Influence of cigarette smoking on oral microbiota in patients with recurrent aphthous stomatitis.

Recurrent aphthous stomatitis (RAS) is a common recurrent ulcerative disease of the oral mucosa which is closely related to oral microbial composition. However, the specific effect and the mechanism of smoking in RAS are unclear. In this study, 16S rRNA sequencing technology was used to compare the differences in saliva microbial community between 28 non-smoking healthy controls (NSctrl), 31 non-smoking RAS patients (NSras), and 19 smoking RAS patients (Sras). The results showed that the bacterial community diversity in patients with RAS (NSras and Sras) was lower than that of NSctrl. The microbial community in smoking-associated RAS is less diverse and distinct from that of non-smokers. The RAS groups have higher abundance of Veillonella, Rothia, and Sneathia and lower abundance of Bacteroidales, Bacteroides, Wolinella, Moryella, Pyramidobacter, and Christensenellaceae at the genera level. A significantly different abundance of Anaerovorax, Candidatus Endomicrobium, Lactococcus, Sneathia, Veillonella, and Cloacibacterium was observed between the Sras and the NSras group. Notably, there was a significant difference in many species from the genus Prevotella and Treponema between the NSras and the Sras group. Further, the relative abundance of several taxa is correlated with smoking age or frequency, including Megasphaera, Haemophilus, Leptotrichia, and Rothia at the genera level, and Prevotella melaninogenica, Prevotella salivae, Megasphaera micronuciformis, Haemophilus parainfluenzae, Alloprevotella tannerae, Actinomyces naeslundii, Lautropia mirabilis, and Capnocytophaga sputigena at the species level. Among patients with RAS, smoking aggravated the pathways of respiration and human pathogens. Our results suggest that smoking is closely related to changes in the oral microbiota, which may contribute an opposite effect to the pathogenesis of RAS. This study provides new insight and theoretical basis for the cause and pathogenesis of RAS and better prevention and treatment.

Assessment of the oral microbiome in the development of recurrent oral aphthae in patients with gastrointestinal pathology

Chronic recurrent oral aphthae in residents living in an ecologically unfavourable region are characterized by a permanent course and prolonged recovery processes of regeneration of pathological elements of the oral mucosa. Using the microbiological method and modern test systems, it has been found that on the surface of aphthae an extremely diverse state of the oral microbiota is determined and its types are diverse. Trigger mechanisms have been determined. The role of representatives of various types of microorganisms - enterococci, staphylococci, streptococci, yeast-like fungi of the genus Candida (C. albicans) and obligate-anaerobes in the development of recurrent oral aphthae has been established. The data obtained can serve as an indication for the development of modern treatment and preventive measures regarding this category of patients.

Recurrent aphthous ulceration: a review of potential causes and novel treatments.

Purpose of article: This review examines studies published between May 2012 and 2017 with a specific interest in potential recurrent aphthous ulceration (RAU) etiologies and treatment modalities/efficacy, including topical treatments, systemic regimens, vitamin repletion, and laser therapy, among others. MATERIALS AND METHODS: PubMed MEDLINE and Cochrane Database of Systematic Reviews were searched using various combinations of: 'aphthous', 'ulcer', and 'treatment'. The titles and abstracts from the initial literature search were appraised to identify articles for full review and reference sections from each article were searched manually for relevant publications. Both randomized controlled trials and observational reports were included in this review, as some treatment types have not been formally examined in randomized trials. Relevant studies were reviewed, compared, and summarized. RESULTS: RAU can result from systemic disease and trauma, but recent studies have shown a variety of potential etiologies, ranging from vitamin deficiencies, oral microbiota derangements, hematological considerations, stress, genetic polymorphisms to oxidant-antioxidant imbalances, among others. Many modalities of therapy are available and have proven efficacious. CONCLUSIONS: As the exact etiology of RAU is still unknown, therapy is based on symptomatic relief.

Impact of Helicobacter pylori on the clinical course of recurrent aphthous stomatitis.

BACKGROUND: Recurrent aphthous stomatitis is one of the most common lesions of oral mucosa. Helicobacter pylori is suggested as one of the etiological agents of recurrent aphthous stomatitis. Here, we conduct a study for evaluating the impact of H. pylori eradication on clinical course of recurrent aphthous stomatitis. METHODS: Forty-six patients with minor aphthous lesions were enrolled. The number of RAS lesions at last 6 months and vitamin B(12) levels were recorded. All patients were detected for H. pylori with endoscopic biopsy. H. pylori was positive in 30 patients and negative in 16 patients. H. pylori-positive 30 patients received eradication therapy. Three months after therapy, patients were re-evaluated with urea breath test; 18 patients were negative (eradicated), and the remainders (12 patients) were positive (non-eradicated) for H. pylori. 6 months after eradication, vitamin B(12) levels and number of aphthous lesions at 6 months were recorded. RESULTS: Vitamin B(12) levels were significantly increased in H. pylori-eradicated group (P = 0.001), whereas no significant change was found in non-eradicated group (P = 0.638). Mean number of aphthous lesions (per 6 months) of H. pylori-eradicated group was significantly decreased after eradication (P = 0.0001); in the non-eradicated group, no significant change was found (P = 0.677). In Hp-positive group, number of RAS lesions and vitamin B(12) levels were negatively correlated when evaluated both before and after eradication. CONCLUSIONS: This study provides evidence to support the beneficial effect of H. pylori eradication in patients with recurrent aphthous stomatitis. The underlying mechanism might be the increase in vitamin B(12) levels after eradication.

Pediatric infectious disease: unusual head and neck infections.

Infections in children in the head and neck regions are common, leading to frequent use and overuse of antibiotics. This review includes common as well as diverse and unusual infectious diseases, such as PFAPA (Periodic Fever Aphthous stomatitis, Pharyngitis, Adenitis) syndrome, Lemierre Syndrome, Arcanobacterium infection, and tuberculous and nontuberculous adenitis, which occur in infants, children, and adolescents. In addition, the first pediatric vaccines available with the potential to prevent oropharyngeal cancers are reviewed.

Topical lavender oil for the treatment of recurrent aphthous ulceration.

PURPOSE: To determine the laboratory and clinical efficacy of lavender oil in the treatment of recurrent aphthous ulceration (RAU). METHODS: This was a randomized double-blind, placebo-controlled study performed firstly to treat the induced ulcers by different methods in experimental animals (rabbits) treated with lavender oil or placebo. Clinical and histological healing was established by measuring the area of the ulcer and inflammation levels in each test group. Secondly, safety/toxicity; the median lethal dose (LD50) was studied in albino mice, and dermal irritation test was performed by primary irritation to the skin and measured by a patch-test technique on the intact skin of the albino rabbit. Thirdly, antibacterial effect; lavender oil was screened against bacteria obtained from swab specimen of human subjects' RAU using disc diffusion method. Fourthly, clinical study; 115 subjects (mean age 38 years, mean weight 75 kg) were divided into two groups of subjects topically treated with lavender oil or placebo. The clinical efficacy was assessed by inflammation level, erythema, edema, ulcer duration, ulcer size, mean area under the curve of ulcer area, healing time, and associated pain intensity and reduction. RESULTS: Animals treated with lavender oil showed a significant ulcer size reduction, increased rate of mucosal repair, and healing within 3 days of treatment compared to baseline and placebo groups [2-3 days (90%), 4 days (10%)] (P=0.001). The intraperitoneal LD50 value in mice was 6.5 gm/kg; clinical dermal irritation test showed no sign of irritation in the tested products. Lavender oil showed a broad antibacterial activity against all tested strains; it exhibited significant inhibition on tested bacteria where the value of zone of inhibition ranged from 14.5-24 mm vs Streptomycin (25 microg/disc) 12-22 +/- 0.5 mm; MIC was > 6.4-36 mg/ml. RAU patients treated with lavender oil showed a significant reduction in inflammation level, ulcer size, healing time, from 2-4 days [2 days (40%), 3 days (50%), 4 days (10%)], and pain relief mostly from the first dose, compared to baseline and placebo. No side effects were reported.

The effect of gastric Helicobacter pylori eradication on recurrent aphthous stomatitis.

BACKGROUND: Helicobacter pylori (H. pylori) has been suggested to be associated with recurrent aphthous stomatitis (RAS) as well as many other diseases. METHODS: We conducted a prospective study on a total of 23 patients with RAS to investigate the relationship between H. pylori and RAS as well as the effect of eradication therapy on the recurrence. All patients underwent endoscopic examination and gastric biopsy. The biopsy materials were examined histopathologically whether they contained H. pylori or not. The density of H. pylori was also noted. The patients with H. pylori infection were followed up for up to 1 year after starting the eradication therapy. RESULTS: Gastric mucosal H. pylori colonization was + in 39%, ++ in 39%, +++ in 9%, and - in 13% of the patients, respectively. There were statistically significant decreases in the recurrence rate and amelioration time of RAS by eradication therapy. There were no significant correlations among the intensity of H. pylori with the recurrence rate, number, diameter, and amelioration time of the lesions in 1-year follow-up. CONCLUSIONS: We concluded that eradication of H. pylori may have reducing effects on the recurrence and amelioration period of the RAS.

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

Prevalence of Helicobacter pylori DNA in recurrent aphthous ulcerations in mucosa-associated lymphoid tissues of the pharynx.

OBJECTIVE: To determine the presence of Helicobacter pylori and, if detected, its potential prevalence in causing recurrent aphthous ulcers confined to mucosa-associated lymphoid tissues of the pharynx. DESIGN: Prospective, controlled clinical trial. SETTING: Otolaryngology Department of Tanta University Hospitals, Tanta, Egypt. PATIENTS: A total of 146 patients with recurrent multiple aphthous ulcers of the oral cavity and pharynx and 20 normal control subjects. INTERVENTIONS: Patients were assigned to group 1 (n = 58), in which the ulcers were strictly limited to the lymphoid tissues, or group 2 (n = 88), in which the ulcers were randomly distributed in the oral cavity and pharynx. Helicobacter pylori DNA was extracted from 3-mm-diameter tissue samples, and polymerase chain reaction amplifications were performed for the 16S ribosomal RNA gene. MAIN OUTCOME MEASURE: Positivity for H pylori. RESULTS: In group 1, 39 patients (67%) were positive for H pylori DNA, while in group 2, 9 patients (10%) were positive (chi(2) test, P<.001). It was not detected in any of the 20 control samples. CONCLUSION: Our results support a possible causative role for H pylori in recurrent aphthous ulcerations with a characteristic distribution and affinity to mucosa-associated lymphoid tissues of the pharynx.

[Detection of Helicobacter pylori in the saliva of patients with recurrent aphthous stomatitis]. / Prukaz Helicobacter pylori ve slinách nemocných s recidivující aftózní stomatitidou.

BACKGROUND: Helicobacter pylori participates significantly on the pathogeny of chronic gastritis, duodenal and gastric ulcer, carcinoma and lymphoma of the stomach. There are some more diseases requiring attention--for example cardiovascular, dermatologic, and autoimmune. METHODS AND RESULTS: Helicobacter pylori was detected in saliva and faeces of 28 persons by the Premier platinum HpSA diagnostic set. Levels of IgA and IgG antibodies were determined by EIA and Western Blott methods. Parameters of salivary immunity were investigated as well. Levels of IgG, SIgA, IgM, lysozyme and albumin were determined. Recommended therapy of Helicobacter infection led to an evident clinical improvement and descent of the documented Helicobacter pylori antigen. CONCLUSIONS: Helicobacter pylori infection can probably participate in some cases of relapsing aphtous stomatitis.

Dental implications of Helicobacter pylori.

Helicobacter pylori infections of the stomach are common worldwide and may cause serious medical problems, ranging from gastritis and its sequelae to gastric carcinoma or lymphoma. Current studies indicate that H. pylori is present in dental plaque, although the number of organisms in individual samples is very low, and these numbers appear to vary from one site to another within the mouth. The presence of this organism in plaque may be intermittent, perhaps occurring as the result of gastroesophageal reflux. It is still unclear if the low numbers of H. pylori present in the mouths of most patients would be sufficient to serve as a source of infection or reinfection for gastric conditions. Whether dental plaque is a significant source for reinfection of the gastric mucosa among patients with fair to poor oral hygiene remains to be confirmed. It has been suggested that attempting to improve oral hygiene through standard periodontal procedures would be prudent as an ancillary measure to conventional ulcer therapy, especially in patients whose gastric infections have proven recalcitrant. H. pylori may also be a cofactor in the recurrence of aphthous ulceration, especially in patients sensitized through gastric colonization and mucosal attachment.

Detection of Helicobacter pylori DNA in recurrent aphthous stomatitis tissue by PCR.

Helicobacter pylori is recognised as being an aetiological agent of chronic active gastritis and peptic ulcer disease and has been associated with an increased risk of gastric cancer. The natural reservoir for H. pylori is unknown, although the oral cavity has been the focus of much attention in this respect. Given the histological similarities between gastric and oral ulceration, it seemed prudent to investigate a possible association between H. pylori and recurrent aphthous stomatitis (RAS). In this study, the potential involvement of H. pylori in the aetiology of RAS was investigated using the polymerase chain reaction (PCR). Biopsies from 28 RAS patients were analysed, in addition to 20 oral lichen planus (OLP) and 13 normal biopsies that were used as controls. Genomic DNA was extracted from biopsies, and confirmation of successful extraction of PCR-amplifiable DNA was achieved by carrying out PCR on each DNA sample with nested primers specific for the human beta-haemoglobin gene. PCR identification of H. pylori was carried out using a primer pair specific for the H. pylori 16S ribosomal RNA (rRNA) gene. Two rounds of PCR were carried out to amplify a 295-bp product, and the identity of amplified products was confirmed by DNA sequencing. H. pylori DNA was detected in 3 of 28 (11%) RAS samples but not in any of 20 OLP and 13 normal samples. These results do not support a definitive aetiological role for H. pylori in RAS, although the possibility that H. pylori may be involved in a small proportion of RAS cases cannot be excluded.

[Manifestations of histoplasmosis]. / Manifestaties van histoplasmose.

Two patients, a 34-year old man-to-woman transsexual and a 32-year-old man, with aids presented with pulmonary symptoms, fever, serious weight loss and an oral ulcer. A third patient, a 16-year-old boy, had signs of transverse myelitis and meningitis without immunodeficiency. All were South American citizens and had disseminated histoplasmosis. After antifungal treatment they recovered, although the third patient remained a wheelchair user. If pulmonary or miliary tuberculosis is suspected in a patient originating from South America, histoplasmosis should be considered. Oral ulcers and skin lesions can be diagnostic clues. Specific stainings of direct preparations and longer-lasting cultures of various materials, especially of biopsy samples, then provide the diagnosis.

Lack of association between Streptococcus oralis and recurrent aphthous stomatitis.

In the present study, the potential involvement of Streptococcus oralis in the aetiology of recurrent aphthous stomatitis (RAS) was investigated using the polymerase chain reaction (PCR). Biopsies from 28 RAS patients were analysed, in addition to 20 oral lichen planus (OLP) and 13 normal biopsies that were used as controls. PCR was carried out using a primer pair that targets the D-alanine:D-alanine ligase gene and detects DNA from both S. oralis and the closely related species Streptococcus mitis. Discrimination between these two species was achieved by digestion of PCR products with the restriction endonucleases HaeIII and HindIII, which both give distinct restriction profiles for each species. S. oralis DNA was detected in 8 of 28 (29%) RAS samples, 10 of 20 (50%) OLP samples and 6 of 13 (46%) normal samples. These results suggest that S. oralis is not of primary aetiological significance in RAS.

Oral ulcerations in HIV infection.

Oral ulceration in HIV infection may be due to: (1) mycotic; (2) bacterial, protozoan; (3) and viral infections; (4) oral neoplasia; (5) aphthous ulceration/ulceration not otherwise specified (NOS); or (6) ulceration of iatrogenic origin. Of particular significance are oral ulcerations caused by viruses of the herpes virus group (HSV 1/2, CMV, VZV) and ulcerations of the aphthous type. It was shown recently that coinfection of viral ulcers occurs. The aetiopathogenesis of the aphthous type of ulcerations including the still debated ulceration NOS is not clear. Further basic and clinical research is necessary in order to better understand ulceration particularly in relation to immunoregulation, tissue breakdown and repair.

Oral ulcers in HIV-infected patients: an update on epidemiology and diagnosis.

Oral ulcers observed during the course of HIV infection may be very severe. Such manifestations may interfere with oral functions and alter the patients' quality of life. It is important to stress that when HIV-infected individuals present with ulcerative lesions of the oral cavity, neoplastic processes and rare infections must be included in the differential diagnosis. Nontumefactive oral ulcers in HIV-positive patients may be a source of diagnostic difficulties because of the diverse array of underlying pathologic entities and multiplicity of etiologic agents. Biopsy should always be performed on long-standing ulcers, since either infection or a neoplastic process may be present. In the absence of infection or neoplasm, such lesions are then designated ulcers not otherwise specified.

Serum IgG antibodies to Helicobacter pylori in patients with recurrent aphthous stomatitis and other oral disorders.

OBJECTIVES: To compare the frequency of serum anti-Helicobacter pylori IgG antibodies in patients with recurrent aphthous stomatitis with patients with other oral ulcerative and nonulcerative disorders. STUDY DESIGN: Prospective study of serum IgG antibodies to H. pylori in 75 patients with recurrent aphthous ulcers, 15 patients with other oral ulcerative disorders, 41 patients with other oral mucosal lesions, 27 patients with oral dysaesthesia, and 25 healthy control patients without oral lesions. RESULTS: The frequency of anti-H, pylori seropositivity was not significantly greater in patients with recurrent aphthous stomatitis (30.6%) compared with patients with other ulcerated oral mucosal lesions (33.0%) and controls (24%). CONCLUSIONS: Helicobacter pylori does not appear to be of etiologic significance in the development of recurrent aphthous stomatitis.

Enterobacteria and oral ulceration in HIV+ and RAU populations

Investigamos a ocorrência de enterobactérias em ulceraçöes bucais de pacientes HIV+ e portadores de ulceraçöes aftosas recorrentes (UAR), coletando amostras através de "swabs" e semeando o material em placas contendo ágar MacConkey. Utilizamos populaçäo controle de indivíduos sadios, para comparaçäo de resultados. Obtivemos 41,6 por cento de positividade para enterobactérias nas amostras do grupo HIV (10/24), 10 por cento no grupo UAR (2/20) e 20 por cento no grupo controle (4/20). Os resultados sugerem correlaçäo entre ulceraçöes bucais em pacientes imunossuprimidos pelo HIV e maior ocorrência de enterobactérias, sem relaçäo entre UAR e enterobactérias