Diagnóstico diferencial e opções de tratamento da úlcera aftosa recorrente: revisão narrativa da literatura / Differential diagnosis and treatment options of recurrent aphrhous ulcer: narrative literature review

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.

Efficacy of ozone therapy for oral mucosa wound healing: a systematic review and meta-analysis.

OBJECTIVES: To conduct a systematic review and meta-analysis to assess the effectiveness of ozone therapy in oral ulcers healing when compared to placebo or active treatments. MATERIALS AND METHODS: The search was carried out using PubMed, EMBASE, Scopus, and Lilacs databases. Clinical trials involving human participants were included. The Risk Ratio (RR) and the standardized mean difference (SMD) with 95%CI (confidence interval) were calculated. The ROBINS-I (risk of bias in non-randomized studies of interventions) and RoB2 (risk of bias tool for randomized trials) assessment tool was used to detect bias. RESULTS: After the selection process, 12 studies were included. The meta-analysis showed that ozone therapy helps to reduce the size of the traumatic and autoimmune ulcers (RR=-0.44; 95% CI -0.71,-0.17; I2=0%) in comparison to placebo. Regarding pain reduction, ozone was superior to placebo (RR = 1.29, 95% CI -1.6 to -0.95); I2=0%), and equivalent to topical corticosteroid and laser photobiomodulation (RR = 0.26, 95% CI -0.27,0.78, p = 0.34). CONCLUSION: Ozone therapy is an alternative for accelerating healing and reducing pain for both traumatic and autoimmune ulcers. However, the quality of evidence is limited. CLINICAL RELEVANCE: Oral ulcerations are usually painful and impact quality of life requiring different approaches to boost wound healing and reduce symptoms. For this purpose, ozone therapy is a promising strategy.

Evaluation of the healing potential of Nile tilapia skin collagen in traumatic oral ulcers in male rats.

OBJECTIVE: To evaluate the healing potential of Nile tilapia skin collagen using a rat model with experimentally induced traumatic oral ulcers. DESIGN: Male Wistar rats were segregated into three experimental groups (n = 8/group/euthanasia day). Ulcers were induced using a dermatological punch on the left buccal mucosa. The rats were then euthanized on days 1, 5, 10, 15, and 20 (ntotal=120 rats). Each group received topical treatment, 2x/day, with 1 % Nile tilapia skin collagen orabase (experimental group), only orabase (negative control), or Oncilom-A® orabase (positive control). Ulcer area, closure percentage, and body mass variation were measured. Slides were prepared for histological analysis, which included Picrosirius red staining (collagen analysis), and immunohistochemistry (platelet endothelial cell adhesion molecule, alpha-smooth muscle actin, and transforming growth factor-beta). RESULTS: On day 15, the experimental and positive control groups displayed smaller ulcer areas, a higher percentage of closure, complete re-epithelialization, superior histological repair scores, and a reduced count of polymorphonuclear cells in comparison to the negative control group (p < 0.05). Additionally, the experimental group exhibited an increased number of blood vessels, total collagen (types I and III) and expression of platelet endothelial cell adhesion molecule, alpha-smooth muscle actin, and transforming growth factor-beta relative to the negative and positive control groups (p < 0.05). By day 20, the experimental group showed a more significant weight gain compared to the other groups (p < 0.0001). CONCLUSIONS: Nile tilapia skin collagen orabase optimizes the healing of traumatic ulcers by stimulating re-epithelialization, angiogenesis, and collagenesis. Transforming growth factor-beta plays a significant role in this process.

Characterization of Kikuchi-Fujimoto Disease in Children and Risk Factors Associated with Its Course.

OBJECTIVE: To outline the characteristics of Kikuchi-Fujimoto disease (KFD) in children and analyze factors associated with severe and recurring courses. METHODS: Electronic medical records of children histopathologically diagnosed with KFD at Seoul National University Bundang Hospital from March 2015 to April 2021 were retrospectively reviewed. RESULTS: A total of 114 cases (62 males) were identified. The mean patient age was 12.0 ± 3.5 years. Most patients came to medical attention with cervical lymph node enlargement (97.4%) and fever (85%); 62% had a high-grade fever (≥39°C). Prolonged fever (≥14 days) was seen in 44.3% and was associated with a high-grade fever (P = .004). Splenomegaly, oral ulcer, or rash was present in 10.5%, 9.6%, and 15.8%, respectively. Laboratory findings showed leukopenia, anemia, and thrombocytopenia in 74.1%, 49%, and 24%, respectively. Sixty percent of cases had a self-limited course. Antibiotics were initially prescribed in 20%. A corticosteroid was prescribed in 40% of patients and was associated with oral ulcer (P = .045) and anemia (P = .025). Twelve patients (10.5%) had a recurrence with a median interval of 19 months. No risk factor for recurrence was identified in multivariable analysis. Clinical characteristics of KFD were similar between our current and previous studies. However, antibiotics use decreased (P < .001); nonsteroidal anti-inflammatory drugs use increased (P < .001), and, although statistically not significant, corticosteroid treatment also increased. CONCLUSIONS: Over a span of 18 years, the clinical characteristics of KFD did not change. Patients presenting with high-grade fever, oral ulcer, or anemia may benefit from corticosteroid intervention. All patients should be monitored for recurrence.

Soluble epoxide hydrolase inhibitor promotes the healing of oral ulcers.

OBJECTIVE: Oral ulcers are a lesion in the oral mucosa that impacts chewing or drinking. Epoxyeicosatrienoic Acids (EETs) have enhanced angiogenic, regenerative, anti-inflammatory, and analgesic effects. The present study aims to evaluate the effects of 1-Trifluoromethoxyphenyl-3-(1-Propionylpiperidin-4-yl) Urea (TPPU), a soluble epoxide hydrolase inhibitor for increasing EETs level, on the healing of oral ulcers. METHODS: The chemically-induced oral ulcers were established in Sprague Dawley rats. The ulcer area was treated with TPPU to evaluate the healing time and pain threshold of ulcers. The expression of angiogenesis and cell proliferation-related protein in the ulcer area was detected using immunohistochemical staining. The effects of TPPU on migration and angiogenesis capability were measured with scratch assay and tube formation. RESULTS: Compared with the control group, TPPU promoted wound healing of oral ulcers with a shorter healing time, and raised pain thresholds. Immunohistochemical staining showed that TPPU increased the expression of angiogenesis and cell proliferation-related protein with reduced inflammatory cell infiltration in the ulcer area. TPPU enhanced cell migration and tube-forming potential in vitro. CONCLUSIONS: The present results support the potential of TPPU with multiple biological effects for the treatment of oral ulcers by targeting soluble epoxide hydrolase.

Oral lesions after infection by SARS CoV 2: two case reports / Lesiones bucales posteriores a infección por SARS CoV 2 presentación de dos casos

Introduction: The SARS CoV 2 infection has resulted in several health, economic, and social crises in all areas. The disease shows a substantial biological diversity in humans causing a series of sequels in the trans- or post-infection period in the entire organism. Case Report: The manifestations that occur in the oral cavity and pharynx have not been evaluated. In this study, two clinical cases are reported. The first patient, a 67-year-old male, presents erosive lesions on the dorsal surface of his tongue after SARS CoV 2 infection. Results: Therapy consisting of reinforcing oral cleaning, use of antifungal solutions, mouthwashes containing superoxidation solution and B complex was given to the patient. The reported lesions improved satisfactorily. The second case, a 47-year-old male patient, presented vesiculobullous lesions on the lingual and labial mucosa accompanied by severe painful symptoms after SARS CoV 2 infection. An incisional biopsy was performed. The histopathological result was compatible with pemphigus vulgaris, and the treatment protocol was started with 0.1% topical mometasone and 2g miconazole gel, observing adequate involution of the lesions after 20 days. Conclusions: The aim of this study is to report on the lesions affecting the oral cavity and pharynx in post-COVID patients with the aim of carrying out a thorough intraoral examination, establishing a clinical or histopathological diagnosis to implement a specific treatment plan in each case to improve the health and quality of life of the patients. Keywords: SARS-CoV-2; Oral manifestations; Oral ulcer; Pemphigus; Mouth; Mucous membrane.

Introducción: La infección por virus de SARS CoV 2 ha dejado a su paso una estela de crisis en materia de salud, económica, social y en todos los ámbitos a la fecha seguimos realizando la observación del comportamiento de la enfermedad en los seres humanos con una diversidad biológica importante y que ha traído como consecuencia una serie de secuelas que se presentan en el periodo trans o posterior a la infección en toda la economía corporal. Reporte de Caso: Se ha evaluado poco las manifestaciones que se presentan en la cavidad bucal y faringe; se presentan dos casos clínicos el primero paciente masculino de 67 años de edad posterior a la infección por SARS CoV 2 presenta diluciones de continuidad en bordes laterales de la lengua se indica terapia y refuerza limpieza bucal, antimicótico, colutorios con solución de superoxidación y complejo B, las úlceras involucionan de manera satisfactoria. Resultados: El segundo caso masculino de 47 años posterior a la infección por SARS CoV 2 debuta con lesiones vesículo-ampollosas en mucosa lingual, labial con sintomatología dolorosa severa, se realiza biopsia incisional donde el resultado histopatológico es compatible con pénfigo vulgar, se inicia protocolo de tratamiento con mometasona tópica al 0.1% y miconazol gel 2g observándose una adecuada involución de las lesiones a los 20 días. Conclusiones: El objetivo de este trabajo es poner en contexto de la comunidad médica y científica las lesiones concernientes a la cavidad bucal y faringe que están presentando los pacientes postcovid con el objetivo de realizar una exhaustiva exploración intraoral, establecer un diagnóstico clínico o histopatológico y con base en esto instaurar un plan de tratamiento específico en cada caso en particular con el fin fundamental de mejorar la salud y calidad de vida del paciente.

Tumor necrosis factor alpha (TNF-α) blockage reduces acute inflammation and delayed wound healing in oral ulcer of rats.

Oral traumatic ulcers (OTU) are common in dental routine, and the control of proinflammatory cytokines, such as the tumor necrosis factor-alpha (TNF-α), may interfere with OTU repair. Our aim was to evaluate the role of TNF-α in the healing process of OTU in rats. Wistar male rats were divided into six groups: a control-group (treated with 0.1 mL/kg of saline) and five groups treated with anti-TNF-α infliximab (INF) at 1, 3, 5, 7, and 10 mg/kg immediately before OTU production. The animals were weighed (day 0) and euthanized on days 1, 3, 7, 14 and 21 after ulceration. The ulcers were clinically measured, and the mucosa samples were histologically (scores 0-4), histochemically (collagen assay (pircrosirius)), histomorphometrically (cell counting), and immunohistochemically (TNF-α, α-smooth-muscle-actin (α-SMA), monocyte-chemoattractive-protein-1 (MCP-1), interleukin-8 (IL-8), and fibroblast-growth-factor (FGF)) analyzed. The Evans blue assay was used to measure the vascular permeability. ANOVA-1-2-way/Bonferroni, Kruskal-Wallis/Dunn, and correlation analyses were performed (GraphPad Prism 5.0, p < 0.05). High doses of INF reduced the OTU area (p = 0.043), body mass loss (p = 0.023), vascular permeability (p < 0.001), and reduced delayed histologic scores (p < 0.05), polymorphonuclear (p < 0.001) and mononuclear (p < 0.001) cells, blood vessel counting (p = 0.006), and total (p < 0.001), type-I (p = 0.018), and type-III (p < 0.001) collagen. INF treatment reduced TNF-α immunostaining and delayed MPC-1, FGF, and α-SMA expression, with little/none influence in IL-8 immunostaining. TNF-α blockage by INF reduced acute inflammation in OTU but delayed cell migration and wound healing.

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.

Photodynamic therapy in the treatment of oral lesions caused by paracoccidiomycosis.

Paracoccidioidomycosis (PCM) is an endemic disease caused by the dimorphic fungus Paracocdioides brasiliensis and Paracoccidioides lutzii. Oral ulcers are usually the first clinical signs of the disease. As it is a systemic fungal disease, local treatments are considered complementary, such as photodynamic therapy (aPDT). We present a patient with ulcerated lesions in the oral cavity of about 6 months duration. The pain complaint in the oropharynx led to a reduction in food acceptance and a weight loss of around 40 kg. He underwent biopsy of the lip lesion, and the histopathological report described yeast with multiple buds compatible with PMC. Our team opted for treatment with aPDT sessions. Two sessions were carried out in the ward and six in the ICU, showing satisfactory results in the remission of ulcerated lesions associated with PCM as well as the painful symptoms in the oral cavity. Also, the patient underwent Amphotericin B and Sulfamethoxazole-trimethoprim. We believe that the association of aPDT with pharmacological therapy possibly accelerated the repair process of oral lesions, as well as providing fungal lesion decontamination, improving progressively the healing of oral lesions.

Oral Manifestation COVID-19 and the Rapid Resolution of Symptoms Post-Phtalox Treatment: a Case Series / Manifestación Oral de COVID-19 y la Rápida Resolución de los Síntomas Después del Tratamiento con Phtalox: una Serie de Casos

The mouth plays a critical role in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) owing to the fact that both the tongue and salivary glands are conducive environments for the storage and spread of the virus. This case series aimed to describe the oral manifestations of coronavirus disease (COVID-19) and report the rapid response to Phtalox® treatment in all patients who tested positive for the virus. The patients were grouped based on whether according to convenience as soon as they tested positive for COVID-19. All patients had mouth ulcers and were advised to use 5 mL of Phtalox® mouthwash for 1 min, five times daily, in addition to standard COVID-19 treatment. Complete healing of mouth ulcers occurred in all patients diagnosed with COVID-19, and the mean duration for complete healing was 2.37 days. General improvement of COVID-19 symptoms was also observed. Based on the rapid recovery of mouth ulcers observed, we suggest that Phtalox® is effective as a complementary oral treatment for ulcers associated with COVID-19.

La cavidad oral juega un papel fundamental en la transmisión del síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2) debido al hecho de que tanto la lengua como las glándulas salivales son entornos propicios para el almacenamiento y la propagación del virus. Esta serie de casos tuvo como objetivo describir las manifestaciones orales de la enfermedad por coronavirus (COVID-19) e informar la rápida respuesta al tratamiento con Phtalox® en todos los pacientes que dieron positivo al virus. Los pacientes se agruparon en función de su conveniencia tan pronto como dieron positivo a COVID-19. Todos los pacientes tenían úlceras en la boca y se les recomendó utilizar 5 ml de enjuague oral Phtalox® durante 1 minuto, cinco veces al día, además del tratamiento estándar de COVID-19. La curación completa de las úlceras orales ocurrió en todos los pacientes diagnosticados con COVID-19, y la duración media para la curación completa fue de 2,37 días. También se observó una mejoría general de los síntomas de COVID-19. Con base en la rápida recuperación de las úlceras orales observadas, sugerimos que Phtalox® es eficaz como tratamiento oral complementario para las úlceras asociadas con COVID-19.

Abatacept treatment impairs the cell migration and wound healing of oral ulcers in rats: Role of interleukin (IL)-1ß, -6 and -10 and CD8/CD30 cells: Influence of abatacept treatment on oral wound healing: Experimental model on rats.

The present study aimed to evaluate the healing process of ulcers in the jugal mucosa of Wistar rats treated with abatacept. The rats were randomly assigned to four groups: saline-treated control (0.3 mL/kg) abatacept-treated groups at dosages of 3.2, 8.0 and 20.0 mg/kg/week. After two weeks of subcutaneous (SC) administration, ulcers were introduced into the left jugal mucosa with an 8-mm diameter punch. SC administration was continued until euthanasia (after 1, 3, 7, 14 and 21 days of ulceration), and ulcers were clinically measured and animals weighed. Histological slides were evaluated (healing scores and polymorphonuclear, mononuclear, vessel, and fibroblast/myofibroblast counts). We also performed collagenesis analysis (Picrosirius Red) and immunohistochemistry (induced nitric oxide synthase (iNOS), interleukin (IL)-1beta (1ß), -6, -10, plus the analysis of CD8 and CD30). The experiment was repeated to perform a vascular permeability assay. ANOVA 1-way or 2-way/Bonferroni and Kruskal-Wallis/Dunn tests were used for statistical analysis (GraphPad Prism 5.0®, p < 0.05). Abatacept treatment reduced the ulcer diameter and the numbers of polymorphonuclear and mononuclear cells; reduced the CD8+/CD30+ ratio and vascular permeability; and increased collagenesis and IL-10 expression at the beginning of the protocol. At the highest dose, there was a delay in repair and vascular proliferation; a reduction in the number of fibroblasts/myofibroblasts; and prolongation of iNOS, IL- and IL- expression. We conclude that abatacept accelerates the healing of oral ulcers by reducing the migration of inflammatory cells, but overdose of abatacept leads to delayed repair and prolongation of proinflammatory cytokine expression.

Utilidad del Oleozón® tópico en las úlceras orales del paciente con ventilación artificial mecánica, Guantánamo 2018 / Utilidade do Oleozón® tópico nas úlceras orais do paciente com ventilação artificial mecânica, Guantanamo 2018 / Usefulness of topical Oleozón® in the oral ulcers of the patient with mechanical artificial ventilation, Guantanamo 2018

Introducción: Las úlceras de la mucosa oral son comunes en los pacientes con ventilación artificial mecánica. Objetivo: Determinar la utilidad del Oleozón® tópico en el tratamiento de las úlceras de la mu cosa oral en pacientes tratados con ventilación artificial mecánica en la Unidad de Cuidados Intensivos (UCI) del Hospital General Docente Dr Agostinho Neto. Método: Se realizó un estudio tipo caso-control durante enero-julio de 2018. El universo lo conformaron 70 pacientes, de los que se seleccionó una muestra aleatoria y se agruparon en un grupo control (n=20) que se les realizó limpieza de la cavidad bucal con solución salina fisiológica 0,9 por ciento y un grupo estudio (n=20) que se les realizó cura de la úlcera con Oleozón® tópico. Se analizó la localización, área, forma de presentación y magnitud de la úlcera y la evolución clínica de acuerdo al tratamiento que se aplicó. Resultados: La evolución satisfactoria de este tipo de úlcera se precisó en el 40,0 por ciento de los pacientes que conformaron el grupo control y el 90,0 por ciento de los que integraron el grupo estudio (p < 0,01). En este último grupo la ventana entre el inicio del tratamiento y control de la úlcera oral fue de 4,5 ± 1,1 días y para el primero fue 8,1 ± 2,7 días (p < 0,01). Conclusión: Se revela la conveniencia de la aplicación de Oleozón® tópico al tratamiento de las úlceras de la mucosa oral que se presentan en los pacientes tratados con ventilación artificial mecánica(AU)

Introduction: Ulcers of the oral mucosa are common in patients with mechanical artificial ventilation. Objective: To determine the usefulness of topical Oleozón® in the treatment of oral mucosal ulcers in patients treated with mechanical artificial ventilation in the Intensive Care Unit (ICU) of the General Teaching Hospital "Dr. Agostinho Neto". Method: A case-control study was carried out during January-July 2018. The universe was made up of 70 patients, from which a random sample was selected and grouped in a control group (n=20) who were cleaned the oral cavity with 0.9per cent physiological saline solution and a study group (n=20) who were cured of the ulcer with topical Oleozón®. The location, area, form of presentation and magnitude of the ulcer and the clinical evolution were analyzed according to the treatment that was applied. Results: The satisfactory evolution of this type of ulcer was required in 40.0por cento of the patients that formed the control group and 90.0per cent of those who made up the study group (p<0.01). In this last group, the window between the start of treatment and control of the oral ulcer was 4.5 ± 1.1 days and for the first one it was 8.1 ± 2.7 days (p<0.01). Conclusion: The convenience of the application of topical Oleozón® to the treatment of oral mucosal ulcers that occur in patients treated with mechanical artificial ventilation is revealed(AU)

Introdução: Úlceras da mucosa oral são comuns em pacientes com ventilação artificial mecânica. Objetivo: Determinar a utilidade do Oleozón® tópico no tratamento de úlceras na mucosa oral em pacientes tratados com ventilação artificial mecânica na Unidade de Terapia Intensiva (UTI) do Hospital Geral de Ensino "Dr. Agostinho Neto". Método: Foi realizado um estudo de caso-controle no período de janeiro a julho de 2018. O universo foi constituído por 70 pacientes, dos quais uma amostra aleatória foi selecionada e agrupada em um grupo controle (n=20) que foi limpo de cavidade oral com solução salina fisiológica a 0,9por cento e um grupo de estudo (n=20) curado da úlcera com Oleozón® tópico. A localização, área, forma de apresentação e magnitude da úlcera e a evolução clínica foram analisadas de acordo com o tratamento aplicado. Resultados: A evolução satisfatória desse tipo de úlcera foi necessária em 40,0por cento dos pacientes que formaram o grupo controle e em 90,0por cento daqueles que fizeram parte do grupo de estudo (p<0,01). Neste último grupo, a janela entre o início do tratamento e o controle da úlcera oral foi de 4,5 ± 1,1 dias e no primeiro foi de 8,1 ± 2,7 dias (p<0,01). Conclusão: É revelada a conveniência da aplicação tópica de Oleozón® no tratamento de úlceras na mucosa bucal que ocorrem em pacientes tratados com ventilação artificial mecânica(AU)

Effects of cannabidiol, a Cannabis sativa constituent, on oral wound healing process in rats: Clinical and histological evaluation.

The effects of cannabidiol (CBD), the main non-psychotropic component of Cannabis sativa, were assessed on oral wound healing in an in vivo model. Standardized ulcers were induced in 60 Wistar rats using a 5-mm biopsy punch on the midline of the ventral tongue. Animals received intraperitoneal injections of CBD at doses of 0 (control), 5, and 10 mg/kg daily. Animals were weighed daily, and wound healing was clinically and histologically evaluated after 3 and 7 days of treatment. CBD treatment did not influence the wound area of ulcerative lesions at either observation time. Conversely, microscopic findings revealed that at Day 3 postwounding, CBD-treated lesions exhibited significantly lower inflammatory scores than those in the control group. However, this difference was not observed at Day 7. Collectively, these findings indicate that CBD exert an antiinflammatory effect in early phase of wound healing process although it was not sufficient promote clinical improvement of oral traumatic ulcerative lesions.

Therapeutic effect of Aloe vera and silver nanoparticles on acid-induced oral ulcer in gamma-irradiated mice.

Radiation combined injury, a life-threatening condition, has higher mortality than simple radiation injury. The aim of the present study was to analyze the efficiency of Aloe vera and silver nanoparticles in improving the healing of ulcerated oral mucosa after irradiation. Thirty male Albino mice were divided into five groups: control, radiation, Aloe vera (AV), silver nanoparticles (NS), and AV+NS. The mice were exposed to whole body 6Gy gamma-radiation. After one hour, 20% acetic acid was injected into the submucosal layer of the lower lip for ulcer induction. The animals received topical treatment with the assigned substances for 5 days. Lip specimens were subjected to hematoxylin and eosin and anti alpha-smooth muscle actin immunohistochemical staining. Results demonstrated occurance of ulcer three days post irradiation in all groups except in the AV+NS group where only epithelial detachment was developed. After seven days, data revealed persistent ulcer in radiation group, and almost normal epithelium in the AV+NS group. A significant reduction of epithelial thickness was detected in all groups at the third day as compared to control. At the seventh day, only the AV+NS group restored the epithelial thickness. Area percent of alpha-smooth muscle actin expression was significantly decreased in radiation group at the third day followed by significant increase at the seventh day. However, all treatment groups showed significant increase in alpha-smooth muscle actin at the third day, which decreased to normal level at the seventh day. Our study demonstrated the efficiency of Aloe vera and silver nanoparticles in enhancing ulcer healing after irradiation.

Therapeutic effect of Aloe vera and silver nanoparticles on acid-induced oral ulcer in gamma-irradiated mice

Abstract Radiation combined injury, a life-threatening condition, has higher mortality than simple radiation injury. The aim of the present study was to analyze the efficiency of Aloe vera and silver nanoparticles in improving the healing of ulcerated oral mucosa after irradiation. Thirty male Albino mice were divided into five groups: control, radiation, Aloe vera (AV), silver nanoparticles (NS), and AV+NS. The mice were exposed to whole body 6Gy gamma-radiation. After one hour, 20% acetic acid was injected into the submucosal layer of the lower lip for ulcer induction. The animals received topical treatment with the assigned substances for 5 days. Lip specimens were subjected to hematoxylin and eosin and anti alpha-smooth muscle actin immunohistochemical staining. Results demonstrated occurance of ulcer three days post irradiation in all groups except in the AV+NS group where only epithelial detachment was developed. After seven days, data revealed persistent ulcer in radiation group, and almost normal epithelium in the AV+NS group. A significant reduction of epithelial thickness was detected in all groups at the third day as compared to control. At the seventh day, only the AV+NS group restored the epithelial thickness. Area percent of alpha-smooth muscle actin expression was significantly decreased in radiation group at the third day followed by significant increase at the seventh day. However, all treatment groups showed significant increase in alpha-smooth muscle actin at the third day, which decreased to normal level at the seventh day. Our study demonstrated the efficiency of Aloe vera and silver nanoparticles in enhancing ulcer healing after irradiation.

Oral manifestation of histoplasmosis on the palate.

This case report describes an uncommon manifestation of histoplasmosis on the soft palate. The importance of appropriate treatment and follow-up in complex cases is emphasized, especially in patients with chronic diseases. Oral lesions may occur as multiple, granular and painful ulcers, as well as verrucous growths. Lesions may also be deep, with infiltrative edges and erythematous or with white areas, accompanied by local lymphadenopathy, resembling a carcinoma on clinical examination. In this sense, a fast and accurate diagnosis is essential to the success of treatment of oral histoplasmosis.

Effects of Copaiba Oil Topical Administration on Oral Wound Healing.

The effects of topical copaiba oil extract and topical corticosteroid were assessed on oral wound healing in an in vivo model using 96 male Wistar rats. Traumatic ulcers were caused in the dorsum of the tongue using a 3-mm punch tool. The animals were divided into: Control; Corticosteroid; Placebo and Copaiba oil Group. The animals received two daily applications of the products. The control group received only daily handling. Six rats in each group were euthanized at days 3, 5, 10 and 14. The animals were monitored daily to determine wound status. The weigh was assessed at day 0 and euthanasia day. The percentage of repair was calculated, and histopathological aspects were analyzed. The Kruskal-Wallis test was used to compare the results between groups and times of evaluation. Closing time was assessed through the log-rank test. The corticosteroid group lost more weight at days 10 and 14 than the control group (p < 0.05). Moreover, the healing time of corticosteroid group was longer than the control group (p = 0.007). No differences were observed between the copaiba oil group and the control group. We concluded that topical copaiba oil, in spite of being safe, did not accelerate the process of oral wound healing. Copyright © 2017 John Wiley & Sons, Ltd.