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Resumo: A úlcera aftosa recorrente (UAR) é uma lesão frequente na mucosa oral de etiologia variada e subdividindo-se clinicamente úlceras menores, maiores e hepertiformes. Caracterizada por formato ovoide, recoberto por uma pseudomembrana e um halo eritematoso, seu diagnóstico é essencial para distinguir outras lesões e o tratamento se faz necessário para tratar a lesão e prevenir recorrências. Desta maneira, o presente estudo teve como objetivo descrever de forma analítica sobre o diagnóstico diferencial e o tratamento da UAR em cavidade oral. Tratou-se de um estudo descritivo, exploratório caracterizado como revisão narrativa da literatura. Os critérios de inclusão estabelecidos foram: estudos que abordassem essa temática, com idiomas inglês e português. O levantamento ocorreu em agosto/2023 a janeiro/2024, através das buscas eletrônicas PubMed, LILACS, SciELO, além da literatura cinzenta Google acadêmico e busca livre secundária. Os Descritores em Ciências da Saúde (DeCS/MeSH) foram cruzados com o operador booleano: "differential diagnosis" AND "aphthous ulcer". A UAR é caracterizada por úlceras arredondadas superficiais que pode persistir por dias ou meses. O seu diagnóstico é fundamentado no histórico do paciente e nas características da lesão. É crucial eliminar possíveis causas de úlceras orais, para evitar confusão com outras lesões, como úlceras traumáticas, imunomedia das ou até mesmo um carcinoma. Diversas terapias são empregadas no manejo da UAR, tais como corticosteroides, suplementos vitamínicos, ozonioterapia e o laser de baixa potência. Portanto, compreender o histórico das lesões é fundamental para diferenciação e diante da diversidade de terapias, é essencial ter estudos que dê esse enfoque.
Abstract: Recurrent Aphthous Ulcer (RAU) is a common lesion in the oral mucosa with varied etiology, clinically subdivided into minor, major, and herpetiform ulcers. Characterized by an ovoid shape, covered by a pseudomembrane and erythematous halo, its diagnosis is essential to distinguish it from other lesions, and treatment is necessary to address the injury and prevent recurrences. Thus, the present study aimed to analytically describe the differential diagnosis and treatment of RAU in the oral cavity. It was a descriptive, exploratory study characterized as a narrative literature review. Inclusion criteria were established as studies addressing this theme in English and Portuguese. The survey took place from August 2023 to January 2024, through electronic searches on PubMed, LILACS, SciELO, in addition to grey literature such as Google Scholar and secondary free searches. Health Sciences Descriptors (DeCS/MeSH) were crossed with the boolean operator: "differential diagnosis" AND "aphthous ulcer." RAU is characterized by round, superficial ulcers that may persist for days or months. Its diagnosis is based on the patient's history and the characteristics of the lesion. It is crucial to eliminate possible causes of oral ulcers to avoid confusion with other lesions, such as traumatic, immunomediated, or even carcinoma ulcers. Various therapies are employed in the management of RAU, such as corticosteroids, vitamin supplements, ozone therapy, and low-level laser. Therefore, understanding the history of lesions is fundamental for differentiation, and given the diversity of therapies, studies focusing on this aspect are essential.
Assuntos
Ferimentos e Lesões , Úlceras Orais , Úlceras Orais/tratamento farmacológico , Úlceras Orais/terapia , Diagnóstico Diferencial , BocaRESUMO
Recurrent aphthous ulcer (RAU) is a common oral mucosal lesion with varied and etiopathogenesis. It presents with pain and clinically manifests as an oval-shaped lesion with regular borders surrounded by an erythematous halo and covered by pseudo membrane. Due to the uncertainty about the possible causative factors, there is a need for studies that seek a better understanding of its pathophysiology. In this context, this study aimed to discuss the etiopathogenesis and clinical aspects of RAU. It was a descriptive study characterized as a narrative literature review. The inclusion criteria were studies relevant to the topic, written in Portuguese and English, without a time limit. The search was conducted between December 2022 and July 2023, through active searching in the Pubmed, LILACS, and SciELO platforms, as well as grey literature from Google Scholar and secondary free search. The Health Sciences Descriptors (DeCS/MeSH) were crossed using a Boolean operator, namely "aphthous ulcers" AND "predisposing factors." RAU has a multifactorial etiopathogenesis and may be associated with immunological, hereditary, nutritional, dietary, psycho-emotional, hormonal, and local trauma factors, although its relationship with microorganisms is controversial. Clinically, it is classified based on its morphology and clinical course. Morphologically, it is classified into minor, major, and herpetiform types, with the minor form being the most common. Therefore, RAU is a frequent oral mucosal lesion, with the minor form being the most prevalent, and despite its uncertain etiopathogenesis, studies indicate that immunological, traumatic, hereditary, hormonal, nutritional, and psycho-social factors are directly related to its development. (AU)
A úlcera aftosa recorrente (UAR) é uma lesão frequente da mucosa oral com etiopategia variada. Apresenta dor e clinicamente se manifesta com formato oval, bordas regulares circundada por halo eritematoso e coberta por pseudomembrana. Devido a incerteza sobre os possíveis fatores causais, há uma necessidade de estudos que busquem maior compreensão sobre sua patofisiologia. Diante desse contexto, o presente estudo teve como objetivo discorrer sobre a etiopatogenia e os aspectos clínicos da UAR. Tratou-se de um estudo descritivo, caracterizado como revisão narrativa da literatura. Os critérios de inclusão estabelecidos foram: estudos pertinentes à temática, redigidos em português e inglês, sem corte temporal. O levantamento ocorreu entre dezembro/2022 a julho/2023, através da busca ativa nas plataformas Pubmed, LILACS e SciELO, além da literatura cinzenta do Google Acadêmico e busca livre secundária. Os Descritores em Ciências da Saúde (DeCS/ MeSH) foram cruzados com operador booleano, a saber: "aphthous ulcers" AND "predisposing factors". A UAR apresenta etiopatogenia multifatorial, em que pode estar associada com fatores imunológicos, hereditários, nutricionais, alimentares, psico-emocionais, hormonais e traumas locais, todavia sua relação com microrganismos é controversa. Clinicamente, é classificada de acordo com sua morfologia e com sua evolução clínica. Morfologicamente, se classifica em menor, maior e herpetiformes, e a forma menor apresenta maior ocorrência. Portanto, a UAR trata-se de uma lesão frequente em mucosa oral, em que a forma menor tem maior frequência, e apesar de sua etiopatogenia incerta, estudos indicam que fatores imunológicos, traumáticos, hereditários, hormonais, nutricionais e psico-sociais apresentam relação direta com seu desenvolvimento. (AU)
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Objetivo: identificar las manifestaciones clínicas bucales de la enfermedad de Crohn y colitis ulcerosa en pacientes adultos mayores. Métodos: se efectuó un estudio descriptivo transversal con un universo de 50 adultos mayores, previamente diagnosticados por los especialistas gastroenterólogos, y prescritos con enfermedad de Crohn y colitis ulcerosa. Estos, confirmados por los hallazgos clínicos, histopatológicos y endoscópicos, remitidos a consulta estomatológica del Policlínico de Especialidades del Hospital Clinicoquirúrgico Universitario "Saturnino Lora Torres" de Santiago de Cuba, entre marzo de 2019 y marzo de 2020, practicándose el examen intrabucal, descripción de las lesiones bucales y su diagnóstico clínico. Para la recolección del dato primario se confeccionó un modelo con las variables: edad, sexo, enfermedad inflamatoria intestinal, localización anatómica, signos y síntomas clínicos orales en ambas patologías. Se creó una base de datos en SPSS versión 22.0 en Windows para el procesamiento y análisis de la información, usándose la técnica estadística descriptiva y agrupándose los datos en frecuencias absolutas y relativas. Resultados: en la serie resaltaron las personas de sexo femenino y el grupo de edades de 60 a 74 años, la pioestomatitis vegetante fue el signo bucal específico más común y la úlcera aftosa recurrente la lesión inespecífica de mayor predominio en ambas patologías. El dolor, el síntoma clínico de mayor afectación y el dorso de lengua el sitio de mayor predilección para su instalación. Conclusiones: las expresiones clínicas bucales más relevantes en pacientes adultos mayores con enfermedad de Crohn y colitis ulcerosa fueron la pioestomatitis vegetante y la úlcera aftosa recurrente.
Objective: Identify the oral clinical manifestations of Crohn´s disease and ulcerative colitis in elderly adults' patients. Methods: a cross-sectional descriptive study was carried out with a universe of 50 older adults previously diagnosed by gastroenterologist specialists, prescribing the presence of Crohn's disease and ulcerative colitis, confirmed by clinical, histopathologica and endoscopic findings, referred to the stomatological consultation of the Specialities Policlinic of the "Saturnino Lora Torres" University Clinical Surgical Hospital of Santiago de Cuba, from March 2019 to the same month of 2020, performing intraoral examination, description of oral lesions and their clinical diagnosis. For the collection of the primary data, a model was made with the variables: age, sex, inflammatory bowel disease, anatomical location, oral clinical signs and symptoms in both pathologies. A database was created in SPSS version 22.0 in Windows for the processing and analysis of the information, using the descriptive statistical technique and grouping the data in absolute and relative frequencies. Results: in the casuistry, females and the age group of 60 to 74 years prevailed, vegetative pyostomatitis was the most common specific oral sign and recurrent aphthous ulcer was the most prevalent non-specific lesion in both pathologies, pain being the most affecting clinical symptom and the back of the tongue is the most preferred site for its installation. Conclusions: the most relevant oral clinical expressions in elderly patients adults with Crohn´s disease and ulcerative colitis were pyostomatitis vegetative and recurrent aphthous ulcer.
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Humanos , AdultoRESUMO
The objective of this study was to compare the safety and efficacy of 0.2% hyaluronic acid (HA) topical gel and dexamethasone topical ointment in the treatment of recurrent aphthous ulcers (RAU) in children. This retrospective observational study included 104 patients who had more than two episodes of oral aphthous ulcers per year and were treated with HA (n=52) or dexamethasone (n=52) from August 15, 2014 to September 3, 2018. Therapy efficacy was evaluated based on the ulcer size and pain score before versus 7 days after either therapy. The paired t-test, chi-squared test, and independent t-test were utilized for statistical analyses. There was no significant difference in ulcer size or pain score between the HA and dexamethasone groups, on day 1 or day 7. Both treatments were tolerated well and no side effects were reported. No significant differences in body temperature, respiration rate, pulse, or systolic/diastolic blood pressure were observed between the start (day 1) and end of treatment (day 7), for either treatment. HA and dexamethasone showed similar efficacy in reducing ulcer size and pain scores, and were tolerated equally well in children with RAU. Future high-quality studies with larger numbers of patients are needed to confirm our findings.
Assuntos
Humanos , Masculino , Feminino , Criança , Estomatite Aftosa/tratamento farmacológico , Dexametasona/uso terapêutico , Adjuvantes Imunológicos/uso terapêutico , Ácido Hialurônico/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Dor , Recidiva , Estudos RetrospectivosRESUMO
Recurrent aphthous ulcer (RAU) is an inflammatory condition of the oral mucosa characterized by painful, well-circumscribed, single or multiple round or ovoid ulcerations. The exact etiologic factor(s) of these ulcerations are not yet understood. The objective of this study was to evaluate inflammatory processes and free radical metabolism of 25 patients with RAUs compared to 25 healthy controls. The levels of malondialdehyde (MDA) and glutathione (GSH) were determined by high-performance liquid chromatography. Tumor necrosis factor-alpha (TNF-α), interleukin-2 (IL-2), IL-10, and IL-12 were determined by ELISA. Nitric oxide (NO), myeloperoxidase (MPO), total antioxidant status (TAS), and total oxidant status (TOS) levels were measured spectroscopically in serum. The levels of MDA, GSH, TNF-α, IL-2, IL-12, MPO, and TOS, and oxidative stress index (OSI) were higher, and the levels of NO, IL-10, and TAS were lower in patients with RAU than in controls. Statistical analysis showed that GSH, TNF-α, IL-2, IL-10, and OSI differed significantly in patients with RAU compared to controls. These parameters have important roles in oxidant/antioxidant defense.