Zinc supplementation for prevention and management of recurrent aphthous stomatitis: a systematic review.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is a very common oral ulcerative disease with no definitive cure. Growing evidence suggests a significant association between zinc deficiency and RAS. OBJECTIVES: To assess the efficacy of systemic zinc supplementations in the prevention and management of RAS. METHODS: Five databases were searched for all English and Chinese studies published up to November 2020. All clinical trials that assessed the efficacy of zinc supplementations in the management and/or prevention of RAS were included. RESULTS: Seven clinical trials comprising 482 RAS patients (250 in zinc group) fulfilled the inclusion criteria. The follow-up period ranged from three months to one year. Five studies showed significantly better efficacy of zinc in reducing the recurrence rates of RAS, whereas two studies did not report any significant differences compared to the controls. Four studies reported on signs/symptoms of RAS, three of which showed superior outcomes in favour of zinc, while one study reported comparable results. CONCLUSION: Zinc supplementation seems to be efficacious in the management and prevention of RAS. However, further clinical trials with standardized methodologies and adequate follow-up periods are required to confirm the efficacy of zinc supplementations.

Association between serum zinc levels and recurrent aphthous stomatitis: a meta-analysis with trial sequential analysis.

OBJECTIVES: The present meta-analysis sought to investigate the potential association between zinc levels and recurrent aphthous stomatitis (RAS). METHODS: A comprehensive search of online databases (PubMed, Scopus, Web of Science, and China National Knowledge Infrastructure (CNKI)) was conducted to identify all English and Chinese studies published up to August 2020. All case-control studies that assessed plasma/serum zinc levels were eligible for inclusion. Data were analyzed using Comprehensive Meta-Analysis software version 2.2.046 (Biostat, Englewood, NJ, USA). Trial sequential analysis (TSA) was conducted with the trial sequential analysis program. RESULTS: Nineteen case-control studies, involving 1079 RAS cases and 965 controls, were included in the meta-analysis. The pooled results of 19 studies showed that zinc level was significantly lower in RAS patients than in healthy controls (weighted difference in means = - 21.092, 95% CI - 26.695 to - 15.490, I2 = 95.375%, P < 0.001). Upon subgroup analysis by geographic distribution of the sample (Chinese vs. others), the association remained significant in each individual subgroup, although the association was more pronounced among Chinese populations. TSA indicated that the current studies surpassed the required information size, confirming that the differences were reliable. CONCLUSION: The results suggest a significant association between low serum zinc levels and the occurrence of RAS. Although TSA confirmed a solid conclusion, conducting large-scale studies with the highest standards of quality is encouraged. CLINICAL RELEVANCE: Determining zinc levels should be considered in diagnosis, management, and prevention of RAS.

Efficacy of propolis-based mouthwashes on dental plaque and gingival inflammation: a systematic review.

BACKGROUND: This systematic review of randomized clinical trials aimed to evaluate the available evidence regarding the efficacy of propolis-based mouthwash on dental plaque and gingival inflammation. METHODS: PubMed, Scopus, and Web of Science databases were searched up to November 2019. Clinical trials that evaluated the efficacy of propolis mouthwashes compared with chlorhexidine (CHX) were included. The primary outcomes comprised dental plaque and/or gingival inflammation. Two authors assessed the risk of bias using the Cochrane tool. Due to marked heterogeneity of the available data, studies were assessed qualitatively, and no metaanalysis was performed. RESULTS: Nine clinical trials, comprising 333 subjects, fulfilled the eligibility criteria. Most of the included studies showed high risk of bias. Overall, propolis mouthwashes showed good efficacy on plaque and gingivitis in all of the included studies. Out of the eight studies that reported on plaque index, 5 studies found equal efficacy of propolis and CHX in reducing plaque, two studies found superior efficacy in favor of CHX, while one study found superior efficacy in favor of propolis. Six studies assessed gingival inflammation outcome, four of which reported better results with propolis, while two studies reported comparable results. CONCLUSIONS: The results suggest that propolis-based mouthwashes have potential benefits in reducing plaque and gingival inflammation. However, methodological limitations along with small sample sizes in some of the included studies weaken the strength of the evidence. Therefore, further well-designed clinical trials with large sample sizes and adequate follow-up period are recommended to discern the efficacy of propolis mouthwash on plaque and gingivitis.

Clinical efficacy of nanosilver and chlorhexidine in the treatment of plaque-induced gingivitis: a randomized controlled clinical trial

Aim: the present study aimed to assess the clinical efficacy of nanosilver (NS) mouthwash and compared with chlorhexidine (CHX) mouthwash for the treatment of plaque-induced gingivitis. materials and methods: sixty-two (28 males and 34 females) plaque-induced gingivitis patients were allocated into two groups and asked to rinse with 10ml of NS or CHX, immediately after brushing, for 1 min, in the morning and evening. the plaque, gingival, and papilla bleeding indices were taken at baseline, two weeks, and finally at four weeks for each patient. the statistical analysis between and within groups were performed using Mann-Whitney U-test and Wilcoxon signed rank test respectively. result: Intergroup comparison by Mann-Whitney U-test showed no statistically significant differences in the investigated groups at the baseline for all studied parameters. at 2 and 4 weeks follow up, the CHX group showed statistically significant lower plaque scores than the NS group (p<0.05). however, there is no statistically significant difference between NS and CHX groups for gingival and papilla bleeding scores (p>0.05). both groups showed statistically significant reductions in plaque, gingival and papilla bleeding scores after 2 weeks and 4 weeks of product use when compared to baseline (p<0.001). conclusion: both mouthwashes decreased plaque, gingival and papilla bleeding scores, however the reduction in plaque scores was higher for the CHX group compared to the NS group.