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Conejero Del Mazo R, García Forcén L, Navarro Aguilar ME. [Recurrent aphthous stomatitis]. Med Clin (Barc) 2023; 161:251-259. [PMID: 37357066 DOI: 10.1016/j.medcli.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/27/2023]
Abstract
Recurrent aphthous stomatitis (RAS) is the most common clinical disease of the oral mucosa. Its prevalence in the general population varies between 5 and 25%, with its peak appearance in the second decade of life. So far, the etiopathogenesis is not clear. In genetically predisposed patients, the effect of certain triggering factors would initiate the proinflammatory cytokine cascade directed against certain regions of the oral mucosa. Ulcers are round or oval with well-defined erythematous margins and a shallow ulcerated center covered with a gray or yellowish fibrinous pseudomembrane. The ulcers may reappear at intervals of a few days and months. Given the appearance of periodic thrush in the oral mucosa, the first thing to do is to make a correct differential diagnosis, rule out associated systemic diseases and assess treatable causes before reaching the diagnosis of RAS. At present, there is no curative treatment.
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Affiliation(s)
| | - Laura García Forcén
- Centro de Salud Ejea de los Caballeros, Ejea de los Caballeros, Zaragoza, España
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Al-Maweri SA, Al-Qadhi G, Halboub E, Alaizari N, Almeslet A, Ali K, Osman SAA. Vitamin D deficiency and risk of recurrent aphthous stomatitis: updated meta-analysis with trial sequential analysis. Front Nutr 2023; 10:1132191. [PMID: 37426194 PMCID: PMC10325032 DOI: 10.3389/fnut.2023.1132191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Background Growing evidence suggests a significant association between vitamin D deficiency and RAS. Hence, the present meta-analysis and trial sequential analysis sought to investigate the potential association between low serum vitamin D levels and RAS. Methods PubMed, Scopus, Embase, and Web of Science were comprehensively searched on December 1st, 2022 to retrieve all relevant studies. The grey literature was also searched via ProQuest. All case-control studies on the association between vitamin D and RAS were considered. The quality appraisal of the included studies was done using Newcastle-Ottawa scale. RevMan 5.0 and trial sequential analysis (TSA) programs were used for analyses. Results A total of 14 case-control studies with 1468 subjects (721 RAS patients and 747 controls) were included. The pooled data revealed a significant association between low serum levels of vitamin D and the risk of RAS (mean difference = - 8.73, 95% CI: - 12.02 to - 5.44, I2 = 94%, P < 0.00001). Additionally, TSA findings indicated that the current studies surpassed the required information size, confirming that the differences were reliable. Conclusion The available evidence suggests that Vitamin D deficiency may have a role in the pathogenesis of RAS. Therefore, evaluation of vitamin D should be considered in RAS patients. Additionally, the results support the possibility of using vitamin D supplements in the management of RAS patients with inadequate serum levels of vitamin D. Future interventional studies are required to evaluate the benefits of vitamin D replacement in prevention and treatment of RAS.
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Affiliation(s)
| | - Gamilah Al-Qadhi
- Department of Basic Dental Sciences, Faculty of Dentistry, University of Science and Technology, Sana'a, Yemen
| | - Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jizan, Saudi Arabia
- Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Sana'a, Yemen
| | | | - Asma Almeslet
- Department of Oral Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Kamran Ali
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
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Zhang Z, Zhang Q, Xue Y, Fang H, Wu Z. Serum levels of reduced glutathione, oxidized glutathione, and glutathione reductase activity in minor recurrent aphthous stomatitis patients. J Dent Sci 2022. [DOI: 10.1016/j.jds.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lau CB, Smith GP. Recurrent Aphthous Stomatitis: A Comprehensive Review and Recommendations on Therapeutic Options. Dermatol Ther 2022; 35:e15500. [PMID: 35395126 DOI: 10.1111/dth.15500] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/18/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022]
Abstract
Recurrent aphthous stomatitis (RAS) is a common chronic disease in the oral mucosa that affects about 20% of the population. It is characterized by solitary or multiple, recurrent, small ulcers with erythematous haloes and yellow/grey floors. RAS can be managed through a wide variety of preventative measures and therapies, intending to reduce ulcer pain, stimulate ulcer healing, and/or prevent ulcer recurrence. First-line treatment options include topical medications in the form of corticosteroids (triamcinolone acetonide), anti-inflammatory drugs (amlexanox), antibiotics (doxycycline), and antiseptics (lidocaine). In more severe cases of RAS where local treatment is insufficient, systemic drugs in the form of corticosteroids (prednisone), immunomodulatory drugs (thalidomide), and antibiotics/antimicrobials (clofazimine) can prove effective. This review will summarize current treatment options for RAS with discussion of prevention, topical measures, natural treatments, systemic therapies, and new potential therapies. Furthermore, this review will provide recommendations on therapeutic options for RAS based on disease severity and patient circumstances. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Charles B Lau
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Gideon P Smith
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
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Wang B, Gao F, Qin N, Duan X, Li Y, Cao S. A comprehensive analysis on source-distribution-bioaccumulation-exposure risk of metal(loid)s in various vegetables in peri-urban areas of Shenzhen, China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 293:118613. [PMID: 34861329 DOI: 10.1016/j.envpol.2021.118613] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 06/13/2023]
Abstract
The health risk induced by metal(loid)s in crops are becoming increasingly serious. In this study, eight major vegetables and rhizosphere soils were collected in a peri-urban area with intense electronic information manufacturing activities. The source, distribution and bioaccumulation of six typical metal(loid)s in different vegetable species were analyzed, and exposure risk through vegetable ingestion was estimated. Results showed that vegetables and agricultural soils in the study area suffered from serious metal(loid)s pollution, especially for Cd and Pb. The bioaccumulation capacity differed greatly among individual metal(loid)s and vegetable categories. In general, the highest transfer factors (TF) for Cd, Pb, and As were found in leafy vegetables, while leguminous vegetables had the highest TF of Cu and Zn and root vegetables had the highest TF for Cr. Significant correlations were found between concentrations in vegetables and rhizosphere soils for most metal(loid)s, the exceptions being Pb and Zn. The enrichment of Pb, Cd, Cr and As was mainly attributed to electronic information manufacturing activities, while the enrichment of Zn, Cu and Cd was associated with the application of commercial fertilizers and pesticides. The health risk associated with vegetable intake decreased in the order of leafy > fruit > leguminous > root vegetables. Leafy vegetables were identified as the category with the highest risk, with the mean risk value of 1.26. Cd was the major risk element for leafy vegetables. The non-carcinogenic risks estimated for leguminous and root vegetables were under the acceptable level. In conclusion, special attention should be paid to the health risks of toxic metal(loid)s in leafy vegetables in peri-urban areas with intense electronic information manufacturing activities. In order to minimize health risk, it is necessary to identify low-risk crops based on a comprehensive consideration of the metal(loid)s' pollution characteristics, transfer factors and local people's consumption behaviors.
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Affiliation(s)
- Beibei Wang
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
| | - Fei Gao
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
| | - Ning Qin
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
| | - Xiaoli Duan
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China.
| | - Yujie Li
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
| | - Suzhen Cao
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
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Al-Maweri SA, Alaizari N, Alanazi RH, Ashraf S, Alanazi RH, Al-Sharani HM, Halboub E. Efficacy of hyaluronic acid for recurrent aphthous stomatitis: a systematic review of clinical trials. Clin Oral Investig 2021; 25:6561-6570. [PMID: 34542725 DOI: 10.1007/s00784-021-04180-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Recurrent aphthous stomatitis (RAS) is a very common oral mucosal disease, and its management is quite challenging with no definitive cure being available so far. Many studies have tried hyaluronic acid (HA) for alleviating signs and symptoms of RAS. The present systematic review sought to assess the available evidence regarding the efficacy of HA in management of RAS. METHODS Two reviewers independently conducted extensive search in four online databases (PubMed, Scopus, Web of Science, and Google Scholar) and the gray literature, with no restriction to date or language of the publication. All clinical trials that assessed the efficacy of HA in reducing signs and symptoms of RAS were included. Risk of bias was assessed by two reviewers independently, using the Cochrane assessment tool. Due to substantial heterogeneity, no meta-analysis was feasible. RESULTS Out of the 75 identified articles, nine clinical trials involving 538 RAS patients (259 in HA group) were included. The risk of bias was high in five studies, low in one study, and unclear in three studies. The comparative groups varied greatly across the included studies: triamcinolone (in three studies), chlorhexidine mouthwash, lidocaine, placebo, iodine glycerin, diclofenac, and laser therapy. Overall, the results revealed a good efficacy of HA in alleviating pain and shortening the healing time of RAS, without any reported side effects. Compared to triamcinolone, HA showed superior results in one study, and comparable results in two studies. CONCLUSIONS The available evidence suggests that HA is a promising treatment option for RAS. However, given the huge heterogeneity of the included studies and high risk of bias in some of these studies, the evidence is inconclusive. Further well-designed clinical trials with standardized methodologies and adequate sample sizes are warranted to discern the efficacy of HA for RAS. CLINICAL RELEVANCE Hyaluronic acid might be a viable alternative therapeutic option for patients with RAS.
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Affiliation(s)
- Sadeq Ali Al-Maweri
- Department of Oral Medicine and Diagnostic Sciences, Vision College of Dentistry and Nursing, Riyadh, Saudi Arabia.,College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.,Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Sana'a, Yemen
| | - Nader Alaizari
- Department of Oral Medicine and Diagnostic Sciences, Vision College of Dentistry and Nursing, Riyadh, Saudi Arabia
| | - Rawan Hejji Alanazi
- Department of Oral and Maxillofacial Surgery, Vision College of Dentistry and Nursing, Riyadh, Saudi Arabia
| | - Sajna Ashraf
- Department of Oral Medicine and Diagnostic Sciences, Vision College of Dentistry and Nursing, Riyadh, Saudi Arabia.
| | | | - Hesham Mohammed Al-Sharani
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen.,Department of Maxillofacial Surgery, School of Stomatology, Harbin Medical University, Harbin, China
| | - Esam Halboub
- Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Sana'a, Yemen.,Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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