3 days (p=0.002) after treatment in group 1 patients (LLLT) compared to group 2 patients (triamcinolone acetonide 0.1%). Conclusion: Waterlase (BIOLASE) LLLT is clinically more effective in relieving pain compared to Triamcinolone Acetonide 0.1%.

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

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

Treatment of Recurrent Aphthous Ulceration by Mastic Orabase

Treatment of Recurrent Aphthous Ulceration by Mastic Orabase

The Most Common Herbs to Cure the Most Common Oral Disease: Stomatitis Recurrent Aphthous Ulcer (RAU).

Context:Recurrent aphthous ulcer (RAU) is an oral disease and the most common oral lesion, with 2% to 66% of the world’s population infected annually. Its prevalence is about 25% in Tehran and 27.6% in Mashhad. The etiology of RAU is multifactorial. Aphthous risk factors include: immunological factors, psychological factors, stress, trauma, sensitivity, family history, blood disorders, malnutrition, and use of certain medications, It should be noted that the best treatment for RAU is the topical application of drugs. The use of topical treatments is recommended not only because the drug can directly impact the source of the disease, but also systemic side effects of the drug are reduced. Treatment of RAU has been considered in Iranian traditional medicine (ITM), and is covered in therapeutic books. The use of herbs in RAU has a centuries-old history; accordingly, extensive research should be conducted for this treatment of the disease.Evidence Acquisition:Iranian medical sources were reviewed and effective plants used in the traditional treatment of RAU were found and compared with new findings. Finally, we have created a table listing the plants that are part of the therapeutic protocol for RAU.Results:Based on this article we can explain some of traditional pharmacological effects of plants and how these plants can be a source for a cure.Conclusions:The plants listed can be used as a prediction of RAU management. Of course, there are is no evidence for curing RAU by some of these plants in allopathic medicine, and the further investigations in this area could lead to the discovery of a new drug

Effectiveness of Amlexanox and Adcortyl for the treatment of recurrent aphthous ulcers.

BackgroundRecurrent aphthous stomatitis (RAS) is a common condition that affects approximately 20% of the general population. The ulcers can interfere with speech and eating and cause significant pain and discomfort. This study aimed to evaluate the efficacy of Amlexanox and Adcortyl in the treatment of aphthous ulcers. Material and Methods In this randomized double blind clinical trial with sequential patient entry, a total of 40 patients who presented with aphthous ulcers were included. Patients were received Amlexanox or Adcortyl four times daily for 7 days. Patients were evaluated for pain, lesion size, and tingling at one day, three days, five days and seven days follow-ups. The treatment effects were then evaluated using the Wilcoxon–Mann–Whitney (WMW) test. Values of p<0.05 were considered significant. Results No significant differences in pain score, tingling and lesion size were observed on similar days between Amlexanox and Adcortyl groups. In both groups, reduction in the assessed variables was significant between days 1-3, 3-5, and 5-7 (p < 0.001). Conclusions This study indicated that Amlexanox as well as Adcortyl was effective in relieving pain and reducing the lesion size during the treatment of aphthous ulcers. Key words:Recurrent aphthous stomatitis, Amlexanox, Adcortyl, pain relief.

Low-level laser therapy in the treatment of recurrent aphthous ulcers: a systematic review.

Recurrent aphthous ulcers (RAUs) are the most common lesion found in the oral cavity. There is no definitive cure for RAUs and current treatments are aimed at minimizing symptoms. Since low-level laser therapy (LLLT) modulates inflammatory responses, and promotes pain reduction and cellular biostimulation, LLLT can be suggested as an alternative treatment for RAUs. The literature concerning the potential of LLLT in the treatment of RAUs was evaluated. A systematic literature review identified 22 publications, of which only 2 studies were adopted. The eligibility criteria consisted of randomized controlled trials (RCTs). Both RCTs achieved significant results concerning LLLT and pain-level reductions and reduced healing times. Despite the variance in irradiation conditions applied in both studies, very similar wavelengths were adopted. There is accordingly strong evidence that wavelength plays an important role in RAU treatment. Taking into account the different parameters applied by selected RCTs, it is not possible to suggest that a specific protocol should be used. However, in light of the significant results found in both studies, LLLT can be suggested as an alternative for RAU treatment. Additional RCTs should be performed in order to reach a clinical protocol and better understand the application of LLLT in RAU treatment.