Treatment Of Recurrent Aphthous Ulcers Research Articles

“Ozone” – The New Nemesis of Canker Sore

Recurrent aphthous ulceration or recurrent aphthous stomatitis is one of the most debilitating and painful oral mucosal disease. This disease entity has no specific cause to occur and no proper laboratory procedures are present to elicit the diagnosis. The treatment options are largely palliative and aimed at reducing symptoms thereby improving patient's oral condition. In the present study the subjects witnessed alleviation of clinical symptoms related to the aphthous ulceration. The aim of the study was to explore the effectiveness of ozonated oil in the treatment of recurrent aphthous ulcer and to compare with sessame oil in order to analyse the effectiveness between the two topical oil medications. A single-blinded placebo-controlled trial comprising of 30 subjects with recurrent aphthous ulcers were divided into Group 1, Group 2 and Group 3 with 10 subjects in each group was performed. Patients in Group 1 received ozonated oil, Group 2 received sesame oil and Group 3 received placebo. Treatment response was assessed by measures of pain reduction, ulcer duration on 2(nd), 4(th) and 6(th) day. Data were analyzed using Wilcokson signed rank test and Friedman test. Participants treated with ozonated oil showed significant reduction in ulcer size, erythema and also alleviated the ulcer pain on 4(th) day of evaluation when compared to sesame oil and placebo group. On 6(th) day subjects treated with ozonated oil and sesame oil showed significant reduction in ulcer size and erythema. No significant difference was observed in placebo group when compared with other two groups on subsequent 2(nd), 4(th) and 6(th) day of evaluation. Ozonated oil and sessame oil, both showed similar effectiveness in relieving the ulcer pain. Ozone with its wide variety of inherent properties has proven to be choice of treatment in completely relieving the ulcer pain and ulcer size when compared with that of its counter medication (i.e. sesame oil).Therefore the results obtained in the present study forecast ozone to be used as a novel treatment approach in recurrent aphthous ulcers.

Efficacy of low-level laser therapy in treatment of recurrent aphthous ulcers - a sham controlled, split mouth follow up study.

Apthous ulcers, commonly referred to as canker sores, are the most common ulcerative lesions of the oral mucosa. These are usually painful and are associated with redness, and occasional bleeding from the affected area(s). The aims of treatment are to reduce pain and healing time. To assess clinically the efficacy of Low-level laser therapy (LLLT) on recurrent aphthous ulcers for reduction of pain, lesion size, and healing time and to compare the results with those of a sham control group. A total of 30 patients who presented with two separate aphthous ulcers were included in the study. Each lesion was randomly allotted to either the active treatment group or the sham control group. Lesions which were included in the active group were treated with LLLT in a single sitting, which was divided into four sessions. Lesions in the sham control group were subjected to similar treatment without activating the LASER unit. Each patient was evaluated for pain, lesion size, and complete healing at the following intervals; immediately post LLLT and one day, two days, and three days follow up. Statistical Analysis : The Student's t-test was used for statistical evaluation of the data. Complete resolution of the ulcers in the active group was 3.05 ± 1.10 days as compared to 8.90 ± 2.45 days in the sham control group. Immediately, post the LLLT application, complete pain relief was observed in 28 of the 30 patients of the active group. LLLT was effective in relieving pain and reducing the healing time during the treatment of aphthous ulcers.

There Is Limited Evidence That Topical Lavender Oil Is Effective for Palliative Treatment of Recurrent Aphthous Stomatitis

Topical lavender oil for the treatment of recurrent aphthous ulceration. Altaei DT. Am J Dent 2012;25(1):39-43. Lorena Baccaglini, DDS, MS, PhD In patients with recurrent aphthous stomatitis, is there a difference in efficacy and safety between treatment with topical lavender oil and placebo? None stated Randomized controlled trial and animal studies Level 2: Limited-quality patient-oriented evidence Not applicable

Rebamipide: A novel agent in the treatment of recurrent aphthous ulcer and Behcet′s syndrome

Rebamipide is an amino acid analog of 2 (1H)-quinolinone. It is being introduced and used since 1980 for the treatment of peptic ulcer. Its therapeutic use in recurrent aphthous ulcer was not known. It acts by the decrease in oxygen radicals, increase in blood flow and production of protective prostaglandins in ulcer mucosa, which accelerates the process of healing. In this article, we focus on the pharmacodynamics, pharmacokinetics, side-effects and other therapeutic uses of Rebamipide. It will be a new and effective drug in the dermatologists’ drug armamentarium for the treatment of aphthous ulcers and related diseases.

Evaluation of efficacy between Amlexanox 5% oral paste & Triamcinolone Acetonide 3 oral paste in the treatment of recurrent aphthous ulcers: A Comparative Study

J Shaheed Suhrawardy Med Coll, 2011; 3 (1): 3-7 DOI: http://dx.doi.org/10.3329/jssmc.v3i1.12052

Clinical evaluation of allicin oral adhesive tablets in the treatment of recurrent aphthous ulceration

We investigated the effectiveness and safety of topical application of 5 mg allicin adhesive tablets in the treatment of minor recurrent aphthous ulcerations (MiRAU). A randomized, double-blinded, placebo-controlled, clinical trial was performed. Tablets containing 5 mg allicin or vehicle only were consecutively applied 4 times per day for 5 days. The size and pain level of ulcers were measured and recorded on days 1, 2, 4, and 6. A total of 96 subjects with MiRAU fulfilled the study. Allicin adhesive tablets significantly reduced ulcer size (P < .005, P < .003, P < .001 for days 2, 4, and 6, respectively) and alleviated ulcer pain score (P < .03, P < .001, P < .05 for days 2, 4, and 6, respectively) compared with vehicle tablets. Minor and major adverse reactions were not observed. Allicin adhesive tablets were effective in reducing ulcer size and alleviating ulcer pain of the patients in the treatment of MiRAU without significant side effects.

Efficacy and Safety of Dexamethasone Ointment on Recurrent Aphthous Ulceration

ObjectiveRecurrent aphthous ulceration is the most common oral mucosal lesion and may be associated with many systemic diseases. Topical corticosteroids are used frequently for recurrent aphthous ulceration; however, the number of high-quality clinical experiments available is insufficient, and no reports exist on the blood level of corticosteroids after topical usage in the oral mucosa. The objective was to determine the efficacy and safety of dexamethasone ointment in the treatment of recurrent aphthous ulceration and detect serum dexamethasone concentrations in the patients. MethodsA randomized, double-blinded, placebo-controlled, parallel, multicenter clinical trial was conducted in 5 centers to compare the efficacy and safety of dexamethasone ointment with placebo. There were 810 patients with minor recurrent aphthous ulcerations screened for study eligibility, and 240 patients were enrolled at 5 centers from March 1, 2009 to April 30, 2010; 120 were assigned randomly to the treatment group and 120 to a control group. Patients were instructed to apply the given agent to the identified ulcer 3 times a day (after meals) for 5 days. The size, pain level, healing ratio, and average duration of ulcers and the safety of the agents were evaluated. The serum concentration of dexamethasone was detected using a high-performance liquid chromatography/mass spectrometry assay. ResultsThe results showed that baseline characteristics were similar (P>.5). At day 6±2 after treatment, there was significant difference in the variation of ulcer size between the treatment group (7.167±6.3415 mm2) and the control group (4.346±7.0666 mm2; P=.000); and in the variation of pain level between the treatment group (5.623±1.9570) and the control group (4.940±2.2449; P=.001). The healing ratio was 83.33% in the treatment group and 54.70% in the control group (P=.000). No severe adverse reactions were observed. No serum dexamethasone was detected before or after the use of the agents (<0.502 ng/mL). ConclusionDexamethasone ointment was efficient in the treatment of recurrent aphthous ulceration and was safe as evaluated using clinical assessment and serum level detection.

Cyanocobalamin May be Beneficial in the Treatment of Recurrent Aphthous Ulcers Even When Vitamin B12 Levels Are Normal

To evaluate the efficacy of cyanocobalamin treatment in patients having recurrent aphthous ulcers (RAUs) with normal or decreased serum vitamin B12 (cobalamin) levels. Seventy-two patients with RAU were included in the study. In addition to serum cobalamin levels, hemanitic and biochemistrical parameters were measured. Patients with serum cobalamin levels < 140 pg/mL were defined as the cobalamin deficient group (CDG) whereas patients with cobalamin levels > or = 140 pg/mL were defined as the cobalamin normal group (CNG). The degree of aphthous ulcer healing was determined according to serum cobalamin levels at the first and sixth month after cyanocobalamin treatment protocol. Of the 72 participants, 37 were in the CDG whereas 35 were considered to have normal cobalamin levels. In the first admission the cobalamin levels were 215.8 +/- 116.90 pg/mL in CNG and 107.43 +/- 29.35 pg/mL in the CDG. The frequency of aphthous ulcers was defined numerically according to monthly occurrence of the lesions. The mean aphthous ulcer frequency in CNG group was 1.9 +/- 0.7, whereas it was 2.4 +/- 0.9 in the CDG. A significant increase in cobalamin levels was observed after cyanocobalamin treatment in both groups. A significant decrease in aphthous ulcer frequency was also concurrently observed. 96% of the patients showed good response to replacement treatment, 4% of the study population did not respond to the treatment. Cyanocobalamin treatment maybe beneficial for patients with RAU even when serum cobalamin levels are normal. We suggest that higher serum cobalamin levels should be attained in patients with RAU for mucosal protection.

Purine catabolic enzymes and nitric oxide in patients with recurrent aphthous ulceration

Recurrent aphthous ulceration (RAU) is one of the most common oral mucosal disorders found in humans. Although the exact etiology of RAU is unkown, local and systemic conditions, and genetic, immunologic, and infectious factors all have been identified as potential etiopathogenic agents. The aim of our study was to compare serum xanthine oxidase (XO) and adenosine deaminase (AD) activities, and malondialdehyde (MDA), nitric oxide (NO) and uric acid (UA) levels in a group of patients affected by RAU and in a group of healthy controls. A total of 26 patients with minor RAU were included in the study. Twenty-six healthy volunteers were selected to form the control group. AD and XO activities, and UA, NO, and MDA levels were studied in the serum samples of all patients and controls. Serum XO and AD activities, and MDA, NO, and UA levels were significantly higher in RAU patients than in controls. Increased XO and AD activities, NO and UA levels and lipid peroxidation were thought to take part in the pathogenesis of RAU. Hence the effects of XO inhibitors in the treatment of RAU should be evaluated in future studies.

Treatment of oral mucosal diseases: part VI. Diagnosis and treatment of recurrent aphthous ulcer

复发性阿弗他溃疡(recurrent aphthous ulcer,RAU)是最常见的口腔黏膜病.流行病学调查显示,每5个人中即有1人至少发生过1次溃疡,且不论男女、年龄、人种均可发生.目前,RAU的病因及致病机制仍不明确.RAU的诱因可能是局部创伤、精神紧张、食物、药物、激素水平改变及维生素或微量元素缺乏.系统性疾病、遗传、免疫及微生物在RAU的发生、发展中可能起重要作用.由于病因不明,RAU的诊断完全是基于病史及临床表现,缺少可作为确诊依据的实验室指标.RAU预示着机体可能有潜在系统性疾病,如胃肠、血液和内分泌系统的疾病,但临床上大部分患者身体健康,无系统性疾病.溃疡灼痛明显,呈圆形或椭圆形,具有周期性、复发性、自限性的特征.RAU又称为复发性阿弗他性口炎(recurrent aphthous stomatitis,RAS)、复发性口腔溃疡(recurrent oral ulcer,ROU)、复发性口疮(recurrent aphthae)或canker sores 。

Leukoencephalopathy induced by levamisole alone for the treatment of recurrent aphthous ulcers

We report imaging and clinical findings of leukoencephalopathy occurring after levamisole. The lesions were hypoattenuating on CT and appeared as multifocal oval or elliptical foci in the white matter or along the subependymal veins on MRI. Most lesions resolve after prompt withdrawal of levamisole. Detailed history taking is important for diagnosing levamisole-induced leukoencephalopathy because multiple sclerosis and acute disseminated encephalomyelitis cannot be differentiated by neuroimaging findings alone.

Lactic acid 5 percent mouthwash is an effective mode of therapy in treatment of recurrent aphthous ulcerations

Recurrent aphthous ulcerations (RAU) are the most common oral mucosal disease among the general population including in Iraq. There is no uniformly effective therapy for this disease. To evaluate the therapeutic efficacy and safety of 5-percent lactic acid mouthwash in the treatment of patients with recurrent aphthous ulcerations. This is a single-blind controlled therapeutic study. We recruited 80 subjects with early-onset oral aphthosis from patients who attended Baghdad Teaching Hospital Department of Dermatology and Venereology in the period between April 2004 and April 2005. Of those subjects, 10 defaulted; the remaining 70 patients were divided into two groups, A and B. Subjects in group A (36 patients) were instructed to use 5-percent lactic acid mouthwash, one teaspoonful three times daily before meals. Subjects in group B (34 patients) were instructed to use placebo (distilled water mouthwash) in a similar way. Assessment of each patient of both groups was done by using oral clinical manifestation index (OCMI) before, after 3 days and after 7 days of therapy. The mean of OCMI in group A started to decline after 3 days of therapy and attained statistically significant lower level after 7 days of therapy (p <0.05). The change in the mean OCMI of group B after 3 and 7 days of therapy was also statistically significant (p <0.05). However, the response rate (percentage of change in the mean) after 3 days of therapy in group A was 63.6 percent and in group B was 8.8 percent, and the response rate after 7 days of therapy in group A was 90.8 percent and in group B was 35.7 percent. The difference in the response rates after 3 and 7 days between groups A and B was statistically significant (p <0.05). No significant side effects were noticed apart from mild irritation in two patients using lactic acid. Lactic acid 5 percent mouthwash is a new effective mode of therapy for patients with RAU and had significantly reduced the signs and symptoms of the disease, especially when compared with placebo. The mechanism of action may be related to increasing spontaneous secretion of endothelial growth factor from keratinocytes.

Laser (and LED) Therapy Is Phototherapy

Laser (and LED) Therapy Is Phototherapy

Amlexanox for the Treatment of Recurrent Aphthous Ulcers

Recurrent aphthous ulcer (RAU) is the most prevalent oral mucosal disease in humans, estimated to affect between 5% and 50% of the general population. The minor manifestation of the condition is the most common and is characterised by small, shallow, round or oval lesions that are surrounded by a raised erythematous halo and are covered by a grey-white pseudomembrane. Appropriate management of patients with this condition is largely symptomatic and should focus on reducing ulcer duration, relieving pain and reducing or preventing ulcer recurrence. Amlexanox is a novel anti-inflammatory and anti-allergic agent that has been evaluated for the treatment of RAU in a series of robust clinical trials. After a 100mg dose of 5% amlexanox topical paste, applied directly to the lesion, the maximum serum concentration of the drug was 120 ng/mL, which was achieved 2.4 hours after application. Steady-state concentrations were achieved within 1 week of starting four times daily dosing and there was no evidence of accumulation. In terms of efficacy, application of 5% amlexanox topical paste was shown to consistently and significantly accelerate complete ulcer healing and the time to resolution of pain across four large efficacy studies. Significantly more patients had completely healed ulcers from day 3 (compared with no treatment) and day 4 (compared with vehicle). Healing was mirrored by an improvement in pain: significantly more patients had complete resolution of pain from day 2 (compared with no treatment) and day 3 (compared with vehicle). Overall, amlexanox was well tolerated, with a low frequency of adverse effects. In the oral application studies, adverse effects that were considered by investigators to be potentially related to the study treatment occurred in 2.4% and 2.1% of 5% amlexanox and vehicle recipients, respectively. These effects were mainly local and were all classed as mild to moderate in severity, with the exception of one case of severe stinging in the vehicle treatment group. Furthermore, the incidence of dermal irritation and sensitisation was very low with amlexanox. These findings suggest that 5% amlexanox topical paste is a useful and well tolerated therapeutic option for the treatment of RAU.

"Tien-Hsien Liquid" Can Modulate Antigen-Stimulated Cytokine Production by T-Cells Isolated from Patients with Recurrent Aphthous Ulcerations

Recurrent aphthous ulcerations (RAU) represent a common oral mucosal disease with altered humoral and cellular immunities. Tien-Hsien liquid (THL) is an extract of Chinese medicinal herbs with immunomodulating effects. Our previous study found that THL can modulate the antigen-stimulated proliferative response of peripheral blood mononuclear cells and T-cells isolated from RAU patients. In this study, we further tested whether THL can modulate the antigen-stimulated cytokine production by T-cells isolated from RAU patients. To achieve this goal, T-cells isolated from 19 RAU patients were incubated with phytohemagglutinin (PHA), glutaraldehyde-inactivated tetanus toxoid (TT), glucosyltransferase D (GtfD), or antigens of Streptococcus mutans in the presence or absence of THL. The levels of interleukin (IL)-2, interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), IL-6, or IL-10 in the supernatants of T-cell cultures were measured by cytokine enzyme-linked immunosorbent assay (ELISA) kits. We found that THL significantly increased the PHA- or TT-stimulated TNF-alpha, IL-6, and IL-10 production by T-cells isolated from RAU patients. However, THL could also significantly decrease the TT-stimulated IL-2 production, the GtfD-stimulated IL-2, TNF-alpha, IL-6 and IL-10 production, and the S. mutans-stimulated IFN-gamma, TNF-alpha, and IL-10 production by T-cells isolated from RAU patients. These results indicate that THL can modulate the antigen-stimulated cytokine production by T-cells isolated from RAU patients. Because RAU is probably a Thl-mediated disease with elevated levels of IL-2, IFN-gamma, TNF-alpha and IL-6 in either the patient's sera or oral lesions and these increased levels of cytokines can be reduced by THL, we suggest that THL may be a potential immunoceutical agent for treatment of RAU.

Immunomodulating effects of "tien-hsien liquid" on peripheral blood mononuclear cells and T-lymphocytes from patients with recurrent aphthous ulcerations.

Recurrent aphthous ulcerations (RAU) represent a common oral mucosal disease with altered humoral and cellular immunities. In our institution, an immunomodulating agent, levamisole, is used to treat RAU with satisfactory therapeutic effect. Tien-Hsien liquid (THL) is an extract of Chinese medicinal herbs with immunomodulating effects. To test whether THL has immunomodulating effects on antigen-stimulated proliferation response (PR) of peripheral blood mononuclear cells (PBMC) and T-cells isolated from RAU patients and to test whether THL is a potential drug for treating RAU, PBMC or T-cells isolated from RAU patients were incubated with lipopolysaccharides (LPS) from Escherica coli, phytohemagglutinin (PHA), staphylococcal enterotoxin B (SEB), glutaraldehyde-inactivated tetanus toxoid (TT), glucosyltransferase D (GtfD), or antigens of Streptococcus mutans in the presence or absence of THL. We found that THL significantly increased the LPS-stimulated PR of PBMC from active RAU patients, the GtfD-stimulated PR of PBMC and of T-cells from inactive RAU patients, and the S. mutans-stimulated PR of PBMC from inactive RAU patients. However, THL could also significantly reduce the SEB-stimulated PR of PBMC and of T-cells from active RAU patients and S. mutans-stimulated PR of T-cells from active RAU patients. These results suggest that THL can modulate the antigen-stimulated PR of PBMC and T-cells from RAU patients. Therefore, it may be a potential immunoceutical agent for treatment of RAU.

Treatment strategies for recurrent oral aphthous ulcers

The clinical features, etiology, and treatment of recurrent aphthous ulcers (RAU) are discussed. Aphthous ulcers are among the most common oral lesions in the general population, with a frequency of up to 25% and three-month recurrence rates as high as 50%. The ulcers, which usually occur on the nonkeratinized oral mucosa, can cause considerable pain and may interfere with eating, speaking, and swallowing. RAU is classified as minor, major, and herpetiform on the basis of ulcer size and number. The cause of RAU is idiopathic in most patients. The most likely precipitating factors are local trauma and stress. Other associated factors include systemic diseases and nutritional deficiencies, food allergies, genetic predisposition, immune disorders, the use of certain medications, and HIV infection. The primary goals of therapy for RAU are relief of pain, reduction of ulcer duration, and restoration of normal oral function. Secondary goals include reduction in the frequency and severity of recurrences and maintenance of remission. Topical medications, such as antimicrobial mouthwashes and topical corticosteroids, can achieve the primary goals but have not been shown to alter recurrence or remission rates. Systemic medications can be tried if topical therapy is ineffective. Levamisole has shown variable efficacy in reducing ulcer frequency and duration in patients with minor RAU. Oral corticosteroids should be reserved for severe cases of major RAU that do not respond to topical agents. Thalidomide is effective but, because of its toxicity and cost, should be used only as an alternative to oral corticosteroids. RAU can be effectively managed with a variety of topical and systemic medications.

Lactic Acid Bacteria Is Beneficial For Oral Aphtous Ulcerations - A Preliminary Report

Recurrent aphthous ulcers of the mouth are difficult to treat because of no known definite aetiology. This paper presents the use of lactic acid bacteria thought to modulate the host immune response to affect improvements in the disease. Twenty-five patients with the disease were treated with 6 lactic bacteria capsules (in the form of OMX capsules) daily for a period of six months, and their responses were evaluated. Seventeen patients (73.9%) became free of the disease six months later, while 6 (26.1 %) experienced very dramatic improvements. Two patients were lost to follow-up. It is concluded that lactic acid bacteria is beneficial in the treatment of recurrent aphthous ulcers of the mouth.

Treatment of Recurrent Aphthous Ulcers in an HIV Patient – An Emerging Use for Pentoxifylline

Patients with human immunodeficiency virus (HIV) infection often suffer from persistent, painful ulcers that commonly occur on the soft palate, buccal mucosa, tonsillar area or tongue, which are referred to as aphthous ulcers. This paper reports the case in which pentoxifylline was successfully used to treat recurrent aphthous ulcers in an HIV patient.

Doxymycine-cyanoacrylate treatment of recurrent aphthous ulcers

Objective. This study addressed the efficacy of singularly applied topical doxymycine in the pain relief treatment of recurrent aphthous stomatitis.Study design. Thirty-one patients with recurrent aphthous lesions were examined and divided randomly in two groups. Experimental group (n = 15) received a topical application of doxymycine and controls (n = 16) received calcii gluconase in the same manner. Medications were covered by isobutyl cyanoacrylate (Iso-Dent). Application was made only once during the recurrent aphthous ulcer episode.Results. Patients recorded their pain level on a visual analog scale for 10 days during healing. Pain decreased more rapidly in the experimental group, and a statistically significant difference (p < 0.05) in the pain intensity was found from the second to the seventh day after application of doxymycine.Conclusions. In recurrent aphthous ulcers, singular treatment of topical doxymycine-cyanoacrylate relieves the pain intensity remarkably for 6 days after a 1 day latency period. Topical doxymycine treatment further exerts potential to directly prevent tissue destruction and to indirectly suppress host inflammatory reaction.