Effect of lactobacillus reuteri-derived probiotic nano-formulation on recurrent aphthous stomatitis: a double-blinded randomized clinical trial

OBJECTIVES

We aimed to assess the therapeutic effects of a topical probiotic nano-formulation derived from Lactobacillus reuteri on treating recurrent aphthous stomatitis.

MATERIALS AND METHODS

60 participants were randomly allocated into two groups (control and probiotic). Probiotic group administered topical probiotic nano-formulation three times a day for seven days. The control group administered a standard analgesic oral rinse. The size of ulcer(s) and pain severity were recorded on days 0, 3, 5, and 7 after intervention.

RESULTS

Before the intervention, the groups had no significant differences in terms of pain severity (P-value = 0.28) and lesion size (P-value = 0.24). Both groups exhibited significant reductions in pain severity and lesion size over the course of the intervention. After one week, the probiotic group had a notably larger lesion size reduction than the control group (P-value = 0.01). The probiotic group also showed a significantly greater reduction in pain severity than the control group (P-value = 0.04).

CONCLUSIONS

Applying topical probiotic nano-formulation derived from Lactobacillus reuteri three times a day decreased lesion size and pain severity in RAS patients faster than the local analgesic oral rinse.

CLINICAL RELEVANCE

Lactobacillus reuteri-derived probiotic nano-formulation might be a promising treatment option for RAS.

Systematic review and meta-analysis of oxidative stress and antioxidant markers in recurrent aphthous stomatitis

BACKGROUND

We performed this systematic review and meta-analysis to synthesize all studies that reported the level of oxidative and antioxidative markers in recurrent aphthous stomatitis (RAS) patients compared to controls.

METHODS

We registered our study in PROSPERO (CRD42023431310). PubMed, ProQuest, Scopus, EMBASE, Google Scholar, and Web of Science were searched to find relevant publications up to June 5, 2023. The standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. We included 30 articles after multiple stags of screening.

RESULTS

We found that erythrocyte superoxide dismutase and Glutathione peroxidase activity were significantly lower in patients with RAS compared to healthy controls (SMD = - 1.00, 95%CI = -1.79 to -0.21, p = 0.013, and SMD = - 1.90, 95%CI = -3.43 to -0.38, p = 0.01, Respectively). However, there was not any difference between patients with RAS and healthy controls in erythrocyte Catalase (SMD = - 0.71, 95%CI = -1.56-0.14, p = 0.10). The total antioxidant status (TAS) level, in serum was significantly lower in patients than healthy controls (SMD = - 0.98, 95%CI = -1.57 to -0.39, p = 0.001). In addition, RAS patients had higher levels of serum Malondialdehyde (MDA), Serum total oxidant status, and serum oxidative stress index than healthy controls (SMD = 2.11, 95%CI = 1.43-2.79, p < 0.001, SMD = 1.53, 95%CI = 0.34-2.72, p = 0.01, and SMD = 1.25, 95%CI = 0.25-2.25, p = 0.014, Respectively); However, salivary MDA and TAS, and serum uric acid, vitamin E and C, and reduced glutathione levels of patients with RAS were not different from that of healthy controls.

CONCLUSIONS

The relationship between oxidative stress and RAS is well established in this meta-analysis. Although the molecular processes underlying the etiology of this pathology remain unknown, evidence indicating oxidative stress has a significant role in the pathogenesis of RAS has been revealed.

Lifetime prevalence of recurrent aphthous stomatitis and its related factors in Northern Iranian population: The PERSIAN Guilan Cohort Study

OBJECTIVES

Recurrent aphthous stomatitis (RAS) is one of the most prevalent oral inflammatory ulcerative lesions. The aim of this large population base study was estimated lifetime prevalence of RAS and its related factors among the Northern Iranian population.

MATERIALS AND METHODS

This study was conducted on 10,520 participants aged 35-70 years based on the PERSIAN Guilan Cohort Study (PGCS). Prevalence proportions and multivariate logistic regression models were constructed for lifetime RAS prevalence using the SPSS software. Data on potential correlates of RAS including demographic profiles, lifestyle habits, and self-reported past medical histories were obtained.

RESULTS

The lifetime prevalence of RAS was 8.3%. Multivariate logistic models showed that urbanization (adjusted odds ratio (AOR) = 1.2) and having a history of systemic disease, including rheumatic disease (AOR = 2.1), genital aphthous disease (AOR = 11.7), depression (AOR = 1.3), chronic headaches (AOR = 1.8), diabetes mellitus (AOR = 1.6), and epilepsy (AOR = 2), were independent predictors of RAS. In addition, smokers (AOR = 0.5) and individuals older than 50 years of age (AOR = 0.8) were less likely to have a history of RAS. The lifetime prevalence of RAS among the Northern Iranian population was relatively low.

CONCLUSIONS

It seems that predisposing factors, such as younger age, urbanization, and systemic disease, including rheumatic disease, genital aphthous disease, depression, chronic headaches, diabetes mellitus, epilepsy, and not smoking, could contribute to RAS prevalence.

Evaluation of the effect of probiotic lozenges in the treatment of recurrent aphthous stomatitis: a randomized, controlled clinical trial

OBJECTIVES

The study aimed to explore the effectiveness of probiotics in the treatment of minor recurrent aphthous stomatitis (RAS).

MATERIALS AND METHODS

We performed a randomized, controlled clinical study. Sixty adult (group A) and 60 children patients (group B) with diagnosis of minor RAS were included. Both groups were divided into two subgroups; AI and BI (test subgroups) and AII and BII (control subgroups). For test subgroups, probiotic lozenges were consecutively administered twice daily, for 5 days. The size and pain level of ulcers were recorded on treatment days 0, 3, and 5. The outbreak frequency of RAS within 6 months was investigated for all subgroups.

RESULTS

Compared with baseline, an improvement was evident for all subgroups. However, for effectiveness in pain reduction, a statistically significant difference in favor of AI was observed for all evaluation periods when compared with control subgroup. Regarding effectiveness in ulcer size reduction, a statistically significant difference in favor of BI was observed at day 5 when compared with control subgroup. No significant difference was observed in the effectiveness index between subgroups AI and BI (test subgroups) except in effectiveness in pain reduction at day 3. The outbreak frequency decreased significantly in subgroup BI.

CONCLUSIONS

Topical application of probiotics decreased pain intensity and accelerates RAS healing. The effectiveness in pain reduction is more evident in adult patients while acceleration of healing is more evident in children.

CLINICAL RELEVANCE

Probiotics could be a well-tolerated, topical therapeutic agent in the treatment of minor RAS.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT04383236.

Silent celiac disease in dermatology

INTRODUCCIÓN

La enfermedad celíaca puede estar asociada de forma silente a varias enfermedades de la piel y las mucosas.

OBJETIVO

Determinar la frecuencia de enfermedad celíaca en portadores de urticaria crónica, vitíligo, alopecia areata, psoriasis y estomatitis aftosa, en el Hospital Nacional de Itauguá, Paraguay, en los años 2017 y 2018.

MATERIAL Y MÉTODOS

Diseño observacional de corte transversal, prospectivo. Se determinaron los anticuerpos IgA antitransglutaminasa tisular e IgA sérica en pacientes adolescentes y adultos que otorgaron su consentimiento informado. En los casos positivos se realizó la confirmación histológica con biopsias duodenales.

RESULTADOS

Se incluyeron 79 pacientes, con predominio del sexo femenino (75%). La mediana de edad fue de 33 años y el índice de masa corporal medio fue de 24.7 kg/m2. La enfermedad celíaca se demostró histológicamente en 4 de 32 portadores de estomatitis aftosa, en 2 de 24 con vitíligo y en 1 de 17 con alopecia areata. No se detectó en pacientes con urticaria crónica ni psoriasis.

CONCLUSIÓN

La frecuencia de enfermedad celíaca confirmada histológicamente en pacientes con estomatitis aftosa, vitíligo o alopecia areata fue del 8.8%.

BACKGROUND

Silent celiac disease may be associated to various skin and mucous membranes diseases.

OBJECTIVE

Determine the frequency of celiac disease in carriers of chronic urticaria, vitiligo, alopecia areata, psoriasis and aphthous stomatitis treated in the National Hospital of Itauguá, Paraguay, in years 2017 and 2018.

MATERIAL AND METHODS

An observational cross-sectional, prospective design was used. IgA tissue antitransglutaminase antibody and serum IgA was determined in adolescents and adult patients who gave their informed consent. In positive cases, histological confirmation was performed with duodenal biopsies.

RESULTS

79 patients were included, with a predominance of females (75%). Median age was 33 years, and the average body mass index 24.7 kg/m2. Celiac disease was demonstrated histologically in 4/32 carriers of aphthous stomatitis, in 2/24 with vitiligo, and in 1/17 with alopecia areata. It was not detected in patients with chronic urticaria or psoriasis.

CONCLUSION

Frequency of celiac disease histologically confirmed in patients with aphthous stomatitis, vitiligo or alopecia areata was 8.8%.

Comparative Study of Punica granatum Gel and Triadent Oral Paste Effect on Recurrent Aphthous Stomatitis, a Double Blind Clinical Trial

Statement of the Problem

Recurrent aphthous stomatitis is a common oral lesion, and the use of herbal remedies containing tannin and flavonoid has been reported to be effective in treating aphthous stomatitis.

Purpose

This study was aimed to evaluate the effect of Punica granatum muco-adhesive gel on controlling the oral recurrent aphthous stomatitis and its comparison with Triadent oral paste.

Materials and Method

In this double-blind clinical trial, 60 patients with minor aphthous stomatitis were enrolled. These patients had no systemic diseases and were not on any medications. The patients were randomly treated with Punica granatum formulated gel, Triadent oral paste and placebo. The time of pain elimination and the time of complete healing were recorded and the pain degree was assessed and recorded by each patient. The data were analyzed using survival analysis and ANOVA test.

Results

The Kaplan-Meier survival analysis demonstrated that pain relief time in Punica granatum group was lower than placebo group (p= 0.002), even so, it caused no significant difference with the Triadent group in comparison with the placebo group (p= 0.08). The survival analysis also indicated that the wound healing time in Punica granatum group was significantly lower than the other two groups (p< 0.05).

Conclusion

Punica granatum gel has a successful effect in controlling and treating recurrent aphthous stomatitis. It can be considered as an affordable and inexpensive treatment.

A novel prognostic biomarker for recurrent aphthous stomatitis: calprotectin

OBJECTIVE

This study aims to investigate whether there is a correlation between serum calprotectin concentration and oral ulcer activity in patients with active recurrent aphthous stomatitis.

METHOD

This prospective, cross-sectional, historical cohort study included 52 patients (26 with active lesions and 26 with inactive lesions) with recurrent aphthous stomatitis and 27 healthy volunteers. The relationship between the groups was statistically evaluated in terms of serum calprotectin level and other inflammatory parameters.

RESULTS

The median calprotectin value of the active lesion group (80.5 ng/ml) was significantly higher than that of the control group (55.4 ng/ml, p = 0.002). Furthermore, the median calprotectin value of the active lesion group was significantly higher than that of the inactive lesion group (72.5 ng/ml, p = 0.017).

CONCLUSION

In patients with recurrent aphthous stomatitis and active ulcer lesions, the serum calprotectin value can be used as a reliable and robust prognostic marker for inflammation.

Therapeutic benefits of liquorice in dentistry

Oral health influences general well-being and quality of life. Oral diseases can be debilitating and are a major heath concern worldwide. Medicinal plants have been used for thousands of years for treating human diseases. Considering the emergence of multi-drug resistant pathogens and financial difficulties in developing countries, there is an urgent need for developing new antimicrobial compounds which are safe, efficient and cost effective. Liquorice also known as yashtimadhu, sweetwood or mulhatti is one such herbal remedy which has shown to have immense potential in treatment of orofacial diseases. Liquorice is rich in secondary metabolites which are used in cosmetics, foods, traditional and modern medicine. It has well known properties such as antiviral, glucocorticoid, anti-inflammatory, antioxidant, anti-ulcerative, anti-carcinogenic and many more. Liquorice extracts and liquorice bioactive ingredients such as glabridin, licoricidin, licorisoflavan A, licochalcone A, and glycyrrhizin have shown beneficial effects in preventing and treating oral diseases. This paper reviews the effects of liquorice and its constituents on oral diseases such as dental caries, periodontitis, gingivitis, candidiasis, recurrent aphthous ulcer and oral cancer and its use as a root canal medicament and summarizes the results of clinical trials that investigated the potential beneficial effects of liquorice and its constituents as a prevention and treatment modality in oral diseases. Clinical trials, case reports and review of literature evaluating the effect of liquorice on oral microorganisms and oral diseases are included. Literature pertaining to the effects of liquorice on systemic diseases have been excluded from this review of literature.

The association between minor recurrent aphthous stomatitis (RAS), children's poor oral condition, and underlying negative psychosocial habits and attitudes towards oral hygiene

BACKGROUND

Minor Recurrent Aphthous Stomatitis (RAS) represents a disease which is very difficult to prevent. This case-control study focused on possible associations between minor Recurrent Aphthous Stomatitis in children, their oral health, and underlying behavioral indexes of children's attitudes and habits pertaining to (home) oral hygiene, with the further goal of enabling the dentist to prevent these specific kind of lesions, both from a clinical and a broader psychosocial perspective.

METHODS

Four hundred one school-children (5-10 years old) in Milan (Italy) were submitted to an intra-oral examination, and interviewed with the aid of a brief psychosocial questionnaire.

RESULTS

At the clinical level, statistically significant associations were observed between the presence of decayed teeth and minor Recurrent Aphthous Stomatitis (Odds Ratio: 3.15; 95% CI: lower limit 1.06; upper limit: 9.36; Z-test: 2.07, p = 0.039; Chi-square = 4.71, p = 0.030), and between the Decayed Missing or Filled Teeth (DMFT) index and minor aphthous stomatitis (Odds Ratio: 3.30; 95% CI: lower limit 1.13; upper limit: 9.67; Z-test = 2.18, p = 0.029; Chi-square = 5.27; p = 0.022), both results pointing to a significant increase-by circa 3 times-in the risk of developing minor Recurrent Aphthous Stomatitis in children exposed to the two above-identified factors (i.e., the presence of decayed teeth and a clearly compromised oral condition, as signaled by the DMFT index), if compared with the risk run by their non-exposed counterparts. At the psychosocial level of analysis, statistically significant associations were observed (1) between children's practice of spontaneously brushing teeth when not at home and a comparatively lower (i.e. better) Decayed Missing or Filled Teeth index (Chi-square: 8.95; p = 0.011), and (2) between receiving parental aid (e.g., proper brushing instructions) while practicing home oral hygiene and a significantly reduced presence of decayed teeth (Chi-square = 5.40; p = .067; Spearman's Rho, p = .038). Further, significant associations were also observed between children's reported severity of dental pain and both (a) the presence of decayed teeth (Chi-square = 10.80; p = 0.011), and (b) children's (poor) oral health condition as expressed by the Decayed Missing or Filled Teeth index (Chi-square = 6.29; p = 0.043). Interestingly, specific lifestyles and social status, showed no systematic association to other clinical or psychological/psychosocial indices.

CONCLUSIONS

These systematic relations suggest that, in the presence of Recurrent Aphthous Stomatitis in pediatric patients, the dentist should carefully monitor children for potential carious lesions, implement protocols of prevention to control Recurrent Aphthous Stomatitis disease in children affected by caries, and also be particularly aware of the right or wrong habits children may acquire in the course of continued social exchange with their caregivers and peers.

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.

Association of Transforming Growth Factor-Beta Gene Polymorphisms in Recurrent Aphthous Stomatitis

This study has been conducted to evaluate the allele, genotype and haplotype frequencies of the polymorphic gene coding TGF-β in recurrent aphthous stomatitis (RAS). TGF-β gene typing was done by polymerase chain reaction with sequence-specific primers (PCR-SSP) assay. Allele frequencies were estimated by direct gene counting. C allele at codon 25 was significantly increased, while G allele at this position was significantly decreased in patients compared to the controls. A significantly higher frequency of CG genotype at codon 25 was found in control group. CC genotype and TT genotype at codon 10 of the gene was significantly decreased, while CT genotype at the same position was significantly increased in patients, indicating that CT heterozygosity at codon 10 TGF-β is associated with greater risk of RAS. CG and TG haplotypes were significantly decreased while CC and TC haplotypes were significantly increased in patients compared with controls. This study indicates the TGF-β single nucleotide polymorphisms could play a role in RAS pathogenesis. Thereby certain SNPs of TGF-β gene have an association with RAS pathogenesis.

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

CONTEXT

Recurrent aphthous ulcer (RAU) is an oral disease and the most common oral lesion, with 2% to 66% of the world's population infected annually. Its prevalence is about 25% in Tehran and 27.6% in Mashhad. The etiology of RAU is multifactorial. Aphthous risk factors include: immunological factors, psychological factors, stress, trauma, sensitivity, family history, blood disorders, malnutrition, and use of certain medications, It should be noted that the best treatment for RAU is the topical application of drugs. The use of topical treatments is recommended not only because the drug can directly impact the source of the disease, but also systemic side effects of the drug are reduced. Treatment of RAU has been considered in Iranian traditional medicine (ITM), and is covered in therapeutic books. The use of herbs in RAU has a centuries-old history; accordingly, extensive research should be conducted for this treatment of the disease.

EVIDENCE ACQUISITION

Iranian medical sources were reviewed and effective plants used in the traditional treatment of RAU were found and compared with new findings. Finally, we have created a table listing the plants that are part of the therapeutic protocol for RAU.

RESULTS

Based on this article we can explain some of traditional pharmacological effects of plants and how these plants can be a source for a cure.

CONCLUSIONS

The plants listed can be used as a prediction of RAU management. Of course, there are is no evidence for curing RAU by some of these plants in allopathic medicine, and the further investigations in this area could lead to the discovery of a new drug.

Efficacy of alum for treatment of recurrent aphthous stomatitis

BACKGROUND

Recurrent aphthous stomatitis (RAS) is the most common painful ulcers of oral mucosal which can cause many sufferings. Treatment of RAS often includes administration of corticosteroids, analgesics and regulators of the immune system. However, considering the side effects of these medications, even their topical application must be done with caution. Alum is used in traditional medicine for treatment of oral ulcers without significant side effect. This study sought to assess the effect of topical application of alum on aphthous ulcers.

METHODS

This clinical randomized double-blind placebo-controlled study was conducted on 50 females aged 21 to 27 years. Mucosal adhesive patches were prepared in two forms of basic and 7% alum-containing patches. Subjects in two groups of case and control randomly received the mucosal adhesive patches containing alum and the basic patches, respectively three times in five days. Duration of recovery, changes in size of lesion and severity of pain were recorded. Data were entered into SPSS Version 16 and analyzed using t-test.

RESULTS

The average period of full recovery was 7.52 days in the case and 12.2 days in the control groups; which was significantly different (p<0.001). Size of wound and severity of pain were significantly lower at one, three and five days posttreatment compared to baseline values before treatment in the case group (p<0.001) and the difference in this regard between the case and control groups was statistically significant.

CONCLUSION

Alum can significantly decrease the size of aphthous lesions, severity of pain and expedite the recovery of patients with RAS.

Oral manifestations of allergic, infectious, and immune-mediated disease

Patients often have oral symptoms, and physicians frequently identify lesions during routine oral examination. Being able to associate these concerns and findings with systemic disease is important to providing effective management of these conditions. This review summarizes the etiology, presentation, and treatment of many oral lesions associated with systemic diseases and infections. The primary focus was on lesions associated with allergic, infectious, and immune-mediated disease; however, other common concerns are addressed as well as lesions that may be misinterpreted as disease and how to address unknown lesions.

Oral mucosal diseases: evaluation and management

Oral mucosal diseases encompass several common conditions that affect the general population. Some of these disorders present with signs and symptoms that are pathognomonic for the condition, whereas others present with similar features that can make clinical diagnosis difficult to achieve. It is important for physicians to have a clear understanding of these disorders to provide appropriate care to patients. This article reviews clinical aspects of common oral mucosal disorders, including candidiasis, herpes simplex viral infections, aphthous stomatitis, lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid.

The efficacy of Punica granatum extract in the management of recurrent aphthous stomatitis

Objective:

Recurrent aphthous stomatitis (RAS) is a common, painful ulcerative disorder of the oral cavity with unknown etiology. No documented cure exists and topical application of medications aims to reduce pain associated with this condition. The aim of this study was to evaluate the efficacy of Punica granatum (PG) extract on the clinical management of RAS.

Methods:

A total of 40 patients with RAS participated in this randomized, double-blind, and placebo-controlled study. During three episodes of RAS, the efficacy of topical PG gel (10%) was evaluated. Patients were randomly assigned to use placebo gel or PG gel daily. The time of pain elimination and the time of complete healing were recorded and the pain degree was assessed and recorded by each patients in different time intervals including: Before using the oral gel (day 0), and on days 1, 3, 5, 7 after using the product. Data were analyzed using the repeated measures ANOVA, paired and independent t-test.

Findings:

Mean time of pain elimination showed a significant difference (P < 0.001) between PG group (3.4 ± 1.09) and placebo group (5.9 ± 0.6). The mean duration of complete healing also showed a significant difference (P < 0.001) between PG group (5.3 ± 0.81) and placebo group (8.6 ± 0.99). The visual analog scale score in PG group was significantly less than the placebo group in all time intervals (day 1 to day 7) (P < 0.001).

Conclusion:

The findings of this study revealed that PG extract in the form of oral gel (10%) may be beneficial in reducing RAS pain and has a positive effect in reducing the overall time period of complete healing. It was concluded that PG is an effective herbal medicine for the management of RAS.

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease affecting the oral mucosa. RAS occurs mostly in healthy individuals and has an atypical clinical presentation in immunocompromised individuals. The etiology of RAS is still unknown, but several local, systemic, immunologic, genetic, allergic, nutritional, and microbial factors, as well as immunosuppressive drugs, have been proposed as causative agents. Clinical management of RAS using topical and systemic therapies is based on severity of symptoms and the frequency, size, and number of lesions. The goals of therapy are to decrease pain and ulcer size, promote healing, and decrease the frequency of recurrence.