Systemic immune inflammation index in patients with recurrent aphthous stomatitis / Índice de inflamação imune sistêmica em pacientes com estomatite aftosa recorrente

Abstract Objectives: Recurrent Aphthous Stomatitis (RAS) a chronic idiopathic oral mucosal disease. But yet the etiology and pathogenesis of RAS are not exactly known, it is thought that inflammation play an important role in the pathogenesis. The aim of this study is to demonstrate the role of systemic inflammation among the possible etiological factors of RAS and to find the possible diagnostic correlation between Systemic Immune Inflammation Index (SII). Methods: Patients who were consulted the otolaryngology outpatient clinic and diagnosed with RAS between 2019-2021 were retrospectively analyzed. Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR) and SII values were calculated based on the results of complete blood count. Demographic and hematological parameters between control and RAS groups were compared. The statistical significance level was considered as <0.05. Results: There was no statistically significant difference between the control and RAS groups in terms of sex and age distributions (p = 0.566 and p = 0.173, respectively). SII, NLR and PLR values were significantly higher in the RAS group compared to the controls (p < 0.001, p < 0.001 and p = 0.001, respectively). A very strong correlation between SII and NLR, moderately strong correlation between SII and PLR and moderate correlation between NLR and PLR values were detected (respectively ρ: 0.813, 0.719, 0.532; p-values <0.001). Conclusion: SII, NLR and PLR has significantly higher levels in the RAS group compared to the control group, that it supports the role of systemic inflammation in the etiopathogenesis of RAS. In addition, the results show that SII is a valuable marker for inflammation. Level of evidence: 4. HIGHLIGHTS RAS is a chronic, idiopathic, ulcerative oral mucosal disease. SII is a new and inexpensive biomarker that can easily be calculated using the platelet, neutrophil, and lymphocyte count. SII may be a valuable marker to demonstrate the role of systemic inflammation in RAS etiopathogenesis. Vascular, thrombotic, and inflammatory processes are thought to have a role in RAS activation.

Resumo Objetivo: A estomatite aftosa recorrente (EAR) é uma doença crônica idiopática da mucosa oral. Embora sua etiologia e patogênese não sejam totalmente conhecidas, acredita-se que a inflamação possa desempenhar um papel importante. O objetivo deste estudo é demonstrar o papel da inflamação sistêmica entre os possíveis fatores etiológicos da estomatite aftosa recorrente e encontrar uma possível correlação diagnóstica com o índice de inflamação imunológica sistêmica, SII. Método: Foram analisados retrospectivamente pacientes avaliados no ambulatório de otorrinolaringologia e diagnosticados com estomatite aftosa recorrente entre 2019-2021. A relação neutrófilos/linfócitos, a relação plaquetas/linfócitos e os valores de SII foram calculados com base nos resultados do hemograma completo. Parâmetros demográficos e hematológicos dos grupos controle e de pacientes foram comparados. O nível de significância estatística foi considerado como <0,05. Resultados: Não houve diferença estatisticamente significante entre os grupos controle e com estomatite aftosa recorrente quanto à distribuição por sexo e idade (p = 0,566 e p = 0,173, respectivamente). Os valores de SII, a relação neutrófilos/linfócitos e a relação plaquetas/linfócitos foram significantemente maiores no grupo de pacientes em relação aos controles (p <0,001, p <0,001 e p = 0,001, respectivamente). Foi detectada uma correlação muito forte entre SII e relação neutrófilos/linfócitos, uma correlação moderadamente forte entre SII e relação plaquetas/linfócitos e uma correlação moderada entre valores da relação neutrófilos/linfócitos e relação plaquetas /linfócitos (ρ: 0,813, 0,719, 0,532 respectivamente; p-valores <0,001). Conclusão: SII, relação neutrófilos/linfócitos e relação plaquetas/linfócitos apresentam níveis significantemente maiores no grupo com estomatite aftosa recorrente quando comparados ao grupo controle, o que corrobora o papel da inflamação sistêmica na sua etiopatogênese. Além disso, os resultados mostram que o SII é um marcador inflamatório valioso. Nível de evidência: 4. HIGHLIGHTS A estomatite aftosa recorrente é uma doença ulcerativa crônica idiopática da mucosa oral. O SII (do inglês Systemic Immune Inflammation Index) é um biomarcador novo e de baixo custo que pode ser facilmente calculado que usa a contagem de plaquetas, neutrófilos e linfócitos. O SII pode ser um marcador valioso para demonstrar o papel da inflamação sistêmica na etiopatogênese da estomatite aftosa recorrente. Acredita-se que processos vasculares, trombóticos e inflamatórios tenham um papel na ativação da estomatite aftosa recorrente.

Tratamiento de la estomatitis aftosa recurrente en pacientes inmunocomprometidos. Revisión sistemática / Treatment of recurrent aphthous stomatitis in immunocompromised patients. Systematic review

RESUMEN Fundamento: Aunque la estomatitis aftosa recurrente no tiene una etiología bien definida porque es una enfermedad multicausal, se ha reconocido que las interacciones o el debilitamiento del sistema inmunitario, contribuyen principalmente a la magnitud del proceso patológico. Las propuestas de tratamiento en pacientes inmunocomprometidos son diversas y por lo general se centran en alteraciones inmunológicas específicas. Objetivo: Evaluar el efecto clínico de los tratamientos propuestos para la estomatitis aftosa recurrente en pacientes inmunocomprometidos. Metodología: La búsqueda se realizó en las bases de datos PubMed/Medline y Cochrane. Se incluyeron ensayos clínicos que tuviesen entre sus variables de respuesta principales: Cicatrización de la úlcera aftosa, tiempo de cicatrización, de recurrencia e intensidad del dolor y entre las variables secundarias: Los efectos adversos y los síntomas. La extracción de datos se realizó de manera independiente por los autores. Se aplicó la metodología por la colaboración Cochrane para evaluar el riesgo de sesgo en cada uno de los estudios. Resultados: Se incluyeron 11 ensayos clínicos (8 controlados) publicados entre 1995 y 2020 y que aportan resultados de la eficacia de varias intervenciones terapéuticas: talidomida (4), irsogladine (2), rebamipida (1), láser de diodo (1), cápsulas de Omega-3 (1), vitamina B 12 (1), Complejo B (1). Seis de estos estudios incluyeron pacientes con la forma menor de estomatitis aftosa recurrente. El periodo de seguimiento estuvo entre los 14 y 360 días. Conclusiones: La talidomida puede ser eficaz en el alivio de los síntomas, la cicatrización y remisión de las lesiones, el diodo de láser y vitamina B12 en la disminución de la intensidad del dolor.

ABSTRACT Background: Although recurrent aphthous stomatitis does not have a well-defined etiology due to it is a multicausal disease, it has been recognized that the interactions or the weakening of the immune system, contribute mainly to the magnitude of the process pathological. Treatment proposals in immune compromised patients are diverse and they usually focus on specific immunological alterations. Objective: To evaluate the clinical effect of the proposed treatments for recurrent aphthous stomatitis in immunocompromised patients. Methodology: The search was performed in the PubMed/Medline and Cochrane databases. Clinical trials were included that could have among their main response variables: Aphthous ulcer healing, healing time, recurrence and pain intensity and among the secondary variables: Adverse effects and symptoms. data extraction was done independently by the authors. The methodology was applied by Cochrane collaboration to assess the risk of bias in each of the studies. Results: 11 clinical trials (8 controlled) published between 1995 and 2020 and that provided the results of the efficacy of various therapeutic interventions: thalidomide (4), irsogladine (2), rebamipide (1), diode laser (1), Omega-3 capsules (1), vitamin B 12 (1), Complex B (1). Six of these studies included patients with the minor form of stomatitis recurrent aphthous. The follow-up period was between 14 and 360 days. Conclusions: Thalidomide may be effective in relieving symptoms, healing and remission of the lesions, the laser diode and vitamin B12 in the decrease of the intensity of the pain.

Effect of Dentoxol® in the treatment of recurrent mild aphthous ulcers. A prospective observational pilot study

ABSTRACT: Background: Recurrent aphthous stomatitis (RAS) is the most common oral ulceration. Its prevalence in the general population varies between 5% and 60%, and during the acute period, it causes pain and interferes with basic activities, such as eating, swallowing and talking. Dentoxol® is a medical mouthrinse that cleans, moisturizes and lubricates the mouth, mechanically stimulating local epithelial regeneration. The aim of this study was to evaluate the efficacy of Dentoxol® in improving the general state of patient with minor RAS using two different treatment schemes. Material and methods: Thirty-nine patients with RAS were recruited in a prospective observational pilot study. Two dosing regimens, 5 ml of Dentoxol® twice daily and 5 ml of Dentoxol® three times daily were evaluated. Results: Efficacy to improve the general state was significant superior in "Three time daily" group compared with "twice daily" at 72 h (66% vs 33% respectively). No pain was reported in approximately 90% of cases at 96 h of use in both group without significant differences between the groups in any evaluation time-point. Conclusion: Despite the limitations of these preliminary data, Dentoxol® shows promising beneficial properties for the management of minor RAS.

The Clinical Efficacy of Minocycline Mouth Rinse on Recurrent Aphthous Stomatitis—A Randomized Controlled Trial

Introduction: Recurrent aphthous stomatitis (RAS) is one of the most common ulcerative diseases affecting the general population. The present study aimed to evaluate the clinical efficiency of 0.5% minocycline mouth rinse prescribed along with the topical anesthetic gel and vitamin supplement over the topical anesthetic gel and vitamin supplement prescribed alone for treating RAS. Materials and Methods: A total of 60 participants were randomly divided into two groups—experimental group: 0.5% minocycline mouth rinse prescribed along with vitamin supplement and topical anesthetic gel; and control group: vitamin supplement and topical anesthetic gel alone. The pain symptoms were evaluated using the VAS scores at baseline and first follow?up visits. The data were analyzed using Student’s t test. Results: A significant reduction in the pain scores was observed in participants using the 0.5% minocycline mouth rinse prescribed along with vitamin supplement and topical anesthetic gel on the first follow?up visit (P = < 0.001). Conclusion: The 0.5% minocycline mouth rinse prescribed along with vitamin supplement and topical anesthetic gel had shown more reduction in the pain symptoms when compared to topical anesthetic gel and vitamin supplement prescribed alone for the treatment of RAS.

Neural network analysis of the correlation between malnutrition-induced stomatitis and vitamin B12 and folic acid / 口腔疾病防治

Objective@# A model was built by neural network analysis to study the relationship between different degrees of vitamin B12 and folic acid deficiency and malnutrition-induced stomatitis.@*Methods@# Data from 30 healthy volunteers and 30 patients with malnutrition-induced stomatitis were collected. The distribution of lesions, the number of affected sites and clinical manifestations were recorded, and the severity was scored. The levels of vitamin B12 and folic acid in the peripheral blood of the two groups were simultaneously measured. The SPSS software was used to analyze the correlation between vitamin B12 and folic acid levels in the peripheral blood of patients with malnutrition-induced stomatitis and healthy volunteers, and the MATLAB software package was used to analyze the data via a neural network.@*Results@#The levels of vitamin B12 and folic acid significantly correlated with the grade of malnutrition-induced stomatitis. Simultaneous B12 and folic acid deficiency linearly correlated with the occurrence and severity of malnutrition-induced stomatitis. Based on this correlation, a thermogram model of malnutrition-induced stomatitis was constructed.@*Conclusion@# Malnutrition-induced stomatitis is closely related to vitamin B12 and folic acid deficiency. Their synergistic effect may promote the occurrence and development of malnutrition-induced stomatitis. The construction of the malnutrition-induced stomatitis model aids the targeted etiological treatment of patients with moderate and severe deficiency to prevent malnutrition-induced stomatitis.

Eficacia clínica del extracto de Matico (Piper angustifolium) en la evolución de la cicatrización de heridas por estomatitis aftosa recidivante / Clinical efficacy of Matico extract (Piper angustifolium) in the evolution of wound healing due to recurrent aphthous stomatitis

La estomatitis aftosa recurrente (EAR) es un trastorno ulcerativo doloroso cíclico que comúnmente afecta la mucosa oral. Factores locales y sistémicos como trauma, sensibilidad alimentaria, deficiencias nutricionales, condiciones sistémicas y desórdenes inmunológicos están asociados con el desarrollo de la enfermedad. Debido a las similitudes en las características de las úlceras pépticas y las úlceras aftosas orales, parece razonable suponer que Helicobacter pylori podría desempeñar un papel en el desarrollo de la EAR. Las especies de Piper son plantas aromáticas que se utilizan como especias en la cocina, pero sus metabolitos secundarios también han mostrado efectos biológicos sobre la salud humana. El objetivo del presente estudio fue determinar la relación entre H. pylori y EAR y el efecto cicatrizante del extracto Matico sobre las ulceras bucales. Se reclutó a cuarenta sujetos con EAR. Los participantes fueron asignados al azar al grupo de prueba o al grupo de control. El tamaño y número de las úlceras se registraron el día 1 (valor inicial) y el día 30 (valor final). El tamaño de la ulceras, presencia de pseudomembranas y halos eritematosos fueron estadisticamente significativas en relación a la positividad de H. pylori (p <0,05). No hubo diferencias significativas entre la morfología, número y localización de las aftas (p> 0,05). El grupo que recibió el extracto tuvo un porcentaje de mejoría en la reducción del número de aftas del 65% el día final de evaluación en comparación de sólo un 25% del grupo que no recibió el extracto Matico(AU)

Recurrent aphthous stomatitis (RAS) is a cyclic painful ulcerative disorder that commonly affects the oral mucosa. Local and systemic factors such as trauma, food sensitivity, nutritional deficiencies, systemic conditions, immunological disorders and genetic polymorphisms are associated with the development of the disease. Because of similarities in the characteristics of peptic ulcers and oral aphthous ulcers, it seems reasonable to hypothesize that Helicobacter pylori could play a role in the development of RAS. Piper species are aromatic plants used as spices in the kitchen, but their secondary metabolites have also shown biological effects on human health. The aim of the present study was to determine the relationship between H. pylori and RAS and the healing effect of Matico extract on mouth ulcers. Fuorty subjects with RAS were recruited. The participants were randomly allocated to the test group or the control group. The size and number of ulcers were recorded on day 1 (initial value) and day 30 (final value). The size of the ulcers, the presence of pseudomembranes and erythematous halos were statistically significant in relation to the positivity of H. pylori (p <0.05). There were no significant differences between the morphology, number and location of the canker sores (p> 0.05). The group that received the extract had a percentage improvement in the reduction of the number of canker sores of 65% on the final day of evaluation compared to only 25% of the group that did not receive the Matico extract(AU)

Manifestaciones bucales de la enfermedad celíaca y alergia al trigo: Reporte de tres casos y revisión literatura / Oral Manifestations of Celiac Disease and Wheat Allergy: Report of Three Cases and Review of Literature

Resumen: La Enfermedad Celíaca (EC) es una enfermedad sistémica inmunomediada, provocada por el gluten y prolaminas relacionadas, en individuos genéticamente susceptibles. Se caracteriza por manifestaciones clínicas dependientes del gluten, anticuerpos específicos de EC, haplotipos HLA DQ2 o DQ8 y enteropatía. La mayoría de los pacientes son asintomáticos o con manifestaciones leves. Afecta principalmente el sistema gastrointestinal causando síntomas y signos como diarrea, dolor abdominal recurrente y distensión abdominal; además manifestaciones extradigestivas. Los pacientes con EC pueden tener manifestaciones bucales que incluyen estomatitis aftosa recurrente (EAR), hipoplasia del esmalte, glositis atrófica, entre otras. El diagnóstico de EC se basa en la historia clínica, serología, endoscopía e histología. Existen otras entidades que deben diferenciarse de la EC, como la sensibilidad al gluten no celíaca y la alergia al trigo. El objetivo de este trabajo es presentar tres pacientes con antecedentes de EAR y otras manifestaciones clínicas asociadas al diagnóstico precoz de EC y alergia alimentaria.

Abastract: Celiac Disease (CD) is an immune-mediated systemic disease, caused by gluten and related prolamins, in genetically susceptible individuals. It is characterized by gluten-dependent clinical manifestations, CD-specific antibodies, HLA DQ2 or DQ8 haplotypes, and enteropathy. Most patients are asymptomatic or with mild manifestations. It mainly affects the gastrointestinal system causing symptoms and signs such as diarrhea, recurrent abdominal pain and abdominal distension; also extradigestive manifestations. Patients with CD may have oral manifestations that include recurrent aphthous stomatitis (RAS), enamel hypoplasia, atrophic glossitis, among others. The diagnosis of CD is based on clinical history, serology, endoscopy and histology. There are other entities that should be differentiated from CD, such as non-celiac gluten sensitivity and wheat allergy. The aim of this study is to present three patients with a history of RAS and other clinical manifestations associated with the early diagnosis of CD and food allergy.

Impacto de enfermedades orales asociadas a estrés sobre la calidad de vida / Impact on Quality of Life of Oral Diseases Related to Stress

Resumen: Se ha sugerido que enfermedades de la mucosa oral asociadas a estrés impactan negativamente la calidad de vida. Sin embargo, la información no es concluyente. El objetivo fue comparar la calidad de vida asociada a salud bucal en dos grupos: Casos (21 pacientes de una clínica de enseñanza de medicina bucal con diagnóstico de liquen plano oral, estomatitis aftosa recurrente y síndrome de boca dolorosa; Control (42 sujetos sanos) pareados por edad y género. Se aplicó el cuestionario perfil de impacto de salud oral. Resultados: El análisis estadístico mostró que el grupo casos tiene peor calidad de vida (p 0.03) comparado con el de los controles, específicamente en las dimensiones incomodidad psicológica (p 0.027); inhabilidad física (p 0.004); e incapacidad (p 0.002; RM 5.63 IC 1.58-20.80). Se concluye que los sujetos que padecen enfermedades de la mucosa oral relacionada a estrés tienen mala calidad de vida.

Abstract: It has been suggested that oral mucosa diseases related to stress have a negative impact on the quality of life. However, the information regarding which aspects are the most affected is inconclusive. The objective was to compare the quality of life associated with oral health in two groups: Cases formed by 21 patients coming from a teaching clinic, suffering oral lichen planus, recurrent aphthous stomatitis, and burning mouth syndrome; Control formed by 42 healthy subjects matched for age and gender. Oral Health Impact Profile questionnaire was applied. Statistical analysis showed that group Cases has worse quality of life (p 0.03) than the one of controls, specifically on psychological discomfort (p 0.027), physical disability (p 0.004); and handicap dimensions (p 0.002; RM 5.63 IC1.58-20.80). It was concluded that patients suffering oral mucosa disease related to stress showed poor quality of life.

Treating recurrent aphthous stomatitis with oral mucoadhesive films containing chitosan: a clinical random⁃ized controlled study / 口腔疾病防治

Objective@#To study the efficacy and safety of oral mucoadhesive containing chitosan for the treatment of recurrent aphothous stomatitis (RAS)@* Methods@#72 subjects, who were diagnosed with RAS, were involved in the study. The subjects were randomly allocated to the test or control group and shown how to use the films. The film con⁃taining chitosan was provided to the participants in the test group and the polyvinyl alcohol film was provided to the con⁃trol group. Baseline, pain score (visual analog scale), ulcer size and adverse effects were recorded@* Results @#The reduc⁃tion in ulcer size was significantly greater (P < 0.05) in the treatment group (2.91 ± 3.66)mm 2 than in the control group (1.10 ± 2.26) mm 2 between days 4 and 6. There was no significant difference between the treatment and control groups in the pain score, ulcer size, or reduction in the pain score (P > 0.05). No obvious adverse effects were observed.@* Con⁃clusion @#The oral mucoadhesive film containing chitosan promotes healing of RAS.

Estomatitis aftosa recurrente y deficiencias nutricionales: Reporte de tres casos y revisión de literatura / Recurrent Aphthous Stomatitis and Nutritional Deficiencies: Report of Three Cases with Literature Review

RESUMEN Introducción: La estomatitis aftosa recurrente (EAR) es la enfermedad ulcerativa más común que afecta la mucosa oral no queratinizada. La etiología aún se desconoce, pero se han propuesto varios factores locales y sistémicos como agentes causales. Descripción del caso: se informa tres pacientes con presencia de EAR asociada a deficiencias nutricionales, debidas a dietas de restricción alimentaria. El primer caso, una mujer de 19 años con deficiencia de hierro, refirió tomar té verde a diario y consumir poca cantidad de carbohidratos, grasas y carne. El segundo caso, un hombre de 32 años con deficiencia de hierro y vitamina B12 asociada a dieta tipo vegana, aunque a veces si consumía carne. El tercer caso, hombre de 50 años, vegano y exfumador desde hace un año, presentó deficiencia de hierro, vitamina B12 y ácido fólico. En los tres casos un detallado interrogatorio, examen clínico y análisis sanguíneo completo, permitió establecer un adecuado diagnóstico, manejo odontológico y derivación con un nutricionista, con el fin de tratar la patología de base y no sólo brindarles un tratamiento sintomático de las lesiones. Discusión: Ante un cuadro de EAR es recomendable realizar un análisis que incluya hemograma, ácido fólico, hierro y vitamina B12, para descartar posibles causas sistémicas y eventualmente tratarlas. El manejo clínico tiene como objetivo mejorar la función del paciente y la calidad de vida mediante terapias tópicas y sistémicas; sin embargo, es fundamental identificar y controlar los factores causales que contribuyen; así como, la exclusión o tratamiento de la enfermedad sistémica subyacente.

ABSTRACT Introduction: Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects the non-keratinized oral mucosa. The etiology is still unknown, but several local and systemic factors have been proposed as causal agents. Case description: three patients are reported with RAS associated with nutritional deficiencies, due to dietary restriction diets. The first case, a 19-year- old woman with iron deficiency, reported taking green tea daily and consuming a small amount of carbohydrates, fats and meat. The second case, a 32-year-old man with iron deficiency and vitamin B12 associated with vegan diet, although sometimes if he consumed meat. The third case, man of 50 years, vegan and ex-smoker for a year, presented deficiency of iron, vitamin B12 and folic acid. In all three cases a detailed questioning, clinical examination and complete blood analysis allowed to establish an adequate diagnosis, dental management and referral with a nutritionist, in order to treat the underlying pathology and not only provide a symptomatic treatment of the injuries. Discussion: In the setting of RAS, it is advisable to perform an analysis that includes a blood count, folic acid, iron and vitamin B12, to rule out possible systemic causes and eventually treat them. Clinical management aims to improve patient function and quality of life through topical and systemic therapies; however, it is essential to identify and control the causal factors that contribute; as well as, the exclusion or treatment of the underlying systemic disease.

Clinical Characteristics of Patients with Recurrent Aphthous Stomatitis

Recent studies indicate that oral health of the human population, unfavorable trends persist. Despite several researches conducted both in Uzbekistan and abroad, the etiology and pathogenesis of recurrent aphthous stomatitis remains unexplained. The aim of the study is to assess the clinical status of patients with recurrent aphthous stomatitis and develop a method of treatment and prevention. Methods: 106 patients with recurrent aphthous stomatitis were diagnosed. The frequency of exacerbations of RAS ranged from 1 to 4 or more relapses per year, the duration of the disease was more than one year. Results: 72.2% of cases (44 people) were women aged 18-29 years, among men a greater number of complaints - 17 (27.8% cases). Disease duration of recurrent aphthous stomatitis in the patients participating in the study averaged 5.17±0.38 years. 41 people suffered from RAS 1 to 3 years. In 38 patients, the disease duration ranged from 3.1 to 5 years, in 12 people, RAS was observed from 5.1 to 7 years, 15 patients suffered from the pathology under study for more than 7 years. Conclusions: Timely early diagnosis of RAS is not only completely cure for patient, avoid complications, but also revise the low efficiency of traditional methods of the treatment.

La efectividad de la crema Calendula officinalis L como tratamiento de la estomatitis aftosa recurrente / Calendula officinalis L cream effective treatment for recurrent aphthous stomatitis

RESUMEN Introducción: la estomatitis aftosa recurrente es una enfermedad habitual en las urgencias de Periodontología. Objetivo: evaluar la efectividad de la crema de Calendula officinalis L. al 10%, en el tratamiento de la estomatitis aftosa recurrente, en una clínica estomatológica. Método: se realizó un ensayo no controlado- no aleatorizado, en una población de 15 a 34 años de edad; que acudieron a la consulta de periodoncia de la Clínica Estomatológica Docente "Manuel Angulo Farrán" en Holguín, Cuba, en el período comprendido del año 2015 al 2017. La muestra fue de 100 pacientes, tratada durante 6 días, con consultas cada 48 horas. Resultados: el 59% de los pacientes fueron del sexo femenino, el 63% entre los 25 y 34 años, y en el 97% predominaron las aftas menores. La crema en estudio mejoró los síntomas en el 97% de los pacientes, y el 94% se curó. Conclusiones: la crema de Calendula officinalis L al 10% parece eficaz en el tratamiento de la estomatitis aftosa recurrente, aunque se requieren ensayos clínicos controlados y aleatorizados que lo demuestren de forma definitiva.

ABSTRACT Introduction: recurrent aphthous stomatitis is a frequent disease in periodontology emergencies. Objective: to evaluate the Calendula officinalis L at 10% cream effectiveness, as treatment for recurrent aphthous stomatitis, in a stomatological clinic. Method: non-control, non-randomized trial was conducted in a population between 15 and 34 years old, who attended "Manuel Angulo Farrán" Stomatological Teaching Clinic in Holguín, Cuba, from 2015 to 2017. Sample was 100 patients, treated in consultations every 48 hours, for 6 days. Results: the 59% of the patients were female, 63% between 25 to 34 years, and minor aphthae predominated in the 97%. The studied cream improved symptoms in 97% of patients and 94% were completely cured. Conclusions: Calendula officinalis L at 10% cream seems effective in the treatment of recurrent aphthous stomatitis, although controlled and randomized clinical trials would definitively demonstrate it.

Eficacia del láser en el tratamiento de la estomatitis aftosa recurrente / Laser effectiveness for recurrent aphthous stomatitis treatment

RESUMEN La estomatitis aftosa recurrente es una enfermedad inflamatoria crónica. Se caracteriza por lesiones aftosas en la mucosa bucal. Para su tratamiento, se han introducido variadas terapéuticas como la terapia láser; un método sencillo, indoloro, no invasivo y cada vez más aceptado por los pacientes. Se presenta una paciente de 37 años de edad, atendida en la consulta estomatológica del Hospital Clínico-Quirúrgico Docente "Celia Sánchez Manduley", de Manzanillo, Granma; con aftas bucales de pequeño tamaño, de forma redondeada y bien delimitadas en la mucosa interna del labio inferior y en el surco vestibular a nivel de incisivos inferiores. Se comprueba la eficacia del láser en el tratamiento de la estomatitis aftosa recurrente; para brindar al paciente un estado general satisfactorio, contribuir a su mejoría definitiva en un período de 5 días en aftas menores y mejorar la calidad de vida de los pacientes durante su curación.

ABSTRACT Recurrent aphthous stomatitis is a chronic inflammatory disease characterized by aphthous lesions in the buccal mucosa. Various therapeutic methods like laser therapy have been recently introduced. This is a simple, painless, non-invasive method very much accepted by patients. We present a 37-year-old woman with small mouth sores, rounded and well-defined on the internal mucosa of the lower lip and in vestibular groove at the level of lower incisors, attended at the Stomatological Clinic of "Celia Sánchez Manduley" Clinical Surgical Teaching Hospital of Manzanillo, Granma. The effectiveness of laser in the recurrent aphthous stomatitis treatment was verified, to obtain a satisfactory general patient´s state and a 5 days effective improvement in minor aphthae, considering patients´ life quality during healing period.

Comparison of therapeutic effect of mucoadhesive Nanotriamcinolone gel and conventional triamcinolone gel on recurrent aphthous stomatitis / Comparação do efeito terapêutico do gel mucoadesivo de nano-triancinolona e do gel convencional de triancinolona na estomatite aftosa recorrente

Objective: Recurrent aphthous stomatitis (RAS) is characterized by recurring ulcers, with well-defined margins. The lesions are confined to the oral mucosa (usually seen in non-keratinized mucosa). The disease manifests in the form of outbreaks, with a chronic and self-limiting course in most cases. Since the cause of the disease is unknown, many drugs have been studied to palliate the symptoms. Treatment used is multifocal and varies according to the predisposing factors. The aim of this study was to investigate the effect of recombinant Nano-based triamcinolone acetonide gel and compare it with conventional triamcinolone gel on RAS. Material and methods: In this triple-blind randomized clinical trial study, sixty patients with minor aphthous lesions were divided into two groups receiving conventional triamcinolone (CT) and Nano-based triamcinolone (NT). The patients were requested to apply drug four times a day for a week. The severity of pain (through VAS) and the size of the lesions (mean of the largest diameter of the lesions) were evaluated on starting day and days 2, 4, 6 after the intervention. Statistical analysis was performed using chi square and independent t-test. Findings were significant with P < 0.05. Results: Of the 60 patients enrolled in the study, 5 patients did not continue; 21 (38.2%) cases were female and 34 (61.8%) cases were male (P=0.6). The severity of pain in NT group before and after the study was 1.4 ± 5.2 and 1.8 ± 1.3 cm, respectively and in CT group was 48.1 ± 1 and 1.8 ± 1.3 cm. The size of the lesions in NT group before and at the end of the study was 0.96 ± 0.1 and 0.18 ± 0.1 cm, respectively and in CT group was 0.93 ± 0.1 and 0.19 ± 0.1 cm. Among the mentioned variables, only size of lesions on the 2nd and 4th days had a significant reduction in NT group in comparison with CT group. Conclusion: The size of lesions showed a significant reduction on the 2nd and 4th days in NT group in comparison with CT group, therefore NT has a better impact on RAS in comparison with CT. (AU)

Objetivos: A estomatite aftosa recorrente (EAR) é caracterizada por úlceras recorrentes, com margens bem definidas. As lesões estão confinadas à mucosa oral (geralmente vista em mucosa não queratinizada). A doença se manifesta na forma de surtos, com um curso crônico e autolimitado na maioria dos casos. Como a causa da doença é desconhecida, muitos medicamentos foram estudados para aliviar os sintomas. O tratamento utilizado é multifocal e varia de acordo com os fatores predisponentes. O objetivo deste estudo foi investigar o efeito do gel acetonido de triancinolona recombinante baseado em Nano e compará-lo com o gel de triancinolona convencional no EAR. Material e métodos: Neste estudo clínico randomizado triplocego, sessenta pacientes com lesões aftosas menores foram divididos em dois grupos que receberam triancinolona convencional (CT) e triancinolona Nano (NT). Os pacientes foram solicitados a aplicar droga quatro vezes ao dia durante uma semana. A gravidade da dor (por meio da EVA) e o tamanho das lesões (média do maior diâmetro das lesões) foram avaliados no dia inicial e nos dias 2, 4 e 6 após a intervenção. A análise estatística foi realizada utilizando teste qui quadrado e teste t independente. Os achados foram significativos com P < 0.05. Resultados: Dos 60 pacientes incluídos no estudo, 5 pacientes não deram continuidade; 21(38,2%) casos foram mulheres e 34 (61,8%) casos foram homens (P=0,6). A gravidade da dor no grupo NT antes e depois do estudo foi de 1,4 ± 5,2 e 1,8 ± 1,3 cm. O tamanho das lesões no grupo NT antes e ao final do estudo foi de 0,96 ± 0,1 e 0,18 ± 0,1 cm, respectivamente, e no grupo de TC foi de 0,93 ± 0,1 e 0,19 ± 0,1 cm. Entre as variáveis mencionadas, somente o tamanho das lesões no segundo e quarto dias tiveram uma redução significativa no grupo NT em comparação com o grupo CT. Conclusão: O tamanho das lesões mostrou uma redução significativa nos 2º e 4º dias no grupo NT em comparação ao grupo CT, portanto o NT tem um impacto melhor no RAS em comparação com o TC. (AU)

Management of recurrent Aphthous Stomatitis major in a bipolar affective disorder patient with food allergy

@#This is the case of a 35-year-old female diagnosed by medical and psychiatric examinations as suffering from bipolar affective disorder and food allergy. Evident characteristic included mood swings. Her main complaint was extensive painful ulcer on the palate and lower lip. Current condition had caused her weight loss. Management included anamnesis, clinical and laboratory examinations, psychometrics, and referral to a psychiatrist. The dentist played an important role in identifying recurrent aphthous stomatitis and in the optimal and comprehensive treatment of the patient through multidisciplinary assessment.

Recurrent aphthous stomatitis / Шинэ санаа Шинэ нээлт

@#Aphthae are common oral lesions that affect approximately 10% to 20% of the population. Recurrent Aphthous Ulcers (RAU) are usually classified into three different types: minor, major and herptiform RAU. The etiology of aphthous stomatitis is unknown but according to increasing evidence, its development has an immunogenic process that causes the ulceration of the involved oral mucosa. Similar-appearing lesions may arise in following systemic disorders: 1. Behcet’s disease 2. Sweet’s syndrome 3. Cyclic neutropenia 4. Benign familial neutropenia 5. MAGIC syndrome 6. A periodic syndrome with fever and pharyngitis 7. Various nutritional deficiencies with or without underlying gastrointestinal disorders Several studies from the UK, United States, and Spain have demonstrated that hematinic deficiency (iron, folic acid, or vitamin B12) are twice as common in RAS patients than incontrols. Case report: A 10 year old male patient presented a 3-year history of episodes of multiple minor recurrent Ulcers, this year major aphthae on the anterior ventral surface of the soft palate. Patient had difficulty in eating and in speech. Clinical examination revealed multiple symptomatic ulcers with a perilesional erythematous halo covered with a pseudomembrane. The size of major aphthae was than 20 mm in diameter. The ulcers were not associated with any type of discharge. The ulcers were tender on palpation. The medical history and the family history were non-contributory. A clinical diagnosis of major aphthous ulcers was made on the basis of the history and the clinical examinations. The patient was subjected to a therapeutic regimen consisting of daily topical application of Prednizoloni 0.05%, topical lidoksor and systemic vitamin and Cefatoxime Natrii, Immunomodulators Biferon, Amphotericin B. Recurrent aphthous stomatitis (RAS) or recurrent aphthous ulcers (RAU) remains a common oral mucosal disorder in most communities of the world. Proper systemic evaluation is important before prescribing the medication.

STUDY OF “AKHIZUNBER” SOLUTION FOR THE TREATMENT OF INFLAMMATORY ORAL STOMATITIS / Шинэ санаа Шинэ нээлт

@#ABSTRACT. Recurrent aphthous stomatitis, or RAS, is common oral disorder of uncertain etiopathogenesis for which only symptomatic therapy is available. This article reviews the current clinical features of RAS among study patients and the result of therapeutic effects of the herbal preparation Akhizunber. Over the past four years we have treated 61 RAS patients with different clinical forms by herbal preparation Akhizunber or Alumekatin. The distribution of clinical forms RAS RAS among study patients were minor aphthae -75.4%, major aphthae -16.4% and herpetiform ulcers -8.2% respectively. The healing time of treated Akhizunber was in minor aphthae -9.28±4.82 days, major aphthae -14 days and herpetiform ulcers -12 days. Of the total study participants, the patients treated by Akhizunber reported a rapid and complete recovery from RAS during treatment compared with treated patients by Alumekatin. Treatment with herbal preparation Akhizunber can be effective for patients suffering from RAS in any clinic form, regardless of their ulcer number and size.

Immune system and zinc are associated with recurrent aphthous stomatitis: an assessment using a network-based approach

OBJECTIVE: The aim of this research was to identify genes, proteins and processes from the biomedical information published on recurrent aphthous stomatitis (RAS) using network-based foci. METHODS: The clinical context was defined using MeSH terms for RAS and biomarkers, combined with words associated with risk. A set of protein coding genes was prioritized using the Génie web server and classified with PANTHER. For defining biologically relevant proteins, protein-protein interaction networks were constructed using Reactome database and Cytoscape. Top 20 proteins were then subjected to functional enrichment using STRING. RESULTS: From 1,075,576 gene-abstract links, 1,491 genes were prioritized. Proteins were related to signaling molecule proteins (n=221), receptor proteins (n=221) and nucleic acid binding proteins (n=169). The network constructed with these proteins included 3,963 nodes and functional analysis showed that main processes involved immune system and zinc ion binding function. CONCLUSIONS: For the first time, bioinformatics tools were used for integrating pathways and networks associated with RAS. Molecules and processes associated with immune system recur robustly in all analyzed information. The molecular zinc ion binding function could be an area for exploring more specific and effective therapeutic interventions

Screening of Antibiotics that Selectively Inhibit a Bacterial Species Associated with a Recurrent Aphthous Stomatitis Risk

Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder for which no curative treatment is available. We previously reported that decreased Streptococcus salivarius and increased Acinetobacter johnsonii on the oral mucosa are associated with RAS risk. The purpose of this study was to identify antibiotics that selectively inhibit A. johnsonii but minimally inhibit oral mucosal commensals. S. salivarius KCTC 5512, S. salivarius KCTC 3960, A. johnsonii KCTC 12405, Rothia mucilaginosa KCTC 19862, and Veillonella dispar KCOM 1864 were subjected to antibiotic susceptibility test using amoxicillin, cefotaxime, gentamicin, clindamycin, and metronidazole in liquid culture. The minimal inhibitory concentration (MIC) was defined as the concentration that inhibits 90% of growth. Only gentamicin presented a higher MIC for A. johnsonii than MICs for S. salivarius and several oral mucosal commensals. Interestingly, the growth of S. salivarius increased 10~200% in the presence of sub-MIC concentrations of gentamicin, which was independent of development of resistance to gentamicin. In conclusion, gentamicin may be useful to restore RAS-associated imbalance in oral microbiota by selectively inhibiting the growth of A. johnsonii but enhancing the growth of S. salivarius.

Evaluation of antioxidant efficacy of Purslane extract in Patients with Recurrent Aphthous Stomatitis: a randomized, placebo-controlled, triple-blinded, clinical trial

Background: This herbal medicine is considered a rich source of antioxidants with anti-inflammatory effects. The purpose of this study was to evaluate the effectiveness of purslane in treatment of recurrent aphthous stomatitis (RAS) and also it ̓s effect on antioxidant level. Materials and methods: 50 patients were selected for this randomized triple-blind placebo-controlled trial. All subjects were randomly divided in to two groups, one group received purslane (n=25) and another group, placebo (n=25) for 3 month. Superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and total antioxidant status (TAS) was measured in plasma at baseline and after 3 month of treatment. Also pain intensity based on the visual analogue scale (VAS), the mean interval between lesion, number of lesions and the mean duration of complete healing at baseline and in month 1, 2 and 3 were recorded. Statistical analysis was performed by using Mann-Whitney and T-test. Results: A significant decrease in pain intensity in VAS scores was seen after treatment in intervention group (p<0.001). The mean duration of complete healing showed significant differences (P<0.001) between the two groups. The mean interval between lesions also showed significant differences (P<0.001) among the intervention group (33.12 days) compared with the placebo group (17.88 days). No significant differences were found regarding the number of lesions, level of erythrocyte GSHPx, TAS and SOD. No serious side-effects occurred in either of groups. Conclusions: According to this study, purslane is clinically effective in treatment of RAS (number of lesions, pain intensity and duration of healing) although it is unable to change the level of antioxidants. (AU)