Tratamiento de la estomatitis aftosa recurrente en pacientes inmunocomprometidos. Revisión sistemática / Treatment of recurrent aphthous stomatitis in immunocompromised patients. Systematic review

RESUMEN Fundamento: Aunque la estomatitis aftosa recurrente no tiene una etiología bien definida porque es una enfermedad multicausal, se ha reconocido que las interacciones o el debilitamiento del sistema inmunitario, contribuyen principalmente a la magnitud del proceso patológico. Las propuestas de tratamiento en pacientes inmunocomprometidos son diversas y por lo general se centran en alteraciones inmunológicas específicas. Objetivo: Evaluar el efecto clínico de los tratamientos propuestos para la estomatitis aftosa recurrente en pacientes inmunocomprometidos. Metodología: La búsqueda se realizó en las bases de datos PubMed/Medline y Cochrane. Se incluyeron ensayos clínicos que tuviesen entre sus variables de respuesta principales: Cicatrización de la úlcera aftosa, tiempo de cicatrización, de recurrencia e intensidad del dolor y entre las variables secundarias: Los efectos adversos y los síntomas. La extracción de datos se realizó de manera independiente por los autores. Se aplicó la metodología por la colaboración Cochrane para evaluar el riesgo de sesgo en cada uno de los estudios. Resultados: Se incluyeron 11 ensayos clínicos (8 controlados) publicados entre 1995 y 2020 y que aportan resultados de la eficacia de varias intervenciones terapéuticas: talidomida (4), irsogladine (2), rebamipida (1), láser de diodo (1), cápsulas de Omega-3 (1), vitamina B 12 (1), Complejo B (1). Seis de estos estudios incluyeron pacientes con la forma menor de estomatitis aftosa recurrente. El periodo de seguimiento estuvo entre los 14 y 360 días. Conclusiones: La talidomida puede ser eficaz en el alivio de los síntomas, la cicatrización y remisión de las lesiones, el diodo de láser y vitamina B12 en la disminución de la intensidad del dolor.

ABSTRACT Background: Although recurrent aphthous stomatitis does not have a well-defined etiology due to it is a multicausal disease, it has been recognized that the interactions or the weakening of the immune system, contribute mainly to the magnitude of the process pathological. Treatment proposals in immune compromised patients are diverse and they usually focus on specific immunological alterations. Objective: To evaluate the clinical effect of the proposed treatments for recurrent aphthous stomatitis in immunocompromised patients. Methodology: The search was performed in the PubMed/Medline and Cochrane databases. Clinical trials were included that could have among their main response variables: Aphthous ulcer healing, healing time, recurrence and pain intensity and among the secondary variables: Adverse effects and symptoms. data extraction was done independently by the authors. The methodology was applied by Cochrane collaboration to assess the risk of bias in each of the studies. Results: 11 clinical trials (8 controlled) published between 1995 and 2020 and that provided the results of the efficacy of various therapeutic interventions: thalidomide (4), irsogladine (2), rebamipide (1), diode laser (1), Omega-3 capsules (1), vitamin B 12 (1), Complex B (1). Six of these studies included patients with the minor form of stomatitis recurrent aphthous. The follow-up period was between 14 and 360 days. Conclusions: Thalidomide may be effective in relieving symptoms, healing and remission of the lesions, the laser diode and vitamin B12 in the decrease of the intensity of the pain.

La tintura de manzanilla al 20 % como alternativa de tratamiento para la estomatitis aftosa / Chamomile tincture at 20 % as an alternative treatment for aphthous stomatitis

RESUMEN Fundamento: Las aftas son causa de consultas frecuentes entre las urgencias estomatológicas. La tintura de manzanilla, resulta muy efectiva por su propiedad analgésica, antiinflamatoria, protectora, reparadora de membrana y reepitelizante. Objetivo: Ilustrar los resultados de la tintura de manzanilla al 20 % como alternativa de tratamiento en una paciente con estomatitis aftosa Presentación de caso: Paciente de 66 años de edad, femenina, con antecedentes de salud, fumadora, sometida a estrés, que acudió a consulta por lesiones aftosas dolorosas en el borde lateral izquierdo y dorso de la lengua. Conclusiones: La paciente con estomatitis aftosa, tratada con tintura de manzanilla al 20 %, mostró moderación del dolor a los 3 días, evolución general satisfactoria y cicatrización de las lesiones a los 5 días de la primera aplicación.

ABSTRACT Background: Aphthous ulcers are a frequent cause of assistance at the stomatology emergencies. Chamomile tincture (Matricaria Chamomilla) is very effective due to its analgesic, anti-inflammatory, protective, membrane-repairing and re-epithelialising properties. Objective: To illustrate the results of chamomile tincture at 20 % as an alternative treatment in a patient with aphthous stomatitis. Case report: A 66-year-old female patient, with healthy backgrounds, smoker, under stress, who consulted because of painful aphthous lesions on the left lateral border and tongue dorsum. Conclusions: The patient with aphthous stomatitis, treated with chamomile tincture at 20 %, showed pain moderation after 3 days, satisfactory general evolution and healing of the lesions 5 days after the first application.

Efectividad terapéutica de la jalea de caléndula al 1 % en pacientes con estomatitis aftosa recurrente / Therapeutic effectiveness of calendula jelly at 1% in patients with aphthous recurrent stomatitis

Introducción: Para el tratamiento de pacientes con estomatitis aftosa recurrente suele emplearse el extracto fluido y la tintura de Caléndula officinalis L. como colutorio disuelto en agua. Teniendo en cuenta los inconvenientes que generan estas formulaciones se elaboró una jalea al 1 % contentiva de los principios activos de la referida planta. Objetivo: Evaluar la efectividad terapéutica de la jalea de caléndula al 1 % en pacientes con estomatitis aftosa recurrente. Métodos: Se realizó una intervención terapéutica en 30 pacientes con estomatitis aftosa recurrente, atendidos en el Policlínico Docente 30 de Noviembre de Santiago de Cuba, desde marzo hasta diciembre de 2019. La muestra se dividió en 2 grupos: control y de estudio, que recibieron tratamiento convencional y jalea de caléndula al 1 %, respectivamente. Se tuvieron en cuenta algunas variables de interés, a saber: edad, sexo, tiempo de remisión del dolor y de cicatrización, respuesta al tratamiento y efectividad terapéutica. Se empleó el porcentaje como medida de resumen y el estadígrafo de Ji al cuadrado con un nivel de significación de 0,05. Resultados: En la serie predominaron el grupo etario de 15- 24 años de edad (33,3 %) y el sexo femenino (60,0 %). En los tratados con la jalea de caléndula, la remisión del dolor y la cicatrización de las lesiones ulcerativas se evidenciaron en las primeras 24 y 48 horas, respectivamente, y la mayoría de estos habían mejorado a las 72 horas. Conclusiones: La jalea de caléndula al 1 % es efectiva como analgésico y cicatrizante en pacientes con estomatitis aftosa recurrente.

Introduction: The officinalis L Calendula fluid extract and tincture is usually used as mouthwash dissolved in water for the treatment of patients with aphthous recurrent stomatitis. Taking into account the inconveniences that generate these formulations a jelly at 1 % was elaborated with the active principles of the plant above mention. Objective: To evaluate the therapeutic effectiveness of the calendula jelly at 1% in patients with aphthous recurrent stomatitis. Methods: A therapeutic intervention in 30 patients with aphthous recurrent stomatitis, assisted in 30 de Noviembre Teaching Polyclinic was carried out in Santiago de Cuba, from March to December, 2019. The sample was divided in 2 groups: control and study that received conventional treatment and calendula jelly at 1%, respectively. Some variables of interest were taken into account, such as: age, sex, pain regression and scaring time, response to the treatment and therapeutic effectiveness. The percentage was used as summary measure and the chi-squared test with a significance level of 0.05. Results: In the series there was a prevalence of the 15 - 24 age group (33.3 %) and female sex (60.0 %). In the patients treated with the calendula jelly, pain regression and scaring of the ulcerative lesions were evidenced in the first 24 and 48 hours, respectively, and most of them had improved at 72 hours. Conclusions: The calendula jelly at 1% is effective as analgesic and healing in patients with aphthous recurrent stomatitis.

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.

Manifestações bucais e considerações gerais da síndrome de Behçet: relato de caso / Oral manifestations and general considerations of Behçet's Syndrome: case report

Objetivo: relatar um caso de síndrome de Behçet, enfatizando o controle das manifestações bucais. Relato de caso: paciente de 21 anos de idade, já diagnosticado com síndrome de Behçet há 7 anos, sem histórico familiar, relatou o aparecimento de úlceras recorrentes, quando iniciou tratamento ortodôntico. Procurou a clínica odontológica da Universidade Estadual de Maringá queixando-se de "aftas e carne crescida" na boca. Foi realizada biópsia excisional do nódulo, e o exame histopatológico revelou tecido hiperplásico com infiltrado inflamatório crônico decorrente. Após 45 dias, observaram-se presença de novas aftas em mucosa labial, língua e gengiva assim como total cicatrização na região da biópsia. Atualmente, o paciente permanece em controle clínico médico e odontológico, estando as lesões aftosas presentes em diferentes regiões. Considerações finais: apesar de rara, essa doença é de grande relevância para o cirurgião-dentista, que deve saber diagnosticá-la e controlar suas manifestações bucais. Além disso, o acompanhamento é necessário para melhorar a qualidade de vida do paciente. (AU)

Objective: report a case of Behçet's Syndrome, emphasizing the control of oral manifestations. Case report: a 21-year-old patient, diagnosed with Behçet's Syndrome for 7 years, with no family history, reporting recurrent ulcers when orthodontic treatment was started. He sought a dental clinic at the State University of Maringá complaining of "aphthae and grown flesh" in the mouth. Excisional nodule biopsy and histopathological examination of hyperplastic tissue with chronic inflammatory infiltrate were performed. After 45 days, the presence of new aphthae were observed in the labial mucosa, tongue and gingiva, as well as total scarring in the region of the biopsy. Currently, the patient remains in clinical and dental control, remaining as aphthous interventions present in different regions. Final considerations: although rare, this disorder is of great relevance for the dental practioner, who must know how to diagnose and control its oral manifestations. In addition, follow-up is necessary to improve the patient's quality of life. (AU)

Aplicación del Láser de Baja Potencia (LLLT) en Pacientes Pediátricos: Revisión de Literatura a Propósito de una Serie de Casos / Application of Low Power Laser (LLLT) in Pediatric Patients: Review of the Literature in a Series of Cases

RESUMEN: El uso del láser de baja potencia en odontología está siendo cada vez más frecuente y con excelentes resultados, los equipos más modernos traen pre-establecidos la dosimetría de los parámetros para las diferentes acciones clínicas. El objetivo de esta revisión fue encontrar evidencia científica que permita al clínico tener como una alternativa de tratamiento el uso del láser de baja potencia en patologías orales de tejidos blandos y duros en pacientes pediátricos. Se realizó una revisión de la literatura por medio de buscadores como PubMed, LILACS y SciELO. Después de leer a texto completo todos los trabajos es posible señalar que el láser de baja frecuencia es una buena alternativa terapéutica en la resolución de signos y síntomas en patologías orales que aquejan al paciente pediátrico, puesto que, presenta un rápido control del dolor, la inflamación, el sangrado y acelera los procesos de reparación celular.

ABSTRACT: Low Level Laser Therapy in dentistry is becoming more frequent and has had excellent results, with state of the art equipment having pre-established dosimetry parameters for the various clinical actions. The objective of this review was to find scientific evidence that allows the clinician to have the use of low power laser as treatment alternative, in oral soft tissue and hard pathologies in pediatric patients. A review of the literature was performed through search engines such as PubMed, LILACS and SciELO. After reading the texts, it was possible to point out that low frequency laser is a good therapeutic alternative in the resolution of signs and symptoms in oral pathologies of the pediatric patient. This alternative allows for rapid pain control, reduces inflammation and bleeding, and accelerates cellular repair processes.

Recurrent aphthous ulceration: an epidemiological study of etiological factors, treatment and differential diagnosis

Abstract: BACKGROUND: Recurrent aphthous ulcerations are common benign ulcerated lesions on the mouth, whose etiology is poorly understood, with controversial treatment and difficult to control in clinical practice. OBJECTIVE: To evaluate the cases of recurrent aphthous ulcerations with a focus on treatment, diagnosis and etiology. METHODS: This is a retrospective study of the cases of the Oral Diagnosis service of the Rio Grande do Norte Federal University in Natal/RN. Data such as sex, age, race, location, smoking habits, types of treatment, relapsing episodes, laboratory test results and clinical characteristics were collected. The associations between the variables were analyzed using the Pearson Chi-square test (p <0.05). RESULTS: A total of 4895 patients were seen in the service over a period of 11 years. Of these, 161 (3.3%) had complaints of oral aphthous ulcerations, of which 76 (47.2%) were diagnosed as suffering from recurrent aphthous ulcerations and 68 (42.2%) with clinical information necessary for evaluation. The tongue was the most affected anatomical region, with 27 individuals (39.7%), followed by the buccal mucosa, with 22 cases (32.3%). STUDY LIMITATIONS: Retrospective study with data from medical records. CONCLUSION: Dental surgeons, dermatologists and otorhinolaryngologists are the main responsible for the first contact with patients with this disease and should be attentive to the clinical aspects and treat each patient in an individualized way, since the therapy is palliative, its diagnosis is by exclusion and its etiology is unknown.

Diretrizes de conduta e tratamento de síndromes febris periódicas: síndrome de febre periódica, estomatite aftosa, faringite e adenite / Guidelines for the management and treatment of periodic fever syndromes: periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome

Resumo Objetivo: Estabelecer diretrizes baseadas em evidências científicas para manejo da síndrome de febre periódica, estomatite aftosa, faringite e adenite (PFAPA). Descrição do método de coleta de evidência: A Diretriz foi elaborada a partir de cinco questões clínicas que foram estruturadas por meio do Pico (Paciente, Intervenção ou Indicador, Comparação e Outcome), com busca nas principais bases primárias de informação científica. Após definir os estudos potenciais para sustento das recomendações, esses foram graduados pela força da evidência e pelo grau de recomendação. Resultados: Foram recuperados e avaliados pelo título e resumo 806 trabalhos e selecionados 32 artigos, para sustentar as recomendações. Recomendações: 1. O diagnóstico da PFAPA é clínico e de exclusão, deve a suspeita ser considerada em crianças que apresentam episódios febris de origem indeterminada recorrentes e periódicos ou amidalites de repetição, intercalados com períodos assintomáticos, sobretudo em crianças em bom estado geral e com desenvolvimento pondero-estatural mantido; 2. Os achados laboratoriais são inespecíficos. Não existem alterações patognomônicas nos exames complementares; 3. A evidência que sustenta a indicação do tratamento cirúrgico (tonsilectomia com ou sem adenoidectomia) é baseada em dois ensaios clínicos randomizados não cegos que incluíram pequeno número de pacientes; 4. O uso de prednisona no início do quadro febril em pacientes com PFAPA mostrou ser eficaz. Melhores evidências ainda são necessárias para apoiar seu uso na PFAPA; 5. Apesar de os resultados obtidos de estudos com inibidores de IL-1ß serem promissores, esses são limitados a poucos relatos de casos.

Abstract Objective: To establish guidelines based on scientific evidence for the management of periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome. Description of the evidence collection method: The Guideline was prepared from 5 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search in key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation. Results: 806 articles were retrieved and evaluated by title and abstract; from these, 32 articles were selected to support the recommendations. Recommendations: 1. PFAPA is a diagnosis of exclusion established on clinical grounds, and one must suspect of this problem in children with recurrent and periodic febrile episodes of unknown origin, or with recurrent tonsillitis interspersed with asymptomatic periods, especially in children in good general condition and with preservation of weight and height development. 2. Laboratory findings are nonspecific. Additional tests do not reveal pathognomonic changes. 3. The evidence supporting an indication for surgical treatment (tonsillectomy with or without adenoidectomy), is based on two non-blinded randomized clinical trials with small numbers of patients. 4. The use of prednisone at the onset of fever in patients with PFAPA proved to be an effective strategy. There is still need for more qualified evidence to support its use in patients with PFAPA. 5. Despite promising results obtained in studies with IL-1β inhibitors, such studies are limited to a few case reports.

Assessment of serum interleukin-8 as a sensitive serological marker in monitoring the therapeutic effect of levamisole in recurrent aphthous ulcers: A randomized control study.

Aim: The study was designed to evaluate the serum interleukin‑8 (IL‑8) levels in patients with recurrent aphthous ulcer (RAU) and monitor the immunomodulation and altered IL‑8 levels by levamisole before therapy and after levamisole therapy. Materials and Methods: This study was carried as a randomized case‑control study involving a study group of 30 patients diagnosed as RAUs and given levamisole (vermisole 150 mg, od for 1st 3 days of 3 weeks in a month and for 3 months with a gap of 1 week) and these patients were recalled after 3 months and were subjected for estimation of serum IL‑8 levels. Control group had 20 age and sex matched individuals with no systemic illness and were not given any levamisole. Good compliance was reported at the end of the study. Results: Mild gastric irritation was reported and when severe it was managed by H1 blocker. Patients were reviewed after 3 months. The follow‑up data at each visit with respect to each other and to base‑line values was calibrated using a Students t‑test. Highly significant comparisons were obtained in the serum IL‑8 between study and control groups before the onset of levamisole (t = 6.53, P ≤ 0.001). IL‑8 levels reduced by 72% after levamisole was instituted in RAU patients and comparison was highly significant for before and after levamisole onset (t = 5.54, P ≤ 0.001). Conclusion: This study points to the effectiveness of levamisole as an effective adjunct therapy in the routine management of RAU.

Evaluation of hbeta;D-1 and hbeta; D-2 levels in saliva of patients with oral mucosal diseases / Evaluación de los niveles de hbeta; D-1 y hbeta;D-2 en la Saliva de pacientes con enfermedades de la mucosa oral

OBJECTIVE: This study aimed to determine a possible correlation between oral mucosal disease and salivary concentrations of the antimicrobial peptides human beta-defensin-1 (hβD-1) and human betadefensin- 2 (hβD-2). METHOD: The present work focussed on the establishment of a reversed phase-high performance liquid chromatography (RP-HPLC) procedure to quantify human beta-defensins (hβD-1 and hβD-2) in saliva samples of patients with oral diseases such as lichen planus (n = 10), Behçet (n = 10) and recurrent apthous stomatitis (n = 10). RESULTS: Linear calibration range for hβD-1 and hβD-2 defensins was 1.67−200 µg mL-1 and 3.13− 100 µg mL-1 with R2 values of 0.9998 and 0.996, correspondingly. The concentration of beta-defensins in saliva was determined by comparing the peak areas of eluted hβD-1 and hβD-2 with that of their standards. The variation of the amount of beta-defensins was evaluated by comparisons of the results obtained from the patients with oral mucosal diseases before and after treatments and the control subjects. The limit of detection (LOD) and limit of quantification (LOQ) were found to be 1.62 µg mL- 1 and 5.39 µg mL-1 for hβD-1 and 0.94 µg mL-1 and 3.13 µg mL-1 for hβD-2, respectively. CONCLUSION: The salivary beta-defensin concentration was significantly higher in patients with oral mucosal diseases than in healthy volunteers; furthermore, in patients with oral mucosal diseases, the concentration was significantly higher before treatment than after treatment.

OBJETIVO: Este estudio tuvo por objeto determinar una posible correlación entre la enfermedad de la mucosa oral y las concentraciones salivales de la beta-defensina humana 1 (hβD-1) y la beta-defensina humana 2 (hβD-2) de los péptidos antimicrobianos. MÉTODO: El presente trabajo estuvo encaminado al establecimiento de un procedimiento de cromatografía líquida de alta eficacia de fase reversa (RP-HPLC) para cuantificar las beta-defensinas humanas (hβD-1 y hβD-2) en muestras de saliva de pacientes con enfermedades orales como el liquen plano (n = 10), Behçet (n = 10), y la estomatitis aftosa recurrente (n = 10). RESULTADOS: El rango de calibración lineal de las defensinas hβD-1 y hβD-2 fue 1.67-200 µg mL-1 y 3.13-100 µg mL-1 con valores R2 de 0.9998 y 996, respectivamente. La concentración de beta-defensinas en la saliva se determinó utilizando el área de sus estándares. La variación de la cantidad de beta defensinas fue evaluada por comparaciones de los resultados obtenidos de los pacientes con enfermedades de la mucosa oral, antes y después de los tratamientos y los sujetos de control. Se halló que el límite de detección (LDD) y el límite de cuantificación (LDC) fueron 1.62 µg mL-1 y 5.39 µg mL- 1 para hβD-1 y 0.94 µg mL-1 y 3.13 µg mL-1 hβD-2, respectivamente. CONCLUSIÓN: La concentración de beta-defensina salival fue significativamente mayor en los pacientes con enfermedades de la mucosa oral que en los voluntarios sanos. Además, en pacientes con enfermedades de la mucosa oral, la concentración fue significativamente mayor antes del tratamiento que después del tratamiento.

Etiologia e tratamento da estomatite aftosa recorrente: revisão de literatura / Etiology and treatment of recurrent aphthous stomatitis: literature review

Objetivos: Descrever as características e os principais achados relatados na literatura quanto à provável etiologia e tratamentos das lesões causadas pela Estomatite Aftosa Recorrente (EAR). Métodos: Realizou-se a revisão da literatura nas bases de dados PubMed, SciELO e LILACS, no período de tempo do ano de 2005 a 2012. Utilizaram-se, isoladamente e em combinação, os descritores a seguir: Stomatitis, Aphthous; Oral Ulcer; Risk Factors e Therapeutics. Resultados: A patogênese da estomatite aftosa recorrente ainda continua indefinida, havendo confirmação científica quanto à sua relação com fatores imunológicos e mutações genéticas. Os procedimentos realizados e recursos utilizados para o tratamento das lesões são paliativos, no intuito de aliviar a dor, não existindo uma terapêutica de cura. Conclusão: Por ser a etiologia da EAR ainda incerta, o tratamento atual das lesões é bastante variado,e baseia-se no alívio dos sintomas da doença, variando, desde o uso de produtos naturais, como a própolis, passando por anti-inflamatórios, até à aplicação do laser de baixa potência.

Objectives: To describe the characteristics and key findings reported in the literature about the possible etiology and treatment of lesions caused by Recurrent Aphthous Stomatitis (RAS). Methods: It was conducted a literature review in the databases PubMed, SciELO and LILACS, from 2005 to 2012. Were used singly or in combination, the following descriptors: Stomatitis, Aphthous; Oral Ulcer; Risk Factors and Therapeutics. Results: The pathogenesis of recurrent aphthous stomatitis still remains unclear, however, there is strong evidence regarding its relationship with immunological factors and genetic mutations. The procedures performed and resources used for the treatment of lesions are palliative in order to relieve pain, there is not a therapeutic healing. Conclusion: As the uncertain etiology of RAS, the current treatment of lesions is very wide, and relies on relieving symptoms of the disease, ranging from the use of natural products, such as propolis, to anti-inflammatories, until the implementation of low-power laser.

Estomatitis aftosa recurrente mayor tipo C: reporte de un caso / Recurrent type C major aphthous stomatitis: report of a case

La estomatitis aftosa recurrente (EAR) ha sido descrita como la enfermedad de la mucosa bucal más común en América. Se considera una enfermedad inflamatoria no infecciosa de la mucosa bucal, de etiología aún desconocida. Las úlceras de la EAR se distinguen por su forma, tamaño, localización (herpetiforme, menor y mayor) y estrategias de manejo (tipos A, B y C), lo que permite diferenciarlas de las diversas enfermedades ulcerativas infecciosas (por ej. las producidas por el virus herpes), y así dirigir el tratamiento adecuado, ya que la EAR afecta en gran medida la calidad de vida del paciente.

Homeopatía y estomatitis aftosa recurrente: revisión bibliográfica / Homeopathy and recurrent aphthous stomatitis: bibliographic review

La estomatitis aftosa recurrente es una de las urgencias periodontales que más afecta a los pacientes que acuden a los servicios estomatológicos. Se caracteriza por la aparición de ulceraciones recurrentes y dolorosas, sumamente molestas, que pueden durar días, semanas, meses o años, y que dificultan realizar algunas funciones. Debido al desconocimiento de su etiología, se han utilizado métodos terapéuticos locales y generales, que han estado encaminados a aliviar los síntomas, a evitar una infección secundaria de las lesiones y, a pesar de que los empleados hasta el momento mejoran el cuadro clínico, esta entidad continúa considerándose como la más frecuente de las lesiones de la mucosa de la cavidad bucal. Al valorar el auge que ha alcanzado en estos últimos años el desarrollo de la homeopatía, y porque se ha comprobado su utilidad en diferentes afecciones agudas de la cavidad bucal con múltiples ventajas y beneficios, se decidió realizar una revisión bibliográfica, con el objetivo de identificar los principales medicamentos homeopáticos a considerar en el abordaje de la estomatitis aftosa recurrente

The recurrent aphthous stomatitis is one of the periodontal urgencies that most affect the patients attending the stomatologic services. It is characterized by the appearance of painful and recurrent, extremely annoying ulcerations, that can last days, weeks, months or years, and could difficult carrying out some functions. Due to the ignorance of their etiology, local and general methods have been used directed to alleviate the symptoms, to avoid the infections secondary to the lesions and, although all the methods used up to the moment improve the clinical features, this entity is still considered the most frequent lesion of the mucous of the oral cavity. When assessing the peak that homeopathy has reached during the last years, and because it has proved its utility in different acute diseases of the oral cavity with multiple advantages and benefits, we decided to make a bibliographic review, with the objective of identifying the main homeopathic drugs to consider in the treatment of aphthous recurrent stomatitis

Aftosis recurrente / Relapsing aphthous ulcers

La aftosis recurrente o estomatitis aftosa recurrente es una de las patologías más frecuentes de la mucosa oral. Aunque sus características clínicas están bien definidas, la etiología específica y la patogenia de este trastorno no han sido dilucidadas. Clínicamente pueden distinguirse dos formas de aftosis recurrente, que varían de un polo de elevada frecuencia y menor severidad conocido como aftosis simple, a uno infrecuente y de mayor severidad asociado o no a patologías sistémicas, que se denomina aftosis compleja. El tratamiento es inespecífico y en ocasiones frustrante, a pesar de la multiplicidad de agentes tópicos y sistémicos descriptos. La presencia de aftas orales recurrentes exige realizar un diagnóstico adecuado y una clasificación clínica apropiada que permitan excluir la enfermedad de Behçet e identificar factores predisponentes y eventuales patologías sistémicas asociadas. Son necesarios más estudios para poder comprender el origen de este trastorno y optimizar su terapeútica.

Relapsing aphthous ulcers or relapsing aphthous stomatitis is one of themost frequent disorders of the oral mucosa. Although their clinical characteristics are well defi ned, the specifi c etiology and pathogenesis of this disorder have not been established. Clinically it is possible to determine two forms of relapsing aphthous ulcers,varying from one pole of high frequency and low severity known as simple aphthosis to another more rare and severe, which may or may not be associated to systemic pathologies, and is called complex aphthosis.Treatment although not specifi c is at times frustrating despite many topical and systemic options.The presence of relapsing oral aphthous ulcers demands an adequate diagnosis and clinical classifi cation in order to rule out Behcet`s disease, as well as the identifi cation of possible predisposing factors and associated systemic diseases. Further studies are required to understand the origin of this disorder and optimize its treatment.

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

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

[Review of routine therapeutic management of common oral lesions]

Since there are not specific pathogens for most of the intraoral lesions and there is not unique protocol for their therapies and also some of these drugs are not accessible in Iran, we decided to introduce the drugs most available and appropriate in our country. This study has been done by review discussion procedures. The articles were extracted from native, foreign and international journals, medline, books and theses. Whole part of therapies were considered in these articles. The following lesions were discussed in this study: 1- Primary and secondary herpetic gingivostomatitis, 2- Recurrent Aphthus stomatitis, 3- Lichen planus, 4-Candidiasis, 5- Burning sensation in oral cavity, 6- Xerostomia and 7- taste disorder. As we know there are several kinds of medications for each lesion, although most of them have side effects, and some of them can not be found in our country, we have tried to do our best to suggest appropriate drugs for each intraoral disorders

Uso del Inmunoferón en el tratamiento de la estomatitis aftosa recurrente en niños / Use of Immunoferon in the treatment of aphthous recurrent stomatitis in children

Se realizó un ensayo clínico terapeútico aleatorizado, controlado, fase III a 40 pacientes de 1 a 18 años, con estomatitis aftosa recurrente que acudieron al Departamento de Periodoncia de la Facultad de Estomatología del ISCM-H y a la consulta externa del Hospital William Soler, de septiembre del 2003 a septiembre del 2004. Se aleatorizaron en 2 grupos de tratamiento: grupo A (control) vitaminas más colutorios de clorhexidina, y grupo B (estudio) tratamiento anterior más Inmunoferón. Las lesiones se clasificaron en menor, mayor, o herpetiforme. La forma menor de la enfermedad fue la más frecuente. Los niños de mayor edad se correspondían con la forma mayor y los de menor edad con la variedad herpetiforme. La duración de la enfermedad disminuyó de 10,5 días a 6,2 días en el grupo estudio y de 10,6 a 8,3 en el control. El 42,1 por ciento de los casos en el grupo A tuvo buena evolución contra el 73,7 por ciento en el grupo B. La forma mayor fue la de mejor evolución y la posibilidad de mejoría clínica fue 7 veces mayor en el grupo B. En general, el porcentaje de pacientes que se agrupó en la categoría de recidiva por encima de los 3 meses, fue muy superior en el grupo B con respecto al A (57,9 por ciento vs. 15,8 por ciento). No hubo reacciones adversas al medicamento(AU)

A controlled, randomized, therapeutic, phase III clinical trial was undertaken in 40 patients aged 1-18 with aphthous recurrent stomatitis that were seen at the Periodontics Department of the Faculty of Stomatology of the Higher Institute of Medical Sciences of Havana and at the outpatient department of William Soler Hospital from September 2003 to September 2004. They were divided at random in 2 treatment groups: group A (control) vitamins and chlorhexidine mouthwashes, and group B (study) that received the same treatment plus Immunoferon. The lesions were classified into minor, major or herpetifom. The most common was the minor form. The major form was observed in the oldest children and the herpetiform variety in the youngest. The duration of the disease decreased from 10.5 days to 6.2 days in the study group and from 10.6 to 8.3 in the control group. 42.1 percent of the cases in group A had a good evolution against 73.7 percent in the group B. The major form had the best evolution and the possibility of clinical improvement was 7 times higher in group B. In general, the percentage of patients that were grouped in the recurrence category over 3 months was much greater in group B compared with group A (57.9 percent vs. 15.8 percent). There were no adverse reactions to the drug(AU)

Evaluación clínica de la efectividad de bórax en el tratamiento de la estomatitis aftosa / Clinical assessment of Borax effectiveness in the treatment of aphtous stomatitis

Existe una vasta experiencia homeopática en el tratamiento de afecciones crónicas descritas en la literatura clásica, no obstante, se recomienda el uso de remedios homeopáticos en el tratamiento de afecciones agudas muy frecuentes en la práctica estomatológica, entre las que se encuentra la estomatitis aftosa. Se realiza el presente estudio con el objetivo de evaluar clínicamente la efectividad del bórax en el tratamiento de esta entidad. Se trataron 390 pacientes entre los 15 y 60 años de edad, cuyo síntoma principal era el dolor intenso. Los 195 pacientes pertenecientes al grupo de estudio fueron tratados con bórax a la 6 centesimal en solución alcohólica al 70 por ciento, durante 3 días, comparando los resultados obtenidos con los del grupo control, al que se aplicó el tratamiento convencional. De los resultados obtenidos se concluye que con la aplicación de un método rápido, de bajo costo y de fácil ejecución, se obtuvieron resultados satisfactorios que corroboran la validez del empleo del bórax en el tratamiento de las aftas bucales(AU)

There is vast homeopathic experience in treating chronic affections described in the classical literature; nevertheless, the use of homeopathic remedies in the treatment of very frequent acute troubles in dental practice such as aphtous stomatitis is also recommended. The present paper was aimed at clinically evaluating the effectiveness of borax in the treatment of this condition. Three hundred and ninety patients aged 15-60 years whose main symptoms was deep pain were treated. The study group comprised 195 patients, who received 006 Borax in 70% alcohol solution for 3 days; the results were compared to those obtained from the control group, which was applied the conventional therapy. It was concluded that a rapid, low cost and easy-to-apply method rendered satisfactory results that confirmed the validity of Borax in the treatment of aphtae(AU)

Clinical evaluation of the topical use of propolis in recurrent minor aphthous ulceration

Nosso objetivo foi avaliar os efeitos terapêuticos da própolis em ulcerações aftosas recorrente (UAR) do tipo minor em relação ao número de lesões, duração e freqüência das lesões. Setenta pacientes com UAR compuseram o grupo estudado que foi examinado conforme critério de inclusão pré-estabelecido. Quarenta pacientes que apresentavam UAR (idade média de 38,5 anos; 25 mulheres e 15 homens) foram selecionados e medicados durante os episódios recorrentes de UAR utilizando-se uma solução de própolis a 5% tendo o propilenoglicol como veículo. Os pacientes foram orientados a aplicar topicamente a solução três vezes ao dia, a partir dos primeiros sinais clínicos de UAR pelo período de um ano. Foi observada uma redução estatisticamente significante no número, freqüência e duração das lesões (p≤ 0,01). A solução de própolis utilizada como terapia das UAR nesse estudo não apresentou efeitos adversos e se mostrou benéfica no tratamento das ulcerações aftosas recorrentes.