Oxypentifylline in the management of recurrent aphthous oral ulcers: an open clinical trial.

OBJECTIVE: The purpose of this study was to determine the efficacy of oxypentifylline in the treatment of recurrent oral aphthous ulcers and to compare the results with those of previous studies. STUDY DESIGN: A 6-week open trial and a patient survey regarding pain were conducted at the Oral and Maxillofacial Surgery Unit, City General Hospital, Carlisle. Twenty-four patients (11 male and 13 female) were selected from sequential referrals involving complaints of recurrent oral ulcers. A 2-week pretrial period was used to record data pertaining to the occurrence, duration, and pain associated with ulcers. A 4-week period of treatment with oxypentifylline (400 mg administered orally 3 times daily) was followed by an assessment of improvement at the end of 6 weeks. RESULTS: The results were comparable to those of previous studies, with positive responses seen in 63.6% of male patients and 61.5% of female patients. However, recurrence of ulcers was noted in all patients once the drug was discontinued. This was attributed to the small size of the patient sample studied and to the relatively short duration of treatment. No significant side effects were noted. CONCLUSIONS: Double-blind, controlled studies are indicated for a definitive assessment of the efficacy of oxypentifylline in the management of recurrent oral aphthous ulcers. The encouraging results of this study support the suggestion that the use of oxypentifylline be considered in refractory cases of recurrent oral aphthous ulcers.     

Randomized, double-blind study of levamisole in recurrent aphthous stomatitis.

A randomized double-blind study was designed to evaluate the safety and efficacy of levamisole in the treatment of recurrent aphthous stomatitis (RAS). Thirty patients, aged 9-65 years, were selected, based on a documented history of three or more episodes of RAS. Patients were instructed to take 150 mg of levamisole (or placebo) daily for 3 days at the onset of the first prodromal symptoms of an ulcer. The regimen was to be repeated for each new episode, but not more than once per week. At each episode patients were examined and evaluated as to number and duration of ulcers, interval between episodes, pain associated with ulcers, and side effects. Data on 24 patients were suitable for analysis. Of those patients receiving levamisole, six showed slight improvement and five were unchanged. Of those patients receiving the placebo, one showed a marked improvement, four slight improvement, six were unchanged, and two deteriorated. There was neither a clinical nor a statistically significant difference between the groups. It is concluded that levamisole, in this study protocol, had no effect on the incidence or severity of aphthous ulcers.     

Randomized, double-blind study of levamisole in recurrent aphthous stomatitis

Abstract A randomized double-blind study was designed to evaluate the safety and efficacy of levamisole in the treatment of recurrent aphthous stomatitis (RAS). Thirty patients, aged 9–65 years, were selected, based on a documented history of three or more episodes of RAS. Patients were instructed to take 150 mg of levamisole (or placebo) daily for 3 days at the onset of the first prodromal symptoms of an ulcer. The regimen was to be repeated for each new episode, but not more than once per week. At each episode patients were examined and evaluated as to number and duration of ulcers, interval between episodes, pain associated with ulcers, and side effects. Data on 24 patients were suitable for analysis. Of those patients receiving levamisole, six showed slight improvement and five were unchanged. Of those patients receiving the placebo, one showed a marked improvement, four slight improvement, six were unchanged, and two deteriorated. There was neither a clinical nor a statistically significant difference between the groups. It is concluded that levamisole, in this study protocol, had no effect on the incidence or severity of aphthous ulcers.     

Smokeless tobacco use prevents aphthous stomatitis.

Aphthous stomatitis is a common, recurrent, painful ulcerative condition of the oral mucosa. Cigarette smoking has been reported to protect against aphthous ulcers. To determine whether smokeless tobacco use also protects against aphthous ulcers, we examined the oral mucosa in 1456 professional baseball players, about half of whom were smokeless tobacco (ST) users. After controlling for the confounding effects of age, race, cigarette smoking, alcohol consumption, and dental hygiene practices, ST use was found to significantly reduce the risk of aphthous ulcers among these healthy young men (odds ratio = 0.4; p = 0.04). It has been suggested that cigarette smoking prevents aphthous ulcers by causing increased keratinization of the oral mucosa, and ST may protect by the same mechanism. Alternatively, a component of tobacco that is systemically absorbed might be responsible for protecting against aphthous ulcers. If the mechanism that protects ST users against aphthous ulcers is systemic, then nicotine is the likely protective factor.     

An evaluation of a chemical cautery agent and an anti-inflammatory ointment for the treatment of recurrent aphthous stomatitis: a pilot study.

OBJECTIVE: Recurrent aphthous stomatitis is a very common condition, currently treated with anti-inflammatory agents, which palliate the symptoms. The purpose of this clinical trial was to compare a medication commonly used to treat recurrent aphthous stomatitis, Kenalog-in-Orabase, and a newer agent, Debacterol. METHOD AND MATERIALS: Sixty patients diagnosed with recurrent aphthous stomatitis were enrolled in the study. Twenty patients were assigned to each of the two treatment groups, and 20 age- and sex-matched patients were assigned to the control group, which received no treatment. After the diagnosis was made, clinical examinations and ulcer measurements were performed, and a subjective evaluation of symptoms (100-mm visual analog scale) was completed by each subject. The subjects did not use any other medications. Both agents were applied topically (the frequency varied depending on the group of subjects) at specified intervals. Ulcer measurements and subjective evaluations were made at days 0, 3, 6, and 10 for all subjects. RESULTS: In both treatment groups, by day 10, 100% of the ulcers had clinically healed and were no longer causing pain. Patients in the Debacterol group reported a significantly greater decrease in pain at 3 days (> 70%) than did subjects in the other groups (< 20%), although the size of the ulcer did not differ significantly in any of the groups. After day 6, 80% of the ulcers in the Debacterol group had clinically disappeared and no longer caused symptoms, as compared to about 30% in the other groups. CONCLUSION: Patients subjectively reported significantly greater relief from symptoms with Debacterol than with Kenalog-in-Orabase or no treatment. The relief of symptoms associated with recurrent aphthous stomatitis may or may not correspond to clinical improvement, and these two topical medications may affect signs and symptoms of the lesions differently.     

Evaluation of salivary nitric oxide levels in oral mucosal diseases: A controlled clinical trial.

Lichen planus is a common dermatologic disease to manifest in the oral cavity. Recurrent aphthous ulcers are the most common ulcers of the oral cavity causing discomfort to the patients. These two diseases have different clinical manifestations which require appropriate treatment after correct diagnosis. Though numerous etiological factors have been proposed for these diseases, their true etio-pathogenesis is not yet established and therefore all therapies are palliative and none is effective universally. In light of this, the role of nitric oxide as a mediator in the etio-pathogenesis of these diseases was considered. The present study was undertaken to note the salivary nitric oxide levels as measured through its product nitrite in oral mucosal diseases like lichen planus and recurrent aphthous ulcers and also to ascertain whether salivary nitric oxide level has a role to play as a pathophysiological mediator in these diseases     

Effect of levamisole on the incidence and prevalence of recurrent aphthous stomatitis. A double-blind clinical trial.

Twenty patients with severe recurrent aphthous stomatitis were treated with a new drug, levamisole, to determine its effects upon the incidence and prevalence of recurrent aphthous stomatitis. The trial, conducted in a non-crossover, double-blind fashion, did not demonstrate any statistically significant differences when levamisole and placebo groups were compared over time either in the number of ulcers, number of ulcer-days, mean duration of ulcers, or mean number of ulcers per day. Positive subjective results were experienced by the 10 patients receiving levamisole but these were not of sufficient magnitude to affect group mean differences.     

Major aphthous ulcers in patients with HIV disease

Major aphthous ulcers are associated with a high degree of morbidity in patients infected with human immunodeficiency virus. A large representative cohort intected with human immunodeficiency virus was examined to evaluate the prevalence of major aphthous ulcers, demographic data of patients with major aphthous ulcers, and the usage of major aphthous ulcers as a marker for immune deterioration. The effects of tobacco smoking and the use of specific antibiotics, trimethoprim/sulfamethoxalazole or dapsone, on the development of major aphthous ulcers was also investigated. In a population of 767 persons infected with human immunodeficiency virus, major aphthous ulcers were found at a prevalence rate of 3.1% (24 patients). This type of lesion did not show any predilection for human immunodeficiency virus transmission category, ethnic group, or gender. Persons who received trimethoprim/sulfamethoxalazole or dapsone or had a history of tobacco smoking showed a decreased prevalence of major aphthous ulcers. All patients (100%) with major aphthous ulcers had CD4+ cell counts below 100 cells/mm³, but only 50% had a previous acquired immunodeficiency syndrome defining illness. Major aphthous ulcers in persons infected with human immunodeficiency virus are suggestive of severe immune suppression and may serve as a marker for human immunodeficiency virus disease progression.     

与经期有关的RAU患者焦虑水平的对照研究

目的：探讨与经期有关的复发性口腔溃疡（RAU）患者焦虑水平,为治疗女性RAU提供依据。方法：选取35例与经期有关的RAU患者,采用状态—特质焦虑量表（STAI）测查,并与35例健康妇女进行比较。结果：RAU患者的状态焦虑总分（STAI-S）为46．69±7．39,对照组为37．57±6．80（p〈0．01）;RAU病例组特质焦虑总分（STAI—T）为46．31±8．04,对照组为38．06＋7．00（p〈0．01）。结论：与经期有关的RAU患者焦虑水平较高,提示精神焦虑可能是女性RAU的影响因素。     

Immunoglobulin-bearing lymphocytes and polymorphonuclear leucocytes in recurrent aphthous ulcers in man.

Direct immunofluorescent techniques were used to study the number of immunoglobulin-bearing lymphocytes and polymorphonuclear leucocytes in specimens of mucosal lesions from 10 patients with recurrent aphthous ulcers. The proportion of immunoglobulin-coated cells in the peripheral blood of the 10 patients was also studied. Ten normal healthy controls were included. IgM-, IgD- and IgE-bearing lymphocytes and polymorphonuclear leucocytes were found in sections adjacent to the mucosal lesions. IgE-bearing peripheral blood lymphocytes were slightly but significantly increased in patients with recurrent aphthous ulcers. The recruitment of immunoglobulin-bearing lymphocytes and polymorphonuclear leucocytes into the lamina propria and their migration into the stratum spinosum of mucosa may be involved in the pathogenesis of these ulcers.     

Mouthrinses containing triclosan reduce the incidence of recurrent aphthous ulcers (RAU)

Abstract Triclosan, an antibacterial agent introduced in toothpastes and mouth-rinses, has recently been shown to have anti-inflammatory and analgesic properties. The aim of the present double-blind cross-over study was to examine the effect of triclosan on the incidence of recurrent aphthous ulceration (RAU) when administered in mouthrinses. The study included 30 patients with a history of multiple recurrent aphthous ulcers. Three different triclosan-containing mouth-rinses, differing only in their solubilizing agents were used and compared with a control rinse. The number of new ulcers, ulcer-free days and the severity of pain were recorded. The results showed that the patients experienced a significant decrease in the number of oral ulcers during the experimental period when the mouthrinses contained triclosan. It may thus be concluded that triclosan has the potential to reduce the number of aphthous ulcers presumably due to its anti-inflammatory properties.     

Detection of Helicobacter pylori in oral aphthous ulcers

A causative role for Helicobacter pylori (H. pylori) in the pathogenesis of oral mucosal ulcerations has been suggested previously. We have adopted the polymerase chain reaction (PCR) as a rapid and sensitive means to detect H. pylori in swabs of recurrent oral aphthous ulcers and in samples of other oral sites. Of the oral aphthous ulcer samples, 32 (71.8%) were found to be positive, while the saliva and plaque samples (most of them taken from the patients with aphthous ulcers) were consistently negative for H. pylori DNA, as detected by the PCR assay. Only two of the swab samples from the tongue (collected at the time of concurrent, H. pylori-positive oral aphthous ulcers) were found to be positive. The data suggest that H. pylori may be associated frequently with recurrent oral aphthous ulcers, and are consistent with previous studies indicating that saliva and plaque are not likely sources of contamination with this microorganism. There was no apparent correlation with HIV status (infection with human immunodeficiency virus). The possible pathogenic significance of Helicobacter pylori in oral ulcerations is discussed.     

Recurrent aphthous ulcers today: a review of the growing knowledge

Recurrent aphthous ulcers represent a very common but poorly understood mucosal disorder. They occur in men and women of all ages, races and geographic regions. It is estimated that at least 1 in 5 individuals has at least once been afflicted with aphthous ulcers. The condition is classified as minor, major, and herpetiform on the basis of ulcer size and number. Attacks may be precipitated by local trauma, stress, food intake, drugs, hormonal changes and vitamin and trace element deficiencies. Local and systemic conditions, and genetic, immunological and microbial factors all may play a role in the pathogenesis of recurrent aphthous ulceration (RAU). However, to date, no principal cause has been discovered. Since the aetiology is unknown, diagnosis is entirely based on history and clinical criteria and no laboratory procedures exist to confirm the diagnosis. Although RAU may be a marker of an underlying systemic illness such as coeliac disease, or may present as one of the features of Behcet's disease, in most cases no additional body systems are affected, and patients remain otherwise fit and well. Different aetiologies and mechanisms might be operative in the aetiopathogenesis of aphthous ulceration, but pain, recurrence, self-limitation of the condition, and destruction of the epithelium seem to be the ultimate outcomes. There is no curative therapy to prevent the recurrence of ulcers, and all available treatment modalities can only reduce the frequency or severity of the lesions.     

Clinical, historic, and therapeutic features of aphthous stomatitis. Literature review and open clinical trial employing steroids.

The clinical and historic features of 50 patients with diagnosed aphthous stomatitis and treated with topical triamcinolone acetonide, 0.1% or 0.2% aqueous suspension; alone or in combination with initial burst therapy of 40 to 60 mg of prednisone, are reviewed. The mean age of our patients was 36.6 years (range 6 to 80 years). The duration of the chief complaint, usually oral pain, or more specifically, recurrent oral ulcers, was 11.1 years (range 4 weeks to 40 years). All patients showed a wide range of ulcer sizes when examined initially or at follow-up. Forty were followed up for an average of 22.9 months. Thirty-four reported prompt healing of ulcers identified at the time of initial evaluation, and no or markedly fewer ulcers subsequently if maintenance therapy of prophylactic topical triamcinolone, 0.1% or 0.2% aqueous rinse, was used. Five patients reported partial relief. No systemic side effects were noted even after long-term topical therapy. Local candidosis was a complication encountered in five patients.     

Relationship between periodontal parameters and Behçet's disease and evaluation of different treatments for oral recurrent aphthous stomatitis

Background and Objective:  The highest prevalence of Behçet's disease (BD) has been reported in Turkey, and therefore research of relations between BD and other disorders have become important in the Turkish population. Since oral aphthous ulcers impair tooth brushing, reducing complaints about aphthous ulcers will motivate the patient to maintain better oral hygiene performance and will thus reduce plaque accumulation and periodontal scores. The purpose of this controlled case study was to evaluate the relationship between the severity of periodontal scores and Behçet's disease, and to compare the treatment modalities with neodymium-doped yttrium aluminium garnet (Nd:YAG) laser and medication on the recurrent aphthous ulcers in BD patients by considering the degree of pre- and post-treatment pain, discomfort and functional complications.
Material and Methods:  The periodontal status of 28 BD patients was evaluated according to periodontal indices. The BD patients were also assessed for clinical severity score as described previously. Levels of pre- and post-treatment pain and functional complications were assessed at patient visits on days 1, 4 and 7.
Results:  Periodontal indices, the number of oral ulcers and the daily frequency of tooth brushing were related to the severity scores of BD ( p  < 0.001). The results indicated that BD patients treated with the Nd:YAG laser had less post-treatment pain and fewer functional complications and reported immediate relief of pain and faster healing ( p  < 0.001).
Conclusion:  Our results suggest that periodontal status is worse in BD patients and is associated with disease severity; also, the Nd:YAG laser has better patient acceptance, shorter treatment time and lower rates of pain and post-treatment adverse events among BD patients with oral recurrent aphthous stomatitis.     

Recurrent aphthous ulcers in association with HIV infection. Description of ulcer types and analysis of T-lymphocyte subsets.

This study was conducted to characterize the recurrent aphthous ulcers (RAU) found in association with human immunodeficiency virus (HIV) infection, to examine evidence for increased severity of the ulcers with HIV disease, and to determine whether increased severity is associated with abnormalities of peripheral blood lymphocyte subsets. Seventy-five HIV-seropositive patients with RAU were followed for up to 2 years, and lymphocyte subsets were analyzed in 42. Minor, herpetiform, and major ulcer types were seen, but unexpectedly, 66% of the patients had the usually uncommon herpetiform and major types. These types were temporally associated with symptomatic HIV disease. Patients with major RAU were significantly more immunosuppressed than those with minor or herpetiform RAU in that they had fewer CD4 and CD8 lymphocytes (p less than 0.05). The lesion of RAU is considered to represent a local breakdown in immunoregulation. The systemic immune imbalance seen with HIV disease may amplify the local defect and lead to more severe ulcers.     

HIV感染者和AIDS患者口腔非特异性溃疡

目的:口腔非特异性(NOS)溃疡是一类与H IV感染有关的口腔病变,其临床表现不同于常见口腔溃疡。通过对NOS口腔溃疡临床特征的分析,为临床医师提供鉴别诊断。方法:回顾性分析72例H IV/AIDS患者,NOS口腔溃疡有3例,探讨其临床特征并与复发性阿弗他溃疡、单纯疱疹性口炎进行比较,探讨其发病机制。结果:NOS口腔溃疡的好发部位为软腭、口咽及舌腭弓处,常为1~2个,病程较长,CD4 细胞明显减少,多伴发白色念珠菌感染。结论:NOS口腔溃疡的发病部位、病程与预后较为特殊,与AIDS的病程进展有一定的联系。     

Effect of levamisole on the incidence and prevalence of recurrent aphthous stomatitis

Abstract Twenty patients with severe recurrent aphthous stomatitis were treated with a new drug, levamisole, to determine its effects upon the incidence and prevalence of recurrent aphthous stomatitis. The trial, conducted in a non-crossover, double-blind fashion, did not demonstrate any statistically significant differences when levamisole and placebo groups were compared over time either in the number of ulcers, number of ulcer-days, mean duration of ulcers, or mean number of ulcers per day. Positive subjective results were experienced by the 10 patients receiving levamisole but these were not of sufficient magnitude to affect group mean differences.     

HL-A histocompatibility antigens in recurrent aphthous ulceration.

The frequency of HL-A phenotypes has been investigated in 64 patients who had recurrent aphthous ulcers and 100 subjects who did not. The HL-A phenotypes were determined by a two-step microcytotoxicity test on peripheral blood lymphocytes, incubating these cells with a range of defined antiserums and complement and subsequently assessing lymphocyte viability by dye exclusion. There were no significant differences between the frequency of individual HL-A antigens in the patients with aphthous ulceration and those of subjects without aphthous ulceration. Similarly, no differences in numbers of shared antigens could be demonstrated. The distribution of HL-A antigens was essentially similar in subdivisions of patients with aphthous ulceration, grouped on the basis of sex, family history, age at onset, and maximum number of concurrent ulcers and their duration before healing.     

Effectiveness of two oral pastes for the treatment of recurrent aphthous stomatitis

OBJECTIVE: To compare the effectiveness of two topical medications to reduce the pain and size of recurrent minor aphthous ulcers. SETTING: Ten Colombian Dental Faculties' clinics. DESIGN: A double-blind randomized multi-centre clinical study. SUBJECTS: Ninety-six patients complaining of at least five acute aphthous ulcers were randomized to two intervention groups. Sample size was calculated using an alpha error of 0.05 and beta of 0.20. MATERIALS AND METHODS: Participants were randomly assigned to receive 5% amlexanox or a 0.05% clobetasol propionate magistral preparation. Observers at the participating institutions were previously trained to standardize clinical diagnosis and data recollection. Ulcer size and pain were measured on treatment days 0, 2 and 5. RESULTS: No significant differences were found between the two groups studied in any of the studied variables at baseline. Both treatment medications significantly reduced pain magnitude and the index ulcer's size on days 2 and 5 compared with day 0 without adverse reactions (within groups differences). No statistical differences between groups of the study medications were found. CONCLUSION: The two treatments applied had similar effectiveness as they both relieved pain and reduced the size of recurrent aphthous ulcers.