Buccal films as a dressing for the treatment of aphthous lesions

Topical Licorice for Aphthous: A Systematic Review of Clinical Trials

Background

Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects oral mucosa. The coating agents, topical analgesics, and topical steroids are usually used as treatment methods. Glycyrrhiza glabra has been used for RAS treatment based on its anti-inflammatory, antioxidant, and immunomodulatory properties. In this study, a systemic review on the therapeutic effect of topical licorice on RAS management was performed.

Methods

Science Direct, Scopus, Cochrane databases, PubMed Google Scholar, and ResearchGate were searched up to September 2021 to find all English randomized clinical trials studying the effect of G. glabra, or its compositions on RAS. Meta-analysis was not conducted because of data heterogeneity. Articles were reviewed qualitatively, and only those with a Jadad score ≥3 were included. Animal studies, in vitro, review papers, non-English papers, and case reports were excluded.

Results

Six studies with 314 subjects were included after screening. The result showed licorice has significant effects on RAS pain reduction, ulcer size, and healing time. Its effectiveness is related to its dose-dependent anti-inflammatory and antioxidant effects through several mechanisms. It also has antibacterial effects against Streptococci mutans and Porphyromonas gingivalis as another mechanism of action in RAS treatment. In addition, licorice can elevate the epidermal growth factor (EGF) level compared to the control group, which has an essential role in oral mucosal tissue integrity.

Conclusion

Licorice extract has been used in different dosage forms, including paste, patch, and mouthwash with concentrations of 1% or 5%. The healing time after licorice therapy is expected to be within 4-8 days. Licorice did not show any adverse effect in the intervention groups, indicating its effectiveness and safety in RAS treatment.

Minor Recurrent Aphthous Ulcer Management with Hyaluronic Acid Gel in an Italian Cohort: A Double-Blind Randomized Clinical Trial

Background. Recurrent aphthous ulcer is a common mucosal disease and encompasses diverse interventions for its management of symptoms like pain and discomfort. Since new therapies keep evolving with better outcomes as compared to traditional interventions, one such therapy using hyaluronic acid has been recently explored using clinical studies based on advances in dental therapeutics. Therefore, we designed this clinical study which is double blinded and randomized using minor recurrent aphthous cases. Objective. To evaluate the efficacy of hyaluronic acid topical oral gel in the treatment of minor RAS ulcers, with regard to pain relief and reduction in ulcer size. Design. A double-blind randomized controlled clinical trial was designed to conduct an experimental research at IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan. The participants were recruited from the unit of oral maxillofacial surgery and randomly assigned to test (hyaluronic acid gel) and control groups (placebo gel). 1 : 1 computer-generated random sequence was prepared, and opaque closed envelopes were used for allocation concealment. Participants and clinical investigators were blinded. The outcome measures included ulcer size (mm) and the visual analogue scale for pain and healing as a secondary outcome measure (efficacy index). Results. The mean baseline score for ulcer size for the test group was $1.85\pm 1$ and the placebo group was $1.85\pm 1.2$ . At day 7, the test group was $1\pm 1.5$ and the placebo group was $2\pm 1.5$ ( $p<0.001$ ). There was significant reduction in ulcer size as compared to the placebo group. In addition, there was significant improvement in pain levels ( $p<0.01$ ) in the test group as compared to the control group. Conclusion. In conclusion, there was significant decrease in the size of the ulcer in the test group as compared to the placebo group. Hyaluronic acid seems to have promising effects on the ulcer size and pain relief associated with minor aphthous ulcers. Trial Registration. The protocol of this clinical trial was registered with the Clinical Trial Registry of ISRCTN with study ID ISRCTN16509838, registered 30 June 2020. It can be accessed on this URL: 10.1186/ISRCTN16509838

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

Conventional topical medications for recurrent aphthous ulcers (RAU) are limited due to the washing effects of saliva and activities of masticatory muscle decreasing the local effective drug concentration. To overcome...

The efficacy of herbal medicine in the treatment of recurrent aphthous stomatitis: A systematic review of randomized clinical trials

This systematic review was undertaken with the main aim of assessing the therapeutic effects of herbal medicines in recurrent aphthous stomatitis (RAS). A comprehensive search was performed in PubMed, Scopus, ISI Web of Science, and Google Scholar up to July 2021 to identify randomized clinical trials investigated the effects of herbal medicines on RAS. Thirty-three papers comprising 2,113 patients met the eligibility criteria, of which 30 studies had a high quality based on the Jadad scale. Totally, 22 out of 30 studies which assessed the pain showed that herbal agents significantly decreased the pain compared with the control group or placebo. In 17 out of 25 studies that evaluated ulcer size, herbal agents significantly reduced the size of ulcers compared with the control or placebo groups. In 15 out of 18 studies that assessed the healing time, herbal agents significantly reduced healing time in the intervention groups compared with the placebo or control groups. Few adverse events were reported only in four studies. Findings of the current review indicated medicinal plants and phytochemicals as effective and safe agents that for the treatment of RAS.

Nanocellulose-Based Patches Loaded with Hyaluronic Acid and Diclofenac towards Aphthous Stomatitis Treatment

Nanostructured patches composed of bacterial nanocellulose (BNC), hyaluronic acid (HA) and diclofenac (DCF) were developed, envisioning the treatment of aphthous stomatitis. Freestanding patches were prepared via diffusion of aqueous solutions of HA and DCF, with different concentrations of DCF, into the wet BNC three-dimensional porous network. The resultant dual polysaccharides-based patches with a nanostructured morphology present thermal stability up to 200 °C, as well as good dynamic mechanical properties, with a storage modulus higher than 1.0 GPa. In addition, the patches are non-cytotoxic to human keratinocytes (HaCaT cells), with a cell viability of almost 100% after 24 h. The in vitro release profile of DCF from the patches was evaluated in simulated saliva, and the data refer to a diffusion- and swelling-controlled drug-release mechanism. The attained results hint at the possibility of using these dual polysaccharides-based oral mucosal patches to target aphthous stomatitis.

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

BACKGROUND

Recurrent or occasional aphthous lesions represent a painful oral condition with high prevalence. Since the etiology is still unclear and most likely related to a dysfunction in the local immune system, several treatment strategies have been proposed, including systemic agents, local agents, and laser therapy, to reduce the pain and discomfort for the patient without acting on the causes.

MATERIALS AND METHODS

The purpose of the present randomized study was to assess the clinical efficacy of a new topical gel with mucoadhesive property to reduce the pain and the dimension of the aphthosis lesions. Fifty patients presenting at least one minor ulcer were randomized to a control group (placebo prescription), a first test group (topical agent with laser), and a second test group (topical agent only). The healing rate, the visual analog scale (VAS) score for pain, and the diameter reduction were monitored for 10 days.

RESULTS

Both test groups showed better results than control group, significant clinical efficacy, and a median total reduction time of 4 days with no significant adjunctive benefit from the use of laser.

CONCLUSION

The clinical results are encouraging; nevertheless other studies are needed to valid this kind of treatment.

CLINICAL SIGNIFICANCE

The present randomized clinical study suggested that the use of topical mucoadhesive agents could represent a valid therapy for minor aphthous lesions. How to cite this article: Giammarinaro E, Cosola S, Oldoini G, et al. Local Formula with Mucoadhesive Property: A Randomized Clinical Trial of a Therapeutic Agent for the Treatment of Oral Aphthous Ulcers. J Contemp Dent Pract 2019;20(11):1249-1253.

Effect of a Misoprostol/Phenytoin Gel on Experimentally Induced Wounds in Brook Trout-A Preliminary Study

Topical treatment for wound management in fish is challenging due to their aquatic life. The objective of the present study was to assess the effect of a topical gel containing misoprostol and phenytoin on the healing of skin wounds in Brook Trout Salvelinus fontinalis. Four 16- × 8-mm, full-thickness wounds were created in each trout. Fish were randomly assigned either to the misoprostol/phenytoin group (14 fish) or to the untreated control group (5 fish). In fish from the misoprostol/phenytoin group, two randomly selected wounds were topically treated with a misoprostol/phenytoin gel, while the other two wounds were left without topical treatment. Follow-up and treatment were performed every 5 d for 120 d. Different macroscopic healing indexes were recorded over time, and histological characteristics of each wound were scored at the end of the study. Treatment with misoprostol/phenytoin was associated with delayed epithelialization and wound maturation in comparison with contralateral untreated wounds. The treatment was also associated with lower histological inflammation scores and increased dermal neovascularization. The untreated wounds of fish in the misoprostol/phenytoin group showed delayed maturation and decreased healing speed and had lower inflammation scores and increased neovascularization compared to untreated control wounds. Topical treatment of wounds in Brook Trout with misoprostol/phenytoin gel at the concentration used had a local and systemic deleterious effect on wound healing. The results of the present study do not support the use of this gel at this dosage for the treatment of wounds in Brook Trout.

Recurrent aphthous ulceration: a review of potential causes and novel treatments

Purpose of article: This review examines studies published between May 2012 and 2017 with a specific interest in potential recurrent aphthous ulceration (RAU) etiologies and treatment modalities/efficacy, including topical treatments, systemic regimens, vitamin repletion, and laser therapy, among others.

MATERIALS AND METHODS

PubMed MEDLINE and Cochrane Database of Systematic Reviews were searched using various combinations of: 'aphthous', 'ulcer', and 'treatment'. The titles and abstracts from the initial literature search were appraised to identify articles for full review and reference sections from each article were searched manually for relevant publications. Both randomized controlled trials and observational reports were included in this review, as some treatment types have not been formally examined in randomized trials. Relevant studies were reviewed, compared, and summarized.

RESULTS

RAU can result from systemic disease and trauma, but recent studies have shown a variety of potential etiologies, ranging from vitamin deficiencies, oral microbiota derangements, hematological considerations, stress, genetic polymorphisms to oxidant-antioxidant imbalances, among others. Many modalities of therapy are available and have proven efficacious.

CONCLUSIONS

As the exact etiology of RAU is still unknown, therapy is based on symptomatic relief.

An overview of polymeric dosage forms in buccal drug delivery: State of art, design of formulations and their in vivo performance evaluation

Owing to the ease of the administration, the oral cavity is an attractive site for the delivery of drugs. The main difficulty for administration via the buccal route is an effective physiological removal mechanism of the oral cavity that takes way the formulation from the buccal site and decreases the bioavailability of drugs. The use of mucoadhesive polymers in buccal drug delivery shows assessing buccal drug permeation and absorption, however some studies bring an in vivo performance. This review points to the use of polymers in the manufacture of drug delivery systems (hydrogels, films and tablets) and shows the results of their in vivo performance tests.