Efficacy of purslane in the treatment of oral lichen planus

A review on ethnopharmacology, phytochemistry, pharmacology and potential uses of Portulaca oleracea L

ETHNOPHARMACOLOGICAL RELEVANCE

Portulaca oleracea L. (PO), popularly known as purslane, has been documented in ethnopharmacology in various countries and regions. Traditional application records indicated that PO might be used extensively to treat the common cold, dysentery, urinary tract infections, coughing, eye infections, skin problems, gynecological diseases, and pediatric illnesses.

AIM OF THE REVIEW

This paper includes a systematic review of the traditional usage, phytochemicals, pharmacological activity, and potential uses of PO to provide an overview of the research for further exploitation of PO resources.

MATERIALS AND METHODS

This article uses "Portulaca oleracea L." and "purslane" as the keywords and collects relevant information on PO from different databases, including PubMed, Web of Science, Springer, Science Direct, ACS, Wiley, CNKI, Baidu Scholar, Google Scholar, and ancient meteria medica.

RESULTS

PO is a member of the Portulacaceae family and is grown worldwide. Traditional Chinese medicine believes that purslane has the effect of improving eyesight, eliminating evil qi, quenching thirst, purgation, diuresis, hemostasis, regulating qi, promoting hair growth, detoxifying, and avoiding epidemic qi. Recent phytochemical investigations have shown that PO is a rich source of flavonoids, homoisoflavonoids, alkaloids, organic acids, esters, lignans, terpenoids, catecholamines, sterols, and cerebrosides. The purslane extracts or compounds have exhibited numerous biological activities such as anti-inflammatory, immunomodulatory, antimicrobial, antiviral, antioxidant, anticancer, renoprotective, hepatoprotective, gastroprotective, metabolic, muscle relaxant, anti-asthmatic and anti-osteoporosis properties. The significant omega-3 fatty acids, vital amino acids, minerals, and vitamins found in purslane also provide nutritional benefits. Purslane as a food/feed additive in the food industry and animal husbandry has caused concern. Its global wide distribution and tolerance to abiotic stress characteristics make it in the future sustainable development of agriculture a certain position.

CONCLUSIONS

Based on traditional usage, phytochemicals, and pharmacological activity, PO is a potential medicinal and edible plant with diverse pharmacological effects. Due to purslane's various advantages, it may have vast application potential in the food and pharmaceutical industries and animal husbandry.

Disease severity scoring systems in mucosal lichen planus: A systematic review

Several scoring systems have been developed to evaluate disease severity in mucosal lichen planus, but only a few have been validated to ensure reproducible and accurate assessment of disease severity. The current systematic review was undertaken to identify clinical severity scoring systems in mucosal lichen planus that have undergone validity or reliability testing and to describe their operating characteristics. We performed a bibliographic search in five databases from their inception to October 2022 for severity scoring systems in mucosal lichen planus that have undergone validity or reliability tests. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal tools. We have included 118 studies and identified 11 clinical severity scoring systems for oral lichen planus that have undergone validity or reliability testing. Of these, the most reported were the Thongprasom score, the Oral Disease Severity Score (ODSS) and the REU (Reticular/hyperkeratotic, Erosive/erythematous, Ulcerative) scoring systems. We did not identify clinical scoring systems for extraoral mucosal lichen planus that have undergone validity or reliability testing. The ODSS and REU scoring systems have undergone the highest number of validation attempts and reliability assessments for oral lichen planus respectively. However, we have identified numerous factors that have hampered the universal adoption of a standardised scoring system. There is a need for the development and validation of scoring systems for extraoral mucosal lichen planus.

A systematic review of medicinal plants and herbal products' effectiveness in oral health and dental cure with health promotion approach

Medicinal plants and herbal drugs are being used increasingly as part of primary health care in most parts of the world. As important adjunctive and alternative treatments for oral health care, herbal products' use may continue to increase and become more widespread. The objective of this study is to present a comprehensive systematic review of the current published literature on the effectiveness of medicinal plants and herbal products employed to improve oral health in adolescents with a health promotion approach. The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The keywords "herbal medicine," "herbal extract," "herbal supplements," "plant extract," "natural drug," "pulpitis," "dental caries," "oral viral diseases," and "abscess" were used in combination with the Boolean operators OR and AND. PubMed, Embase, Scopus, and Web of Science were searched. Quality assessment of the included studies was performed using the Cochrane Handbook for Systematic Reviews of Interventions. The search yielded 49 original research studies. A total of 22 studies had low or unclear risk bias. The geographical distribution of included studies was primarily concentrated on western countries. Overall, studies reported herbal product users' age, ranging from young adults aged 18 years to elderly people aged 75 years or older. Most studies reported multiple compounds, including herbal drugs and herbal extracts. Chamomile and Aloe vera were the most frequently reported herbal compounds. The most commonly described herbal products to treat oral diseases were gels, mouth rinses, and pastes. The studies included a range of people with oral diseases, including periodontal and gingival diseases, recurrent aphthous stomatitis, oral lichen planus, and oral candidiasis. Herbal product interventions were found to be effective and safe alternatives for oral health care. One of the most important goals of the World Health Organization (until 2015) is the oral health index, so it is important that dental services be followed up more seriously. Considering the problems in reaching this goal of the World Health Organization in our country, herbal products have the ability to improve clinical oral health outcomes in adolescents. Limited adverse side effects indicate the overall safety of these treatments for a wide range of oral diseases. Therefore, the use of medicinal plants as well as alternative medicine is one of the useful methods in achieving this important goal of public health.

Comparison of topical purslane & topical 0.1% triamcinolone acetonide in the management of oral lichen planus - a double blinded clinical trial

AIM AND BACKGROUND

Oral lichen planus (OLP) is a chronic autoimmune mucocutaneous disorder of unknown etiology and treatment is targeted at alleviating symptoms. At present, corticosteroids are the mainstay treatment, and their side effects hamper their long-term use, demanding alternative therapy. This study intended to assess the efficacy of topical purslane (Portulaca oleracea) at two concentrations, 5% and 10%, in OLP and to compare the level of clinical improvement in comparison to topical 0.1% triamcinolone acetonide gel.

MATERIALS AND METHODS

After sample size determination, thirty-four subjects confirmed histopathologically with OLP were included in the study. They were divided into 3 groups, Group 1(Control) was treated with 0.1% triamcinolone acetonide, and Group 2(Case) and 3 (Case) were treated with topical purslane 5% and 10%, respectively. They were examined at baseline, 14 days, 30 days, 60 days, and 90 days. Clinical improvement was then analyzed at the end of 90 days using a visual analog scale (VAS) and Thongprasom's criteria.

RESULTS

The study was analyzed statistically and a P value of < 0.05 was considered statistically significant. Intragroup comparison revealed a statistically significant difference between the five time periods (baseline, 14 days, 30 days, 60 days, and 90 days) for the study variables (burning sensation, pain, lesion score, clinical response, symptomatic response) for all three groups (p = 0.001). Alleviation of all symptoms and remission of the lesion were noted for all three groups at the end of three months.

CONCLUSION

Purslane is a magical herb with a plethora of rich nutrients, ease in accessibility and devoid of side effects. It was concluded that its preparation is beneficial and can be a safer alternative long-term drug for the management of OLP.

CLINICAL SIGNIFICANCE

With available literature evidence, our present study is the first of its kind to formulate a topical gel with purslane to treat symptomatic OLP. Our study had a longer follow-up of 3 months compared to other studies in the literature.

Cepharanthine and Oral Lichen Planus Efficacy (COLE) study: protocol for a multicentre randomised controlled study assessing the efficacy and safety of cepharanthine with topical corticosteroids in oral lichen planus

INTRODUCTION

Oral lichen planus (OLP) is a chronic, inflammatory oral condition leading to a range of symptoms from mild discomfort to severe pain, affecting patients' quality of life. Standard therapy involves the use of topical corticosteroids, although some patients respond insufficiently or develop resistance to therapy. We aim to explore if adding cepharanthine, an herbal extract from Stephania cepharantha Hayata, can enhance the efficacy of corticosteroid therapy in symptomatic OLP.

METHODS AND ANALYSIS

This open-label, parallel-group, multi-centre, randomised controlled study will be conducted at three Japanese hospitals. It will compare safety and efficacy of integrated oral cepharanthine and corticosteroid therapy versus standard corticosteroid therapy. 50 symptomatic OLP patients will be randomised 1:1 to receive cepharanthine (30 mg/day) plus topical dexamethasone, or topical dexamethasone alone for 8 weeks. The primary outcome will be changed in pain intensity while drinking room-temperature water, measured on a visual analogue scale. The primary outcome is the change in pain intensity from baseline when drinking room-temperature water, evaluated using a visual analogue scale. Secondary outcomes are changes in the longest diameter of the target lesion from baseline to weeks 4 and 8, improvement and deterioration rates according to appearance and severity criteria at weeks 4 and 8, change in pain intensity when drinking room-temperature water from baseline to week 4, changes in pain intensity at rest from baseline to weeks 4 and 8, and the rates of adverse events.

ETHICS AND DISSEMINATION

This protocol was approved by the Certified Review Board of Nara Medical University (CRB5200002). Participants will provide informed consent. Results will be disseminated in peer-reviewed journals and conferences.

TRIAL REGISTRATION NUMBER

Japan Registry of Clinical Trials (jRCTs051220130).

Experimental and clinical trial investigations of phyto-extracts, phyto-chemicals and phyto-formulations against oral lichen planus: A systematic review

ETHNOPHARMACOLOGICAL RELEVANCE

Bio-assay guided phytoextracts and derived phytoconstituents reported having multipotent biological activities and nearly 60-80% of the global population still using natural regimens as an alternative therapeutic source. This study focused on the ethnopharmacological and experimental evidence of natural remedies that are effective in treating oral lichen planus (OLP), a chronic T-cell mediated autoimmune disease that is associated with oral cancer transmission.

AIM OF THE REVIEW

A number of studies have shown that antioxidants and antiinflammatory phytoextracts and phyto-constituents are effective against OLP. In this systematic review, we summarize the details of experimentally assessed ancient Traditional Chinese Medicine (TCM), Indian Ayurveda or Ayurvedic Medicine, and Japanese Kampo Medicine (JKM) regimens (crude extracts, individual phytochemicals, and phyto-formulations) that reduce oral lesion, severity index and pain associated with OLP based on studies conducted in vivo, in vitro, and in randomized controlled trials (RCTs).

MATERIALS AND METHODS

Experimental, clinical and RCT investigation reports were gathered and presented according to PRISMA-2020 format. Briefly, the information was obtained from PubMed, ScienceDirect, Wiley journal library, Scopus, Google Scholar with ClinicalTrials.gov (a clinical trial registry database operated by the National Library of Medicine in the United States). Further, individual phytochemical structures were verified from PubChem and ChemSpider databases and visualized by ChemDraw 18.0 software.

RESULTS

We summarized 11 crude phytoextracts, 7 individual phytochemicals, 9 crude formulations, 8 specific TCM and JKM herbal cocktails, and 6 RCTs/patents corroborated by multiple in vitro, in vivo and enzyme assay methods. Briefly, plants and their family name, used plant parts, reported phytochemicals and their chemical structure, treatment doses, and duration of each experiment were presented more concisely and scientifically.

CONCLUSION

Documentation of evidence-based natural ethnomedicines or remedies could be useful for promoting them as potential, cost-effective and less toxic alternatives or as complementary to commonly prescribed steroids towards the control of OLP.

Antioxidant therapy for patients with oral lichen planus: A systematic review and meta-analysis

Aims: This study aimed to systematically review the efficacy and safety of antioxidants for patients with Oral lichen planus (OLP). Methods: Databases, including PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar, were searched up to 30 April 2022, for randomized controlled trials on the antioxidant therapy of OLP. The following endpoints were analyzed: pain score, clinical score, pain resolution rate, clinical resolution rate, and adverse effects. Results: A total of 19 studies met the inclusion criteria, and 17 studies with 704 patients were included in the meta-analysis. The findings showed that antioxidant therapy could significantly reduce the pain score [standardized mean difference -0.72 (-1.36, -0.07), P = 0.03, I2 = 87%, PI2 < 0.00001] and clinical score [SMD -2.06 (-3.06, -1.06), P < 0.0001, I2 = 94%, PI2 < 0.00001] of patients with OLP and improve the pain resolution rate [risk ratio (RR) 1.15 (1.01, 1.31), P = 0.04, I2 = 45%, PI2 = 0.09] and clinical resolution rate [RR 1.40 (1.10, 1.78), P = 0.006, I2 = 72%, PI2 = 0.002]. Conclusion: The study demonstrated that antioxidant therapy was beneficial for patients with OLP, and antioxidants might be used to treat OLP. Systematic Review Registration: https://clinicaltrials.gov/, identifier CRD4202233715.

A review on bioactive phytochemicals and ethnopharmacological potential of purslane (Portulaca oleracea L.)

The Portulaca oleracea L. commonly known as purslane is distributed all over the world and easily grows in diverse soil and climatic conditions. It has been traditionally used as a nutritious and ethnomedicinal food across the globe. Various studies have shown that the plant is a rich source of various important phytochemicals such as flavonoids, alkaloids, terpenoids, proteins, carbohydrates, and vitamins such as A, C, E, and B, carotenoids and minerals such as phosphorus, calcium, magnesium and zinc. It is particularly very important because of the presence of a very high concentration of omega-3- fatty acids especially α-linolenic acid, gamma-linolenic acid and linoleic acid, which are not generally synthesized in terrestrial plants. Various parts of purslane are known for ethnomedicinal and pharmacological uses because of its anti-inflammatory, antidiabetic, skeletal muscle relaxant, antitumor, hepatoprotective, anticancer, antioxidant, anti-insomnia, analgesic, gastroprotective, neuroprotective, wound healing and antiseptic activities. Due to multiple benefits of purslane, it has become an important wonder crop and various scientists across the globe have shown much interest in it as a healthy food for the future. In this review, we provide an update on the phytochemical and nutritional composition of purslane, its usage as nutritional and an ethnomedicinal plant across the world. We further provide a detailed account on ethnopharmacological studies that have proved the ethnomedicinal properties of purslane.

Short Overview of Some Assays for the Measurement of Antioxidant Activity of Natural Products and Their Relevance in Dermatology

Impaired systemic redox homeostasis is implicated in the onset and development of various diseases, including skin diseases. Therefore, continuous search for natural products with antioxidant bioactivities applicable in biomedicine is attractive topic of general interest. Research efforts aiming to validate antioxidant potentials of natural products has led to the development of several assays based on various test principles. Hence, understanding the advantages and limitations of various assays is important for selection of assays useful to study antioxidant and related bioactivities of natural products of biomedical interest. This review paper gives a short overview on some chemical and cellular bioassays used to estimate the antioxidant activity of chosen natural products together with a brief overview on the use of natural products with antioxidant activities as adjuvant medicinal remedies in dermatology.

Therapies with Antioxidant Potential in Psoriasis, Vitiligo, and Lichen Planus

Oxidative stress plays an important pathogenetic role in many chronic inflammatory diseases, including those of dermatological interest. In particular, regarding psoriasis, vitiligo, and lichen planus, excess reactive oxygen species and a decline in endogenous antioxidant systems are observed. In this regard, treatments with antioxidant properties could be appropriate therapeutic options. To date, clinical trials in dermatology on these treatments are limited. We reviewed the available studies on the efficacy of antioxidant therapies in psoriasis, vitiligo, and lichen planus. The role of herbal derivatives, vitamins, and trace elements was analyzed. The antioxidant properties of conventional therapies were also evaluated. Data from the literature suggest that antioxidants might be useful, but available studies on this topic are limited, heterogeneous, not completely standardized, and on small populations. Furthermore, in most cases, antioxidants alone are unable to induce significant clinical changes, except perhaps in mild forms, and must be used in conjunction with standard drug treatments to achieve measurable results. Further studies need to be conducted, considering larger populations and using internationally validated scales, in order to compare the results and clinical efficacy.

Effect of Portulaca Oleracea (purslane) extract on liver enzymes, lipid profile, and glycemic status in nonalcoholic fatty liver disease: A randomized, double-blind clinical trial

Purslane (Portulaca oleracea L.) is the richest green leafy vegetable source of omega-3, especially alpha linolenic acid (ALA). Experimental studies have shown beneficial effects of purslane extract on liver enzymes. The aim of the present study was to examine the effect of purslane hydroalcohoic extract in patients with non-alcoholic fatty liver disease (NAFLD). In a randomized double-blinded clinical trial, 74 patients were randomly assigned to receive either 300 mg purslane extract or placebo capsules for 12 weeks. Compared with baseline, alanine aminotransferase (ALT) (-9 [-17, 0.50] mg/dl; p = .007), aspartate aminotransferase (AST) (-4 [-10, -0.50] mg/dl; p = .001), gamma glutamyltransferase (GGT) (-6.21 ± 9.85 mg/dL; p < .001), fasting blood glucose (FBG) (-8 [-11, -1.50] mg/dl; p < .001) insulin resistance (-0.95 ± 2.23; p = .020), triglyceride (-20 [-67.50, 3.50] mg/dl; p = .010), and low-density lipoprotein cholesterol (LDL-C) (-5 [-12, -1] mg/dl; p < .001) decreased significantly in the purslane group. At the end of study, no significant changes were observed in liver steatosis grade, insulin, liver enzymes, total bilirubin, lipid profile, and blood pressure between the two groups. The findings of our study show that purslane extract at the dose of 300 mg/day for 12 weeks has no significant effects on liver enzymes, lipid profile, and glycemic indices in patients with NAFLD.

Interventions for oral lichen planus: A systematic review and network meta-analysis of randomized clinical trials

BACKGROUND

Corticosteroids, calcineurin inhibitors, vitamin D, photodynamic therapy, herbal drugs are some of the interventions tried in clinical trials for treating oral lichen planus. We carried out the present network meta-analysis to compare the above-mentioned interventions.

METHODS

Electronic databases were searched for randomized clinical trials evaluating interventions in patients with symptomatic oral lichen planus. Clinical resolution, clinical score, pain resolution, pain score, and adverse effects were the outcomes evaluated.

RESULTS

Fifty-five (2831 patients) trials were included. Corticosteroids (OR: 13.6; 95% CI: 1.2, 155.4), pimecrolimus (OR: 14.7; 95% CI: 1.7, 125), purslane (OR: 18.4; 95% CI: 3.5, 97), and ozonized water/corticosteroids (OR: 52; 95% CI: 1.4, 1882.6) had better rates of clinical resolution compared to placebo. Corticosteroids (OR: 3.18; 95% CI: 1.2, 8.43), ozonized water/corticosteroids (OR: 9.9; 95% CI: 2.7, 36.2), aloe vera (OR: 13; 95%: 1.5, 111.8), pimecrolimus (OR: 18.8; 95% CI: 2, 177.4) and hyaluronic acid (OR: 24.8; 95% CI: 1.3, 457.6) were significantly associated with superior rates of pain resolution compared to placebo. Pimecrolimus and cyclosporine were associated with significantly higher risk of adverse effects than placebo.

CONCLUSION

Topical corticosteroids were the most effective drug class for treating oral lichen planus.

Therapeutic effectiveness of alternative medications in oral lichen planus: A systematic review

Lichen planus is a chronic inflammatory condition affecting the skin and mucosa. The etiology is unknown but the pathogenesis appears to be an immune-mediated reaction. The mainstay drugs used in the treatment are immunomodulators. The aim of this paper is to report on the therapeutic effectiveness of the alternate medications used in the management of oral lichen planus (OLP). A systematic search of PubMed, Web of Science and Cochrane Controlled Clinical trials were done for all the papers published until December 2019. The search resulted in a total of 20 studies that were found suitable for the review. The results showed that the reduction in pain, treatment effectiveness was comparable between the steroids and alternative medications. However, the alternative medications had a therapeutic advantage in studies that had used placebo as controls and the results were statistically significant (P < 0.05). No major adverse effects were reported with the usage of alternative medications. There is definitely a therapeutic potential in the usage of alternative medications in the management of OLP. In terms of therapeutic effectiveness, they are on par with the immunomodulators. These alternative medications offer us a new therapeutic option in the management of OLP without any adverse effects.

Salivary β2-microglobulin levels in patients with erosive oral lichen planus and squamous cell carcinoma

OBJECTIVES

β2 microglobulin, as a biomarker, is used for the diagnosis of oral malignant and pre-malignant lesions. The components of the microglobulin system can directly or indirectly help grow and develop tumors. The present study aims to compare beta-2 microglobulin levels in patients with lichen planus of the esophagus, oral squamous cell carcinoma, and healthy individuals. Further, it evaluated the salivary β2-microglobulin level in malignant and pre-malignant lesions. Oral lichen planus (OLP) is a chronic skin-mucus disorder. Of the total 75 patients referred to Oral Medicine at Dentistry School of Zahedan University of Medical Sciences, 25 were healthy and 25 had oral lichen planus (OLP) and the rest had squamous cell carcinoma (SCC). To collect the saliva samples, unstimulated spitting was used. They were collected between 9 and 12 a.m. Salivary beta2 microglobulin was recorded based on the factory instructions by ELISA optical density method with 450 nm wavelength for each sample. The data were analyzed using descriptive, Kruskal-Wallis and Mann-Whitney and Pearson's correlation coefficient (SPSS 21).

RESULTS

The salivary β2 microglobulin level in patients with squamous cell carcinoma (SCC) and oral lichen plan (OLP) is significantly higher than that in healthy group. Thus, this index is used for assessing early malignant transformation and oral pre-malignant lesion.

Interventions for treating oral lichen planus: corticosteroid therapies

BACKGROUND

Oral lichen planus (OLP) is a relatively common chronic T cell-mediated disease, which can cause significant pain, particularly in its erosive or ulcerative forms. As pain is the indication for treatment of OLP, pain resolution is the primary outcome for this review. This review is an update of a version last published in 2011, but focuses on the evidence for corticosteroid treatment only. A second review considering non-corticosteroid treatments is in progress.

OBJECTIVES

To assess the effects and safety of corticosteroids, in any formulation, for treating people with symptoms of oral lichen planus.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases to 25 February 2019: Cochrane Oral Health's Trials Register, CENTRAL (2019, Issue 1), MEDLINE Ovid, and Embase Ovid. ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. There were no restrictions on language or date of publication.

SELECTION CRITERIA

We considered randomised controlled clinical trials (RCTs) of any local or systemic corticosteroid treatment compared with a placebo, a calcineurin inhibitor, another corticosteroid, any other local or systemic (or both) drug, or the same corticosteroid plus an adjunctive treatment.

DATA COLLECTION AND ANALYSIS

Three review authors independently scanned the titles and abstracts of all reports identified, and assessed risk of bias using the Cochrane tool and extracted data from included studies. For dichotomous outcomes, we expressed the estimates of effects of an intervention as risk ratios (RR), with 95% confidence intervals (CI). For continuous outcomes, we used mean differences (MD) and 95% CI. The statistical unit of analysis was the participant. We conducted meta-analyses only with studies of similar comparisons reporting the same outcome measures. We assessed the overall certainty of the evidence using GRADE.

MAIN RESULTS

We included 35 studies (1474 participants) in this review. We assessed seven studies at low risk of bias overall, 11 at unclear and the remaining 17 studies at high risk of bias. We present results for our main outcomes, pain and clinical resolution measured at the end of the treatment course (between one week and six months), and adverse effects. The limited evidence available for comparisons between different corticosteroids, and corticosteroids versus alternative or adjunctive treatments is presented in the full review. Corticosteroids versus placebo Three studies evaluated the effectiveness and safety of topical corticosteroids in an adhesive base compared to placebo. We were able to combine two studies in meta-analyses, one evaluating clobetasol propionate and the other flucinonide. We found low-certainty evidence that pain may be more likely to be resolved when using a topical corticosteroid rather than a placebo (RR 1.91, 95% CI 1.08 to 3.36; 2 studies, 72 participants; I² = 0%). The results for clinical effect of treatment and adverse effects were inconclusive (clinical resolution: RR 6.00, 95% CI 0.76 to 47.58; 2 studies, 72 participants; I² = 0%; very low-certainty evidence; adverse effects RR 1.48, 95% 0.48 to 4.56; 3 studies, 88 participants, I² = 0%, very low-certainty evidence). Corticosteroids versus calcineurin inhibitors Three studies compared topical clobetasol propionate versus topical tacrolimus. We found very low-certainty evidence regarding any difference between tacrolimus and clobetasol for the outcomes pain resolution (RR 0.45, 95% CI 0.24 to 0.88; 2 studies, 100 participants; I² = 80%), clinical resolution (RR 0.61, 95% CI 0.38 to 0.99; 2 studies, 52 participants; I² = 95%) and adverse effects (RR 0.05, 95% CI 0.00 to 0.83; 2 studies, 100 participants; very low-certainty evidence) . One study (39 participants) compared topical clobetasol and ciclosporin, and provided only very low-certainty evidence regarding the rate of clinical resolution with clobetasol (RR 3.16, 95% CI 1.00 to 9.93), pain resolution (RR 2.11, 95% CI 0.76 to 5.86) and adverse effects (RR 6.32, 95% CI 0.84 to 47.69). Two studies (60 participants) that compared triamcinolone and tacrolimus found uncertain evidence regarding the rate of clinical resolution (RR 0.86, 95% CI 0.55 to 1.35; very low-certainty evidence) and that there may be a lower rate of adverse effects in the triamcinolone group (RR 0.47, 95% CI 0.22 to 0.99; low-certainty evidence). These studies did not report on pain resolution.

AUTHORS' CONCLUSIONS

Corticosteroids have been first line for the treatment of OLP. This review found that these drugs, delivered topically as adhesive gels or similar preparations, may be more effective than placebo for reducing the pain of symptomatic OLP; however, with the small number of studies and participants, our confidence in the reliability of this finding is low. The results for clinical response were inconclusive, and we are uncertain about adverse effects. Very low-certainty evidence suggests that calcineurin inhibitors, specifically tacrolimus, may be more effective at resolving pain than corticosteroids, although there is some uncertainty about adverse effects and clinical response to tacrolimus showed conflicting results.

Herbal medicine in oral lichen planus

Oral lichen planus (OLP) is a common chronic inflammatory and T cell-mediated autoimmune disease in which the oral mucosa, tongue, and gingiva are involved. Different treatments have been suggested to reduce the symptoms of this disease. Currently, a common treatment for OLP is the use of corticosteroids as the gold standard, although they have considerable side effects. The chronicity of the disease needs the long-term use of these drugs with ensuing side effects. Therefore, various studies have been done to find an alternative and effective treatment. The use of herbal medicine as an alternative therapy with antioxidant and anti-inflammatory properties seems promising. Hence, this review study was done to summarize the efficiency of different herbal medicine in the treatment of OLP.

Salivary MMP-1, MMP-2, MMP-3 and MMP-13 Levels in Patients with Oral Lichen Planus and Squamous Cell Carcinoma

The aim of present study was to evaluate salivary matrix metalloproteinase-1 (MMP-1), MMP-2, MMP-3 and MMP-13 levels in patients with oral lichen planus (OLP) and squamous cell carcinomas (SCC) as well as in healthy controls. Thirty cases of OLP (bilateral lesions, papular and reticular lesions, and Wickham lines) clinically and histopathologically (group A), 30 with oral SCCs (group B), and 30 with no history of oral cancer, other lesions or lichen planus (group C) were enrolled at the Department of Oral Medicine School of Dentistry, Zahedan, Iran. Unstimulated whole saliva was collected and laboratory measurement of salivary concentration of MMP-1, MMP-2, MMP-3 and MMP-13 was conducted by immuno-sorbent enzyme-linked methods. Data analysis was performed with Kruskal-Wallis and Mann-Whitney tests and Pearson’s correlation coefficients. In the present study, MMP-2 and MMP-13 levels were higher in oral SCC patients than in OLP and healthy individuals. More research is required to assess MMP links with tumor invasion.

Interventions for the management of oral lichen planus: a review of the conventional and novel therapies

OBJECTIVE

This narrative review focuses on the rationale and role of conventional and newer therapies in the management of oral lichen planus (OLP) with emphasis on randomized controlled trials (RCTs) reported over two decades.

MATERIALS AND METHODS

Literature search was conducted to identify RCTs for the management of OLP from 1 January 1995 to 31 December 2015; Medline and Cochrane databases complemented with manual search were used. Primary outcome as resolution of pain was evaluated with the analysis of clinical resolution of erythema and ulceration as secondary outcome.

RESULTS

The search provided 260 abstracts, of which 70 full-text articles were included. Majority of trials used topical steroids with very few trials on newer therapies. It was found that topical steroids are effective for symptomatic management of OLP with equal efficacy shown by topical calcineurin inhibitors and retinoids. However, the side effect of transient burning sensation with relapse was more with calcineurin inhibitors.

CONCLUSION

Although the newer therapies offer advantage over steroids for the management of OLP in recalcitrant cases, extensive lesions, and cases unresponsive to steroids, but sufficient clinical data on their use are still lacking. Hence, more RCTs with large sample size, adequate treatment duration, and long-term follow-up are required for clinical utility.

Evaluation of Potential Risk Factors that contribute to Malignant Transformation of Oral Lichen Planus: A Literature Review

AIM

Many studies have suggested that a lesion originally diagnosed as oral lichen planus (OLP) has different possibilities of undergoing malignant transformation in time, although these findings remain a controversial issue; for example, some studies reported different values of potential malignancy of OLP.

INTRODUCTION

World Health Organization (WHO) classifies OLP as a "potentially malignant disorder" with unspecified malignant transformation risk, and suggests that OLP patients should be closely monitored. Numerous studies have attempted to confirm the malignant transformation potential of OLP.

REVIEW RESULTS

The Cochrane Controlled Trials Register, Medline and EMBASE databases, PubMed, Google Scholar, Ovid, Up To Date, BMJ Clinical Evidence, MD Consult, and Science Direct were searched for papers published between 1997 and 2015. The medical subject heading search terms were "lichen planus," "oral lichen planus," "erosive oral lichen planus," "dysplasia," "oral precancerous condition," "oral premalignant condition," oral cancer, oral squamous cell carcinoma (OSCC), and atrophic lichen planus. A total of 120 English language abstracts were reviewed, and 50 relevant articles identified. Because of the extensive literature on the association between OLP and SCC, we have divided the data into genetic and non-genetic factors for more accurate assessment.

CONCLUSION

In this evidence base, malignant transformation ranges from 0 to 37% with a mean of 4.59%. The highest rate of malignancy was noted in erythematosus and erosive lesions. In this way, follow-up of OLP patients could be carried out more efficiently and appropriately.

CLINICAL SIGNIFICANCE

Oral lichen planus is a premalignant lesion. All types of OLP in any site of oral mucosa must be monitored regularly.

Phytodentistry: use of medicinal plants

Finding healing powers in plants is an ancient idea. Herbs have been used as a traditional form of medicine since time immemorial. The natural products derived from medicinal plants have proven to be an abundant source of biologically active compounds, many of which have been the basis for the development of new chemicals for pharmaceuticals. Phytodentistry implies the use of plants and their products in the process of treating disease directly or indirectly. A crucial role is played by phytotherapy in the treatment of stomatological problems. It started with the use of miswak (chewing stick), and it is still relevant today as herbal toothpaste in many parts of the country. India is the largest producer of medicinal herbs and is appropriately called the botanical garden of the world. The use of this readily available, natural and safe resource as a part of dental practice has great potential for a more "Natural and Green Dental Practice". Plant products have long been used in dentistry as part of various dental materials right from impression materials to eugenol, which forms an integral part of the dental clinic. The use of herbs in dental practice is not limited to only material sciences. A single herb shows a variety of effects like anti-inflammatory, antibacterial, antifungal activity and many more. Hence the incorporation of these herbs in dental practice will prove to be a valuable adjunct in dental treatment. This review is aimed at exploring the perspectives of this holistic treatment approach in dentistry and its benefits as an adjunctive therapy.

Serum and Saliva MMP-3 in Patients with OLP and Oral SCC

BACKGROUND

Matrix metalloproteinase-3 (MMP-3) plays a key role in development of cancer. The purpose of this study was to assess MMP-3 in the serum and saliva of patients with oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

Thirty patients with OLP (8 reticular and 22 erosive forms), and 20 patients with OSCC (6 in low stage and 14 in advanced stage), were enrolled in this study, conducted at the Cancer Department, Clinic of Oral Medicine, Tehran University of Medical Sciences. The serum and saliva MMP-3 was assayed by ELISA method. Statistical analysis of the Student's t-test, ANOVA and Pearson correlation coefficient was performed. The mean saliva and serum levels of MMP-3 were significantly higher in patients with OSCC compared with OLP.

RESULTS

The serum and saliva MMP-3 concentrations increased from reticular form of OLP to erosive form of OLP, and increased further to low stage of OSCC and advanced stage of OSCC. Serum MMP-3 correlated significantly with unstimulated (r = 0.310, p = 0.038) and stimulated (r = 0.365, p < 0.026) saliva MMP-3.

CONCLUSION

Serum and saliva MMP-3 levels appear associated with OLP and OSCC.

Evaluation of the Effects of Dental Implants on Oral Lesions

Objective

To determine whether dental implants impress oral lesions, and to evaluate the nature of their effect on the lesions.

Materials and methods

A comprehensive search was done via Google and PubMed for articles (including case reports and literature reviews) containing the keywords ‘oral squamous cell carcinoma’ (OSCC), ‘oral lichen planus’ (OLP), ‘lichenoid contact reaction’ (LCR), ‘osseointegrated implants’, and ‘dental implants’, in the last 10 years (2002-2012).

Results

The study included 24 articles involving patients with dental implants, and some oral lesions (e.g. oral lichen planus and oral squamous cell carcinoma) or with a history of lesions. In these publications, there is evidence suggesting the possibility of emergence, exacerbation, recurrence, or even malignant transformation of the oral lesions after implant placement in some cases.

Conclusion

Based on our review of the literature, implant treatment does not seem to be completely safe under any circumstances, but may have some complications in subjects with certain diseases (e.g. oral lesions, autoimmune diseases, malignancies, allergic reactions, etc.). Therefore prior to treatment, patients should be fully informed of the risks.

Clinical significance

Implant treatment is best done with caution in patients with cancer or mucocutaneous disorders.

How to cite this article

Agha-Hosseini F, Rohani B. Evaluation of the Effects of Dental Implants on Oral Lesions. J Contemp Dent Pract 2015;16(5):400-406.

Mucosal lichen planus: an evidence-based treatment update

BACKGROUND

Mucosal lichen planus (MLP) is a chronic mucosal disorder that often poses a therapeutic challenge to dermatologists, dentists, and gynecologists. To relieve patients' pain and discomfort, improve their quality of life, and achieve clinical improvement, various therapeutic approaches can be considered for this disease. Based on the current literature it is difficult to define any particular treatment as the main therapeutic modality.

OBJECTIVE

We aimed to systematically review the current literature for the effectiveness of available treatment modalities for MLP.

METHODS

All of the randomized controlled trials and systematic reviews of MLP were collected by searching Pubmed, EMBASE, the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, and China National Knowledge Infrastructure. Meta-analysis was performed, if possible.

RESULTS

Topical betamethasone valerate, clobetasol-17-propionate, and fluocinonide are effective in the treatment of oral lichen planus (OLP) when compared with placebo. Calcineurin inhibitors and topical retinoids are also beneficial treatment options.

LIMITATIONS

The review does not include therapies with a lower level of evidence.

CONCLUSION

Topical corticosteroids are the mainstay of therapy for OLP. High-quality evidence is lacking for the treatment of lichen planus.

Salivary biomarkers of oxidative stress and quality of life in patients with oral lichen planus

AIM

Lichen planus is a T cell-mediated chronic inflammatory disease of unknown etiology. The objective of the present study was to evaluate the status of oxidative stress in saliva and the anti-oxidant defense system in relation to quality of life parameters in patients with oral lichen planus (OLP).

METHODS

The sample consisted of 70 patients (40 with OLP and 30 control patients). The average age of OLP patients was 60 years (9 males and 31 females), and of the control group 57 years (6 males and 24 females). All participants completed the Oral Health Impact Profile-49 quality of life questionnaire. Total anti-oxidant activity and lipid peroxidation products in saliva were evaluated, using ferric reducing anti-oxidant power and thiobarbituric acid reactive substance.

RESULTS

Mean levels of salivary malondialdehyde were higher in the OLP group than the control group (P = 0.001), and total anti-oxidant capacity was lower among OLP patients than control patients (P = 0.02). There was no correlation between Oral Health Impact Profile-49 findings and the oxidative stress parameters studied.

CONCLUSIONS

The results of the present study point to the possible function of oxidative stress in the etiopathogenesis of OLP.

Diets containing traditional and novel green leafy vegetables improve liver fatty acid profiles of spontaneously hypertensive rats

BACKGROUND

The consumption of green leafy vegetables (GLVs) has been demonstrated to reduce the risks associated with cardiovascular and other diseases. However, no literature exists that examines the influence of traditional and novel GLVs on the liver fatty acid profile of an animal model genetically predisposed to developing hypertension. The aim of the present study was to examine the effects of diets containing 4% collard greens, purslane or sweet potato greens on the liver fatty acid profiles of four-week old male spontaneously hypertensive rats (SHRs, N = 44). Following four weeks consumption of the diets, liver fatty acid profiles were determined by gas-liquid chromatography of transesterified fatty acid methyl esters.

RESULTS

SHRs consuming the control diet had greater percentages of liver saturated fatty acid and less omega-3 fatty acid percentages. SHRs consuming the diets containing vegetables had significantly greater liver concentrations of γ- linolenic, docosahexaenoic and docosahexaenoic acids, as well as lower levels of lauric, palmitic and arachidonic acids. SHRs consuming the control diet had significantly greater percentages (p < 0.05) of oleic; significantly less γ-linolenic and docosahexaenoic acids.

CONCLUSIONS

This study demonstrates the ability of GLVs to modulate liver fatty acid composition, thus providing protection against elevations in atherogenic fatty acids, which may be involved in CVD pathogenesis. Consequently, dietary recommendations for the prevention of CVD should consider the possible cardioprotective benefits and the subsequent alterations in fatty acid profiles afforded by diets containing collard greens, purslane and sweet potato greens.

Novel therapies for oral lichen planus

Oral lichen planus (OLP) is a chronic mucocutaneous disorder commonly found in middle-aged women. Despite the progress in research and advance in knowledge on OLP, a successful management is still difficult to achieve. The main aim of OLP treatment is to control the symptoms of the affected patients. Steroids and other immunosuppressive drugs have been recommended and widely used in the treatment of OLP. Topical corticosteroids are the mainstay of OLP treatment, but strong evidence on their effectiveness is lacking. The effectiveness of alternative ways of managing OLP has been recently reported. Topical aloe vera, topical pimecrolimus and oral curcuminoids are the most promising of the new treatment modalities. Other interesting modalities are topically applied thalidomide and amlexanox. Nevertheless, the careful assessment between the risks and benefits of these drugs is crucial and larger and well-conducted trials need to confirm the above encouraging results.

p53 as a neoplastic biomarker in patients with erosive and plaque like forms of oral lichen planus

AIM

Unstimulated whole salivary p53 was assessed in patients suffering from erosive and plaque-like form of oral lichen planus (OLP).

MATERIALS AND METHODS

Eighteen patients with erosive form, 17 patients suffering from plaque-like form and 38 noninvolvement subjects were enrolled. The unstimulated whole saliva p53 level was assayed by ELISA.

RESULTS

The mean concentration of salivary p53 was significantly higher in patients with plaque-like form compared to both patients with erosive form and the control group.

CONCLUSION

We conclude that plaque like form of OLP is important in view of the potential for malignancy and is not safety form.

CLINICAL SIGNIFICANCE

It seems that all forms of OLP must be considered accurately, should be followed up with biannual examinations, and if possible, assessment of salivary p53 every year.

Accumulation of fatty acids in purslane grown in hydroponic salt stress conditions

Purslane (Portulaca oleracea L.) is the eighth most common plant distributed throughout the world being a heat- and drought-tolerant plant. In this study, we evaluated the effect of salinity on total amounts of fatty acids (FAs) and ω3/ω6 ratio in leaves of purslane. Plants exposed to four levels of chloride salinity in the root zone (60, 90, 120 and 240 mM NaCl) for 40 days showed no signs of toxicity or death. The main FAs detected were C16:0>C18:3>C18:2. The ratio of ω6 to ω3 was not changed with salt stress. Hierarchic cluster analysis brought together 60 and 90 mM NaCl in control plants, based on their FA content. The results of this study confirm the purslane as a plant rich in FAs whose consumption may contribute to dietary intake of ω3 polyunsaturated fatty acid, with obvious benefits to human health.

Urban legends series: lichen planus

Oral Diseases (2012) Lichen planus (LP) is a common disorder affecting the oral cavity (OLP) and skin. Despite intensive research, LP/OLP etiology and treatment remain controversial. We investigated four controversial topics: (i) Is hepatitis C virus (HCV) infection associated with LP and involved in its pathogenesis? (ii) Should all patients with LP be screened for HCV? (iii) Should patients with OLP have all their amalgam restorations removed? (iv) Are there any new treatments for OLP? Results from extensive literature searches suggested that: (i) Robust evidence from three meta-analyses indicate that HCV is associated with LP and might be involved in OLP pathogenesis (ii) It would be prudent to screen patients with LP/OLP at significant risk with an ELISA for HCV antibodies using country-specific screening strategies (iii) There is no evidence that either OLP or oral lichenoid lesions patients would routinely benefit from having all their amalgam restorations replaced. Weak evidence from potentially very biased, small, non-randomized, unblinded studies suggests that a small fraction of patients may benefit from targeted amalgam replacement. (iv) There is weak evidence that, among new OLP treatments, topical pimecrolimus, aloe vera, and oral curcuminoids may be useful. The development of specific formulations for oral delivery of topical medications is a promising field.

Interventions for erosive lichen planus affecting mucosal sites

BACKGROUND

Erosive lichen planus (ELP) affecting mucosal surfaces is a chronic autoimmune disease of unknown aetiology. It is often more painful and debilitating than the non-erosive types of lichen planus. Treatment is difficult and aimed at palliation rather than cure. Several topical and systemic agents have been used with varying results.

OBJECTIVES

To assess the effects of interventions in the treatment of erosive lichen planus affecting the oral, anogenital, and oesophageal regions.

SEARCH METHODS

We searched the following databases up to September 2009: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE (from 2005), EMBASE (from 2007), and LILACS (from 1982). We also searched reference lists of articles and online trials registries for ongoing trials.

SELECTION CRITERIA

We considered all randomised controlled trials (RCTs) that evaluated the effectiveness of any topical or systemic interventions for ELP affecting either the mouth, genital region, or both areas, in participants of any age, gender, or race.

DATA COLLECTION AND ANALYSIS

The primary outcome measures were as follows:(a) Pain reduction using a visual analogue scale rated by participants; (b) Physician Global Assessment; and (c) Participant global self-assessment.Changes in scores at the end of therapy compared with baseline were analysed.

MAIN RESULTS

A total of 15 RCTs were identified, giving a total of 473 participants with ELP. All studies involved oral ELP only. Six of the 15 studies included participants with non-erosive lichen planus. In these studies, only the erosive subgroup was included for intended subgroup analysis. We were unable to pool data from any of the nine studies with only ELP participants or any of the six studies with the ELP subgroup, due to small numbers and the heterogeneity of the interventions, design methods, and outcome variables between studies. One small study involving 50 participants found that 0.025% clobetasol propionate administered as liquid microspheres significantly reduced pain compared to ointment (Mean difference (MD) -18.30, 95% confidence interval (CI) -28.57 to -8.03), but outcome data was only available in 45 participants. However, in another study, a significant difference in pain was seen in the small subgroup of 11 ELP participants, favouring ciclosporin solution over 0.1% triamcinolone acetonide in orabase (MD -1.40, 95% CI -1.86 to -0.94). Aloe vera gel was 6 times more likely to result in at least a 50% improvement in pain symptoms compared to placebo in a study involving 45 ELP participants (Risk ratio (RR) 6.16, 95% CI 2.35 to 16.13). In a study involving 20 ELP participants, 1% pimecrolimus cream was 7 times more likely to result in a strong improvement as rated by the Physician Global Assessment when compared to vehicle cream (RR 7.00, 95% CI 1.04 to 46.95).There is no overwhelming evidence for the efficacy of a single treatment, including topical steroids, which are the widely accepted first-line therapy for ELP. Several side-effects were reported, but none were serious. With topical corticosteroids, the main side-effects were oral candidiasis and dyspepsia.

AUTHORS' CONCLUSIONS

This review suggests that there is only weak evidence for the effectiveness of any of the treatments for oral ELP, whilst no evidence was found for genital ELP. More RCTs on a larger scale are needed in the oral and genital ELP populations. We suggest that future studies should have standardised outcome variables that are clinically important to affected individuals. We recommend the measurement of a clinical severity score and a participant-rated symptom score using agreed and validated severity scoring tools. We also recommend the development of a validated combined severity scoring tool for both oral and genital populations.

Biopsy techniques and diagnoses & treatment of mucocutaneous lesions

Oral mucosal lesions are commonly encountered in clinical practice. One study reported that they occurred in approximately 27.9% of patients aged 17 years and older and in 10.3% of children aged 2 to 17 years. The diagnosis and treatment of mucosal diseases should be an integral part of the general practitioner's practice. According to an American Dental Association survey conducted in 2007, 44% of biopsies were performed by a general practictioner. Understanding of the fundamentals of diagnosing mucocutaneous lesions requires a sound knowledge of their origin and clinical course, and of biopsy methods using contemporary diagnostic tools and techniques.

Interventions for treating oral lichen planus

BACKGROUND

Oral lichen planus (OLP) is a common chronic autoimmune disease associated with cell-mediated immunological dysfunction. Symptomatic OLP is painful and complete healing is rare.

OBJECTIVES

To assess the effectiveness and safety of any form of therapy for symptomatic OLP.

SEARCH STRATEGY

The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 26 January 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to 26 January 2011) and EMBASE via OVID (1980 to 26 January 2011). There were no restrictions regarding language or date of publication.

SELECTION CRITERIA

All randomised controlled clinical trials (RCTs) of therapy for symptomatic OLP which compared treatment with a placebo or between treatments or no intervention were considered in this review.

DATA COLLECTION AND ANALYSIS

The titles and abstracts of all reports identified were scanned independently by two review authors. All studies meeting the inclusion criteria were assessed for risk of bias and data were extracted. For dichotomous outcomes, the estimates of effects of an intervention were expressed as risk ratios (RR) together with 95% confidence intervals. For continuous outcomes, mean differences (MD) and 95% confidence intervals were used to summarise the data for each group. The statistical unit was the patient. Meta-analyses were done only with studies of similar comparisons reporting the same outcome measures.

MAIN RESULTS

28 trials were included in this review. Pain is the primary outcome of this review because it is the indication for treatment of OLP, and therefore this review indicates as effective, only those treatments which significantly reduce pain. Although topical steroids are considered first line treatment for symptomatic OLP, we identified no RCTs that compared steroids with placebo. There is no evidence from the three trials of pimecrolimus that this treatment is better than placebo in reducing pain from OLP. There is weak evidence from two trials, at unclear and high risk of bias respectively, that aloe vera may be associated with a reduction in pain compared to placebo, but it was not possible to pool the pain data from these trials. There is weak and unreliable evidence from two small trials, at high risk of bias, that cyclosporin may reduce pain and clinical signs of OLP, but meta-analysis of these trials was not possible.There were five trials that compared steroids with calcineurin inhibitors, each evaluating a different pair of interventions. There is no evidence from these trials that there is a difference between treatment with steroids compared to calcineurin inhibitors with regard to reducing pain associated with OLP. From six trials there is no evidence that any specific steroid therapy is more or less effective at reducing pain compared to another type or dose of steroid.

AUTHORS' CONCLUSIONS

Although topical steroids are considered to be first line treatment, we identified no RCTs that compared steroids with placebo in patients with symptomatic OLP. From the trials in this review there is no evidence that one steroid is any more effective than another. There is weak evidence that aloe vera may reduce the pain of OLP and improve the clinical signs of disease compared to placebo. There is weak and unreliable evidence that cyclosporin may reduce pain and clinical signs of OLP. There is no evidence that other calcineurin inhibitors reduce pain compared to either steroids or placebo. From the 28 trials included in this systematic review, the wide range of interventions compared means there is insufficient evidence to support the effectiveness of any specific treatment as being superior.