Treatment of recurrent aphtous stomatitis: A systematic review

Background: Recurrent Aphtous Stomatitis (RAS) is the most common process affecting the oral mucosa. It is painful, multifactorial and generally recurrent. The aim of this systematic review is to know the last treatment approaches and their effectivity. Material and methods: we compared the outcome of different kind of treatments in terms of the improvement of the lesions, reduction of the size of those lesions and the time needed for their healing. Inclusion criteria were: clinical trials, articles written in English or Spanish and published less than 5 years ago. Results: we used the following keywords: "treatment", "aphtous stomatitis", "canker sores"; combined with Boolean operators AND y OR. We selected 28 articles for reading the whole text, and after applying the eligibility criteria, we selected 17 articles for our revision. Among all the treatments, we emphasize the barrier method based in compound of cellulose rubber and a calcium/sodium copolymer PVM/MA, with which the difference in the 3rd and 7th day was of -6,29 ± 0,14 points in the pain score. The treatment with insulin and chitosan gel, brought a pain suppression on the third day, with no reactivation of the pain during the whole study. The application of a film composed of polyurethane and sesame oil with chitosan, brought a reduction in the size of the lesions of 4,54 ± 2,84mm on the 6th day compared with the situation before the beginning of the treatment. The different kinds of laser, which produced a reduction in the pain score just at the beginning of the treatment up to 8,1 ± 1,6 points, and a reduction of the size of the lesions of 4,42 ± 1,02mm on the 7th day. Conclusions: Besides the classic treatments for RAS, we have to take into account other treatment modalities, above all the different kinds of laser. (AU)

Oral Mucosal Lesions in Childhood.

Childhood diseases are a continuous source of interest in all areas of general and dental medicine. Congenital, developmental, and hereditary diseases may either be present upon birth or appear in early childhood. Developmental anomalies, although often asymptomatic, may become grounds for different infections. Furthermore, they can indicate certain systemic disorders. Childhood age frequently brings about benign tumors and different types of traumatic lesions to the oral mucosa. Traumatic lesions can be caused by chemical, mechanical, or thermal injury. Mucocele and ranula are, by definition, traumatic injuries of the salivary glands or their ducts. Recurrent aphthous lesions are the most common type of ulcerations in childhood, and their etiology is considered multifactorial. Oral mucosal lesions in children require different treatment approaches depending on etiological factors and clinical presentation. Clinicians should have adequate knowledge of oral anatomy in order to diagnose and treat pathological conditions.

The evaluation of thiol/disulphide homeostasis in recurrent aphthous stomatitis.

The objective of our study was to determine thiol/disulphide homeostasis in recurrent aphtous stomatitis (RAS) patients. A prospective monocentric study was designed. Forty-three recurrent aphtous stomatitis patients and 43 healthy subjects were included to study. Venous blood samples collected and assessed with novel automatic system. Results compared statistically. Disulphide levels were found significantly higher in RAS patients than control group. There was no significant difference between native thiol and total thiol levels. Thiol/disulphide homeostasis is impaired in RAS patients in favor of disulphide levels compared with control group. To the best of our knowledge, the present study is the first examination on the correlation between thiol and disulfide homeostasis in patients with RAS.

Guidelines for the treatment of skin and mucosal lesions in Behçet's disease: A secondary publication.

In the current study, we present guidelines for the diagnosis and treatment of the mucocutaneous lesions of Behçet's disease, which is a chronic inflammatory disease characterized by the involvement of various organs, including mucocutaneous, ocular, vascular, intestinal and central nervous system lesions. It is often identified in the Middle East Mediterranean to East Asia region. Skin manifestations include erythema nodosum, papulopustular lesions and thrombophlebitis, and mucosal manifestations include oral and genital ulcers. These mucocutaneous lesions are characteristically the first signs of Behçet's disease and are important to be recognized for the early diagnosis of the disease. Moreover, these manifestations also recur and persist over the long-term course of the disease. The management of mucocutaneous lesions is important to prevent recurrence. We developed consensus guidelines that provide recommendations for general practitioners and dermatologists and physicians on the management of the mucocutaneous lesions of Behçet's disease.

[Ulcerations of the extremities: An unusual manifestation of Behçet's disease]. / Ulcérations des extrémités : une manifestation inhabituelle de la maladie de Behçet.

BACKGROUND: Although cutaneous and mucosal involvement is a major manifestation in Behçet's disease, ulcerated lesions of the extremities are exceptional and poorly known. CASE REPORT: A 57-year-old male patient was diagnosed 7 years ago with Behçet's disease. This diagnosis was made in the presence of recurrent bipolar aphtous ulcers, pseudofolliculitis lesions and retinal vasculitis. After having been lost to follow up for two years, during which his treatment was discontinued, he presented centimetric necrotic ulcerations of the fingers of the hand and of the right big toe. The biopsy revealed leucocytoclastic and necrotizing vasculitis. The patient improved with antibiotic, oral corticosteroids, colchicine and local care. CONCLUSION: Linking extremity ulcers with Behçet's disease, though sometimes difficult, is essential for proper management.

Low laser therapy as an effective treatment of recurrent aphtous ulcers: a clinical case reporting two locations.

Apthous ulcers, commonly referred to as canker sores, are the most common ulcerative lesions of the oral mucosa. These are usually painful and are associated with redness and occasional bleeding from the affected area(s). Low Level Laser Therapy (LLLT) has shown excellent results in relieving the pain and complete remission of the oral ulcers. Through a clinical case, we report two locations of oral ulcers treated successfully with diode laser.

Cutaneous and Mucosal Manifestations Associated with Celiac Disease.

Celiac disease (CD) is an immune-mediated, gluten-induced enteropathy that affects predisposed individuals of all ages. Many patients with CD do not report gastrointestinal symptoms making it difficult to reach an early diagnosis. On the other hand, CD is related to a wide spectrum of extra-intestinal manifestations, with dermatitis herpetiformis (DH) being the best characterized. These associated conditions may be the clue to reaching the diagnosis of CD. Over the last few years, there have been multiple reports of the association between CD and several cutaneous manifestations that may improve with a gluten-free diet (GFD). The presence of some of these skin diseases, even in the absence of gastrointestinal symptoms, should give rise to an appropriate screening method for CD. The aim of this paper is to describe the different cutaneous manifestations that have been associated with CD and the possible mechanisms involved.

Treatment of recurrent aphthous stomatitis with Er,Cr:YSGG laser irradiation: A randomized controlled split mouth clinical study.

The present randomized controlled split mouth clinical study aimed to investigate the efficacy of Er,Cr:YSGG laser irradiation on pain reduction and healing rate of recurrent aphthous stomatitis. 40 patients with RAS were recruited for this study and RAS ulcerations of each patient were randomly assigned to the control or test group. In the test group, Er,Cr:YSGG laser with non-contact mode was used to irradiate RAS lesions. In the placebo group, RAS lesions were irradiated with the same device without laser emission. Pain was evaluated with visual analog scale (VAS) while a clinician graded healing of RAS (HRAS). In the placebo group at immediate; scores of VAS presented no statistically significance; in the test group, laser application showed significant pain reducing, at 1st day control. In the test group, a significantly healing effect at 1st day control was observed and this effect was maintained throughout the study. In the placebo group, scores of HRAS were statistically significant at controls on 3, 7, 10days. Statistically significant difference between the scores of VAS and HRAS was found for all control days except day 10 according to the intergroup comparisons. Based on these findings, Er,Cr:YSGG laser application at 0.25W without water may be appropriate to reduce pain and also accelerate the healing of RAS.

Laser terapia en el manejo de aftas mayores: reporte de un caso / Laser therapy in the management of major afthas: case report

Las lesiones ulcerativas, como las Aftas pueden originarse por múltiples factores y afectar la masticación, nutrición, deglución, fonación y la estética. Dentro de los tratamientos se sugiere el uso de fármacos antibióticos, antivirales, anestésicos tópicos y medidas locales paliativas. Se presenta caso de un paciente masculino de 34 años, sin antecedentes médicos relevantes, con diagnostico de estomatitis aftosa recurrente desde los 8 años; inicialmente aftas menores, después las lesiones aumentaron en tamaño. Con antecedentes de tratamientos antivirales, antibióticos, antimicóticos, sin evolución satisfactoria. Al examen estomatológico se observan múltiples ulceras en carrillos, piso de boca, dorso y superficie ventral de lengua. Se decide tratamiento con Láser de alta y baja potencia para terapia de barrido en zonas intraorales y sobre puntos de acupuntura; obteniendo cicatrización de las lesiones y disminución de la sintomatología. El uso de la terapia láser es una propuesta innovadora, indolora y satisfactoria mediante la cual se pueden combinar los beneficios del laser de alta y baja potencia para generar efectos analgésicos y cicatrizantes

Ulcerative lesions, such as canker can be caused by many factors and affect chewing, nutrition, swallowing, speech and aesthetics. Within treatments suggest the use of antibiotic drugs, antivirals, local anesthetics and local palliative measures. A case report of a male patient of 34 years, with no relevant medical history, with a diagnosis of recurrent aphthous stomatitis from 8 years, initially under thrush after injuries increased in size. With a history of antiviral treatments, antibiotics, antifungals, with no satisfactory outcome. Stomatological examination were multiple ulcers in cheek, floor of mouth, back and ventral surface of tongue laser treatment is decided high-and low-power scanning therapy in intraoral areas and acupuncture points, achieved healing in wounds and reducing pain. The use of laser therapy is an innovative, painless and successful through which you can combine the benefits of high and low laser power to generate analgesic and healing

Urgencias periodontales en el paciente diabético / Periodontal emergencies in diabetic patient

Se realizó un estudio descriptivo transversal de tipo observacional en el período comprendido entre febrero del 2008 a marzo del 2009, con el objetivo de determinar el comportamiento de las principales urgencias periodontales en 84 pacientes con diagnóstico de Diabetes Mellitus, pertenecientes a los consultorios del policlínico René Bedia Morales de Santiago de las Vegas en Ciudad de La Habana; previo consentimiento de estos, se estudiaron las variables edad, sexo, presencia de Gingivitis Ulceronecrotizante Aguda, Estomatitis Aftosa Recurrente, Absceso Gingival y Absceso Periodontal y se relacionó con el total de Urgencias Periodontales encontradas en dicha población. El estudio realizado demostró que fueron numerosas las urgencias periodontales que padecen los pacientes diabéticos con predominio del absceso periodontal. El grupo de edades más afectado por la GUNA y la EAR fue el de 35-59 años, con predominio del sexo femenino. El Absceso Gingival prevaleció en el grupo de edades menor o igual a 34 años y en el sexo femenino. El Absceso Periodontal fue la urgencia más frecuente en los pacientes de 60 y más años, con comportamiento similar en cuanto al sexo(AU)

A descriptive, transversal and observational study was performed from February 2008 to March 2009, with the objective to determine the deeds of Periodontal Emergencies among 84diabetic patients attending their respective Family Practice Clinics belonging to Rene Bedia Morales Policlinic, from Santiago de las Vegas, Havana City, provided their informed consent. Different variables were studied: age, sex, presence of Acute Ultranecrotizing Gingivitis, Recurrent Aphtous Stomatitis, Gingival Abscess and Periodontal Abscess, all of them being related to the total amount of Periodontal Emergencies found in this population. The results show that diabetic patients draw on very often to suffer periodontal emergencies, with the prevalence of the periodontal abscess. The age group most affected by Acute Ultranecrotizing Gingivitis and Recurrent Aphtous Stomatitis was the one from 35 to 39 years, mostly females. Gingival Abscess prevailed in the age group less than 35 years. Periodontal Abscess was the most frequent emergencies in patients over 59 years, with no sex differences(AU)

Ulceração aftosa recorrente no Ambulatório de Estomatologia da UNIFESP / Recurrent aphtous stomatitis in Stomatology Clinic UNIFESP (Universidade Federal de São Paulo)

Introdução e objetivo: A ulceração aftosa recorrente (UAR) é uma doença inflamatória bucal crônica de distribuição mundial, cuja prevalência varia entre 5% e 66%, com média de 30%, e continua representando problema clínico sem solução satisfatória. Apesar da etiopatogenia da UAR ainda ser desconhecida, ela é considerada doença multifatorial, na qual componentes genéticos, microbiológicos e imunológicos concorrem simultaneamente ou sequencialmente para o surgimento e evolução das lesões ulcerativas. Alguns fatores são apontados como modificadores ou desencadeantes das UAR, entre eles os mais estudados estão as alterações hormonais, estresse, traumatismos locais e nutricionais (deficiências de vitamina B12, ácido fólico e ferro). O objetivo deste artigo foi delinear o perfil dos pacientes com UAR acompanhados no Ambulatório de Estomatologia da UNIFESP, no período de 1999 a 2009. Foi elaborado um questionário, assim como um banco de dados para coletar e gerenciar as características clínicas da UAR dos pacientes. Resultados: O tipo mais comum de afta era o tipo minor (92%), o sítio de maior acometimento das lesões era a mucosa jugal (21%), seguida pela mucosa labial, 90% dos pacientes eram não fumantes, em 50% dos pacientes encontramos história familiar de UAR e apenas 28% dos pacientes relacionaram o estresse ao surto de aftas. Apenas 45% dos pacientes relataram piora com alimentação. Conclusões: Concluiu-se que os principais fatores associados à ocorrência da UAR foram predisposição familiar e alimentação e de forma negativa o uso do tabaco.

Oral manifestations of coeliac disease.: A clinical-statistic study.

AIM.: The aim of the clinical-statistic study was to evaluate the prevalence of the different oral manifestations in a sample of coeliac patients, in comparison with a control group of healthy subjects. Moreover, a second objective was to determine if the clinical oral examination is useful as a diagnostic tool of screening for atypical forms of coeliac disease (CD). METHODS.: The enrolment of 300 coeliac patients, aged between 4 and 13 years (mean age 8.16), was carried out at the Pediatric Dentistry Unit in patients sent from the Pediatric Gastroenterology Unit of the PTV Hospital, University of Rome Tor Vergata. The control group was composed of 300 healthy subjects, age-matched (mean age 8.29), enrolled from the Pediatric Dentistry Unit. The patients were examined for hard tissues (enamel hypoplasia, dental caries), soft tissues (recurrent aphthous stomatitis RAS, atrophic glossitis, geographic tongue) and delay dental eruption. Enamel defects were classified according to Aine's criteria, while dental caries was recorded as dmft/DMFT indices. Statistical analysis was carried out by using SPSS/PC+ Software. Differences between case and control groups were tested using Paired samples T-test, and Chi-Square Test, depending on the variable considered. The minimal level of significance of the differences was fixed at p≤0.05 for all the procedures. RESULTS.: Statistical differences between groups were observed for the prevalence of enamel defects (p=0.0001), RAS (p=0.005), delay in dental eruption (p=0.0001), but not for the prevalence of atrophic glossitis (p=0.664). Differences in symmetrical distribution and a chronologic coherence of enamel defects were statistically significant between CD and control groups (p=0.0001). Regarding dental caries, the coeliac patients had higher indexes of caries than healthy subjects, both in deciduous teeth (dmft 2.31±1.84 vs 1.42±1.13; p= 0.021) and permanent teeth (DMFT 2.97±1.74 vs 1.74±1.64; p=0.0001). CONCLUSIONS.: The clinical oral examination should be considered a diagnostic tool for the characterization of subjects affected by silent-atypical forms of CD.

Efeito de pomada de própolis em orabase para tratamento de ulcerações aftosas recorrentes - um estudo piloto / Effect of orabase propolis ointment for recurrent minor aphthous treatment - a piloty study

As ulcerações aftosas recorrentes (UAR), popularmente conhecidas como aftas, acometem cerca de 20% da população e causam muito desconforto. Como sua etiologia não está bem definida, os tratamentos empregados nem sempre são eficazes. As terapias naturais são cada vez mais procuradas, dentre elas destaca-se a utilização da própolis. A própolis é um composto resinoso produzido pelas abelhas para proteção da colmeia. Inúmeros trabalhos demonstram propriedades farmacológicas da própolis. Trabalhos na área odontológica, inclusive, demonstram a utilização da própolis para tratamento das aftas na forma de solução alcóolica. Considerando que não há estudos sobre o uso de pomada de própolis para a terapêutica das lesões aftosas, o objetivo deste trabalho foi analisar o efeito de uma pomada de própolis no tratamento de aftas. Os resultados obtidos demonstraram que o uso da pomada de própolis em orabase reduziu o índice de dor e o tempo de cicatrização em casos de aftas, e ocasionou um prolongamento entre as recidivas em portadores de UAR. Esses resultados são promissores, entretanto, considerando ser um estudo preliminar, novos trabalhos nesta área devem ser realizados para solidificar a eficácia da própolis em pomada para tratamento de UAR.

The recurrent aphthous ulcers, commonly known as aphthae, affect about 20% of population and cause much discomfort when chewing, swallowing and speaking. As its etiology is not well defined the treatments employed are not always effective. The natural therapies are increasingly sought by people, among them there is the use of propolis. Propolis is a resinous compound produced by bees for protecting the hive. Numerous studies demonstrate the propolis pharmacological properties. There are works in dentistry showing the propolis use for aphthae treatment in alcoholic solution form. There are no studies about propolis ointment use for ulcers treatment. The objective of this work was to analyze the effect of a propolis ointment for aphtae treatment. The results showed that propolis ointment use reduced the pain level and the healing time in aphtae cases, and it causes a prolongation between relapses in patients with this kind of lesions. These results are promising, however, it must be considered that it is a preliminary study and further work in this area should be conducted to solidify the effectiveness of propolis ointment for treating aphthae.

Factores inmunológicos y microbiológicos asociados con la etiología de la estomatitis aftosa recurrente / Microbiological and immunological factors associated with the etiology of recurrent aphthous stomatitis

La Estomatitis Aftosa Recurrente (EAR) es una enfermedad ulcerativa, dolorosa y muy común de la cavidad bucal, cuya etiología es desconocida. Algunos reportes han señalado que los pacientes afectados con esta condición presentan una respuesta inmunológica defectuosa. Adicionalmente, existe atención en destacar la importancia y participación de las moléculas de adhesión en el reclutamiento del infiltrado inflamatorio en esta condición. Las moléculas de adhesión VCAM-1 (molécula de adhesión vascular-1) e ICAM-1 (molécula de adhesión intercelular-1), son esenciales para la unión de las células inflamatorias a las células endoteliales. Formas circulantes de estas moléculas han sido detectadas en un número de enfermedades vasculíticas, y EAR tiene características similares a esta entidad. Por otra parte Helicobacter pylori ha sido demostrado como el agente causal de la úlcera gástrica que presenta gran similitud histológica con la EAR. El objetivo del presente trabajo es realizar una revisión de los principales factores inmunológicos y microbiológicos, asociados con la EAR

Recurrent aphtous stomatitis (RAS) is a common, painful and ulcerative disorder of the oral cavity of unknown etiology. Several reports have suggested that the patients affected with this condition have a defectous celular immune response. Aditionally, adhesion molecules are known to play a crucial role in the recruitment of immflamatory cells to sites of inflammation. Adhesion molecules VCAM-1 (vascular cell adhesion molecule-1), and ICAM-1 (intercellular adhesion molecule-1) are essential for the binding of inflammatory cells to Endothelial cells. Circulating forms of these molecules have been detected in a number of vasculitic disease. RAS has some features of a vasculitic disease process. Helicobacter pylori has been shown to be the causative factor in peptic ulcers, which is very similar with RAS The aim of this study was to review the inmmunological and microbiological factors associated with the etiology of RAS