Photobiomodulation therapy assisted orthodontic tooth movement: potential implications, challenges, and new perspectives. / ­­æ¿€å ‰å ‰å­ç”Ÿç‰©è°ƒèŠ‚ç–—æ³•è¾ 助正畸牙齿移动：潜在的作用、挑战与新观点.

Over the past decade, dramatic progress has been made in dental research areas involving laser therapy. The photobiomodulatory effect of laser light regulates the behavior of periodontal tissues and promotes damaged tissues to heal faster. Additionally, photobiomodulation therapy (PBMT), a non-invasive treatment, when applied in orthodontics, contributes to alleviating pain and reducing inflammation induced by orthodontic forces, along with improving tissue healing processes. Moreover, PBMT is attracting more attention as a possible approach to prevent the incidence of orthodontically induced inflammatory root resorption (OIIRR) during orthodontic treatment (OT) due to its capacity to modulate inflammatory, apoptotic, and anti-antioxidant responses. However, a systematic review revealed that PBMT has only a moderate grade of evidence-based effectiveness during orthodontic tooth movement (OTM) in relation to OIIRR, casting doubt on its beneficial effects. In PBMT-assisted orthodontics, delivering sufficient energy to the tooth root to achieve optimal stimulation is challenging due to the exponential attenuation of light penetration in periodontal tissues. The penetration of light to the root surface is another crucial unknown factor. Both the penetration depth and distribution of light in periodontal tissues are unknown. Thus, advanced approaches specific to orthodontic application of PBMT need to be established to overcome these limitations. This review explores possibilities for improving the application and effectiveness of PBMT during OTM. The aim was to investigate the current evidence related to the underlying mechanisms of action of PBMT on various periodontal tissues and cells, with a special focus on immunomodulatory effects during OTM.

Intratumor delivery of amino-modified graphene oxide as a multifunctional photothermal agent for efficient antitumor phototherapy.

Due to the high selectivity and non-invasive property, phototherapy has attracted increasing attention in the treatment of cancer. Targeted delivery and retention of photoactive agents in tumor tissue is of great significance and importance for safe and efficient phototherapy. Herein, we report a multifunctional nanomaterial photothermal agent, namely amino-modified graphene oxide (AGO) for anti-oral cancer photothermal therapy (PTT). Compared to the parental graphene oxide (GO) which has a negative charge and weak photothermal effect, AGO possesses a positive charge (∼+50 mV) and the significantly enhanced photothermal effect. Positive charge allows AGO to efficiently interact with tumor cells and retain in tumor tissue after intratumor injection. The enhanced photothermal effect allows AGO to achieve the tunable and efficient PTT. In vitro results show that AGO (15 µg/mL) reduces the viability of HSC-3 cells (oral squamous cell carcinoma cell line) to 5% under near infrared (NIR) irradiation (temperature increased to 58.4 °C). In vivo antitumor study shows that intratumor delivery of AGO (200 µg/mouse) has no inhibition effects on tumor growth (454% of initial tumor size) without NIR. With a single dose of NIR irradiation, however, AGO significantly reduces the tumor size to 25% of initial size in 1 of 4 mice, and even induces the complete tumor ablation in 3 of 4 mice. Furthermore, the injected AGO falls off along with the scab after PTT. Our findings indicate that AGO is a potential nano-photothermal agent for tunable, convenient and efficient anticancer PTT.

Photothermal and natural activity-based synergistic antibacterial effects of Ti3C2Tx MXene-loaded chitosan hydrogel against methicillin-resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) has strong resistance to antibiotic therapy. In this regard, developing antibiotic-free antibacterial agents is of great significance to treat MRSA infections. Herein, we loaded Ti3C2Tx MXene nanomaterial in the non-crosslinked chitosan (CS) hydrogel. The obtained MX-CS hydrogel is expected to not only adsorb MRSA cells via CS-MRSA interactions, but also gather the MXene-induced photothermal hyperthermia, achieving the efficient and intensive anti-MRSA photothermal therapy. As a result, under NIR irradiation (808 nm, 1.6 W/cm2, 5 min), MX-CS showed a greater photothermal effect than MXene alone did (30 µg/mL, 49.9 °C for MX-CS and 46.5 °C for MXene). Importantly, MRSA cells were rapidly adsorbed on MX-CS hydrogel (containing 30 µg/mL MXene) and completely inhibited (99.18 %) under NIR irradiation for 5 min. In contrast, MXene (30 µg/mL) and CS hydrogel alone only inhibited 64.52 % and 23.72 % MRSA, respectively, significantly lower than the inhibition caused by MX-CS (P < 0.001). Interestingly, when the hyperthermia was depleted by a 37 °C water bath, the bacterial inhibition rate of MX-CS significantly decreased to 24.65 %. In conclusion, MX-CS hydrogel has a remarkable synergistic anti-MRSA activity by gathering MRSA cells and MXene-induced hyperthermia, and may have great potentials in treating MRSA-infected diseases.

Nanoparticulate cell-free DNA scavenger for treating inflammatory bone loss in periodontitis.

Periodontitis is a common type of inflammatory bone loss and a risk factor for systemic diseases. The pathogenesis of periodontitis involves inflammatory dysregulation, which represents a target for new therapeutic strategies to treat periodontitis. After establishing the correlation of cell-free DNA (cfDNA) level with periodontitis in patient samples, we test the hypothesis that the cfDNA-scavenging approach will benefit periodontitis treatment. We create a nanoparticulate cfDNA scavenger specific for periodontitis by coating selenium-doped hydroxyapatite nanoparticles (SeHANs) with cationic polyamidoamine dendrimers (PAMAM-G3), namely G3@SeHANs, and compare the activities of G3@SeHANs with those of soluble PAMAM-G3 polymer. Both G3@SeHANs and PAMAM-G3 inhibit periodontitis-related proinflammation in vitro by scavenging cfDNA and alleviate inflammatory bone loss in a mouse model of ligature-induced periodontitis. G3@SeHANs also regulate the mononuclear phagocyte system in a periodontitis environment, promoting the M2 over the M1 macrophage phenotype. G3@SeHANs show greater therapeutic effects than PAMAM-G3 in reducing proinflammation and alveolar bone loss in vivo. Our findings demonstrate the importance of cfDNA in periodontitis and the potential for using hydroxyapatite-based nanoparticulate cfDNA scavengers to ameliorate periodontitis.

Ti3C2Tx MXene loaded with indocyanine green for synergistic photothermal and photodynamic therapy for drug-resistant bacterium.

Infections caused by antibiotic-resistant bacteria are a critical threat to human health. Considering the difficulties and time-consuming nature of synthesizing new antibiotics, it is of great significance and importance to develop the antibiotic-independent antibacterial approaches against drug-resistant bacteria. Nanomaterials-based photothermal therapy (PTT) and photodynamic therapy (PDT) have attracted much attention due to their broad-spectrum bactericidal activity, low toxicity, and drug-free feature. In this work, we loaded indocyanine green (ICG) on the Ti3C2Tx MXene nanosheets (454 nm) so as to combine the photothermal effect of MXene with the photodynamic effect of ICG. Without near-infrared (NIR) irradiation, MXene (20 µg/mL), ICG (5 µg/mL) or ICG-loaded MXene (ICG-MXene) showed no significant antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA). Under NIR, however, the viability loss of MRSA remarkably increased to 45% for MXene, 66% for ICG and 100% for ICG-MXene. We further found that the great anti-MRSA activity of ICG-MXene under NIR was attributed to the combination of photothermal effect of MXene (high temperature) and photodynamic effect of ICG (high level of reactive oxygen species). Our findings indicate that MXene can be used as both the photothermal agent and the carrier of photosensitizers to achieve the synergistic PTT/PDT therapy for bacterial infections.

Abnormal Micronutrient Intake Is Associated with the Risk of Periodontitis: A Dose-response Association Study Based on NHANES 2009-2014.

The association between micronutrient intake and the risk of periodontitis has received much attention in recent years. However, most studies focused on the linear relationship between them. This study aimed to explore the dose-response association between micronutrient intake and periodontitis. A total of 8959 participants who underwent a periodontal examination, and reported their micronutrient intake levels were derived from the US National Health and Nutrition Examination Survey (NHANES, 2009-2014) database. Logistic regression was performed to evaluate associations between micronutrient intake and periodontitis after propensity score matching (PSM), and restricted cubic splines (RCS) analysis was conducted to explore the dose-response associations. Following PSM, 5530 participants were included in the RCS analysis. The risk of periodontitis was reduced with sufficient intake of the following micronutrients: vitamin A, vitamin B1, vitamin B2, and vitamin E. In addition, the risk of periodontitis was increased with excessive intake of the following micronutrients: vitamin B1 (1.8 mg/day, males; 1.3 mg/day, females), vitamin C (90 mg/day, males), and copper (1.1 mg/day, combined). In conclusion, a linear association was found between vitamin A, vitamin B2, vitamin C, and copper and periodontitis-namely, a sufficient intake of vitamin A and vitamin B2 might help reduce the prevalence of periodontitis; by contrast, a high intake of vitamin C and copper increased the risk. In addition, a nonlinear dose-response association was found for the incidence of periodontitis with vitamin B1 and vitamin E. When within reasonable limits, supplemental intake helped reduce the prevalence of periodontitis, while excessive intake did not help significantly and might even increase the risk. However, confounding factors, such as health awareness, should still be considered.

Size-dependent photothermal antibacterial activity of Ti3C2Tx MXene nanosheets against methicillin-resistant Staphylococcus aureus.

Developing antibiotics-independent antibacterial materials is of great importance for combating drug-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA). MXene (transition metal carbides and nitrides), a class of novel 2D nanomaterials, has shown great potentials in biomedical areas. However, the effect of MXene size on its properties and bioactivity is still unknown. Herein, we report for the first time that the antibacterial photothermal therapy efficacy of Ti3C2Tx MXene nanosheets is size-dependent. Three MXene suspensions with small size of 196 nm (MX-s), medium size of 347 nm (MX-m) and large size of 497 nm (MX-l) were prepared via ultrasonication. Upon NIR irradiation for 5 min, the temperature of MXene suspensions (10 µg/mL) increased to 64, 60 and 56 °C for MX-s, MX-m and MX-l, respectively. Accordingly, the viability loss of MRSA induced by MX-s, MX-m and MX-l under NIR was 93%, 69% and 56%, respectively. The in vivo study in the MRSA-infected mouse model showed that the photothermal therapy efficacy of MX-s was comparable to that of the positive control vancomycin. This is the first report on the size-dependent photothermal effect and photothermal antibacterial activity of MXene, which may guide the development of MXene-based therapeutics in the future. In addition, the drug-free antibacterial therapy has great implications for the treatment of antibiotics-resistant bacteria infections.

Application status and prospects of topical drug therapy in oral mucosal diseases / 口腔疾病防治

@#Oral mucosal disease is a general term for a type of disease that mainly affects the oral mucosa and surrounding soft tissues. In the treatment of oral mucosal diseases, due to the particularity of the anatomical location, the use of topical administration is relatively simple and convenient; drugs can easily accumulate in the lesions, and at the same time, they can also avoid adverse reactions caused by systemic drug delivery. Topical administration has become an important and even preferred option for the treatment of oral mucosal diseases. There are various types of topically used drugs for oral mucosal diseases, such as glucocorticoids (triamcinolone acetonide), immunomodulatory drugs (tacrolimus), antiseptic drugs (chlorhexidine), pain relievers (lidocaine) and proprietary Chinese medicines (aloe vera gel). Among these drugs, although the most widely used liquid formulations such as gargles and sprays are easy to use, they are not conducive to local retention of drugs due to the particularity of the oral environment and function. Based on this, researchers have continuously improved the dosage form of the drug, and developed a series of semi-solid pharmaceutical preparations such as gels and ointments, some of which have exerted good curative effects in clinical work. In addition, although films, patches and other solid oral mucosal topical pharmaceutical preparations have few clinical applications, they have also been widely researched and described and are expected to become the mainstream dosage form in the future. In general, with the improvement of dosage forms, topical administration is playing an increasingly important role in the treatment of oral mucosal diseases. Therefore, combined with basic research and clinical reports, this article reviews the application of topical drug delivery in the treatment of oral mucosal diseases

Design and Evaluation of Multiplex One-Step Reverse Transcription PCR-Dipstick Chromatography Method for the Analysis of Seven Respiratory Pathogens.

Influenza A, influenza B, severe acute respiratory syndrome coronavirus 2, adenovirus, respiratory syncytial virus, Mycoplasma pneumoniae, and Chlamydophila pneumoniae are common pathogens that can cause severe pneumonia and other symptoms, resulting in acute lower respiratory tract infections. The objective of this study was to design and evaluate a sensitive and specific multiplex one-step reverse transcription PCR (RT-PCR)-dipstick chromatography method for simultaneous rapid detection of these seven pathogens. Streptavidin-coated blue latex particles were used to read out a positive signal. Based on the DNA-DNA hybridization of oligonucleotide sequences (Tag) for forward primer with the complementary oligonucleotide sequence (cTag) on the dipstick and biotin-streptavidin interactions, PCR products were able to be illuminated visually on the dipstick. The specificity and the limit of detection (LOD) were also evaluated. Moreover, the clinical performance of this method was compared with Sanger sequencing for 896 samples. No cross reaction with other pathogens was found, confirming the high specificity of this method. The LOD was 10 copies/µL for each of the tested pathogens, and the whole procedure took less than 40 min. Using 896 samples, the sensitivity and specificity were shown to be no lower than 94.5%. The positive predictive value was higher than 82.1%, and the negative predictive value was higher than 99.5%. The kappa value between the PCR-dipstick chromatography method and Sanger sequencing ranged from 0.869 to 0.940. In summary, our one-step RT-PCR-dipstick chromatography method is a sensitive and specific tool for rapidly detecting multiplex respiratory pathogens.

Glutamine Metabolism Is Essential for Stemness of Bone Marrow Mesenchymal Stem Cells and Bone Homeostasis.

Skeleton has emerged as an endocrine organ which is both capable of regulating energy metabolism and being a target for it. Glutamine is the most bountiful and flexible amino acid in the body which provides adenosine 5'-triphosphate (ATP) demands for cells. Emerging evidences support that glutamine which acts as the second metabolic regulator after glucose exerts crucial roles in bone homeostasis at cellular level, including the lineage allocation and proliferation of bone mesenchymal stem cells (BMSCs), the matrix mineralization of osteoblasts, and the biosynthesis in chondrocytes. The integrated mechanism consisting of WNT, mammalian target of rapamycin (mTOR), and reactive oxygen species (ROS) signaling pathway in a glutamine-dependent pattern is responsible to regulate the complex intrinsic biological process, despite more extensive molecules are deserved to be elucidated in glutamine metabolism further. Indeed, dysfunctional glutamine metabolism enhances the development of degenerative bone diseases, such as osteoporosis and osteoarthritis, and glutamine or glutamine progenitor supplementation can partially restore bone defects which may promote treatment of bone diseases, although the mechanisms are not quite clear. In this review, we will summarize and update the latest research findings and clinical trials on the crucial regulatory roles of glutamine metabolism in BMSCs and BMSC-derived bone cells, also followed with the osteoclasts which are important in bone resorption.

D-mannose induces regulatory T cells and suppresses immunopathology.

D-mannose, a C-2 epimer of glucose, exists naturally in many plants and fruits, and is found in human blood at concentrations less than one-fiftieth of that of glucose. However, although the roles of glucose in T cell metabolism, diabetes and obesity are well characterized, the function of D-mannose in T cell immune responses remains unknown. Here we show that supraphysiological levels of D-mannose safely achievable by drinking-water supplementation suppressed immunopathology in mouse models of autoimmune diabetes and airway inflammation, and increased the proportion of Foxp3+ regulatory T cells (Treg cells) in mice. In vitro, D-mannose stimulated Treg cell differentiation in human and mouse cells by promoting TGF-ß activation, which in turn was mediated by upregulation of integrin αvß8 and reactive oxygen species generated by increased fatty acid oxidation. This previously unrecognized immunoregulatory function of D-mannose may have clinical applications for immunopathology.

Possible alternative therapies for oral lichen planus cases refractory to steroid therapies.

Oral lichen planus (OLP) is a chronic inflammatory disorder with a multifactorial etiopathogenesis. Immune dysregulation plays a critical role in the development and progression of this disease. Patients' lives may be affected by pain caused by atrophic-erosive lesions. Given the obscure etiology, treatment is usually symptomatic. Topical steroids remain the mainstay of management. However, their therapeutic benefits are not always evident. There are substantial data on the possible therapeutic strategies that are effective in OLP cases refractory to steroids. This review provides an overview of the current approaches for the management of steroid-refractory OLP. The miscellaneous treatment regimens include tacrolimus, pimecrolimus, thalidomide, low-level laser therapy, photodynamic therapy, and surgical excision. Some results obtained from these studies were promising. However, further studies, especially randomized controlled trials with strict inclusion and exclusion criteria and larger sample sizes, are required for the evaluation of the long-term safety and efficacy of these therapies.

Hyperthermia inhibited the migration of tongue squamous cell carcinoma through TWIST2.

BACKGROUND: Hyperthermia has been shown promising in the treatment of head and neck squamous cell carcinoma (HNSCC); however, the mechanism underlying hyperthermia reducing tumor metastasis is poorly elucidated. TWIST2, an important transcription factor of epithelial-mesenchymal transition (EMT), plays a critical role in the tumor progression and metastasis. The role of TWIST2 in tongue squamous cell carcinoma (TSCC) and its association with hyperthermia still have not been reported. METHOD: The correlations between TWIST2 expression and the clinical-pathologic characteristics of 89 patients with TSCC were evaluated by immunohistochemical staining. TSCC cell lines transfected with siRNA against TWIST2 were heated for 40 min at 42.5°C, and the migration capability of cells was examined by migration assay. Xenograft tumors in nude mice were treated by hyperthermia, and TWIST2 expression was measured. RESULTS: Our data showed that TWIST2 expression was associated with the metastasis of human TSCC. In Tca8113 and Cal-27 cells, TWIST2-siRNA treatment can reduce cell migration ability and has no effect on the cell proliferation and apoptosis. Hyperthermia can decrease the level of TWIST2 in TSCC and inhibit the migration of cells. CONCLUSIONS: This demonstrated that hyperthermia might decrease the migration of Tca8113 and Cal-27 cells by reducing TWIST2 expression. Altogether, these findings suggest an as yet undescribed link between TWIST2 and hyperthermia in TSCC.

Haloemodin as novel antibacterial agent inhibiting DNA gyrase and bacterial topoisomerase I.

Drug-resistant bacterial infections and lack of available antibacterial agents in clinical practice are becoming serious risks to public health. We synthesized a new class of haloemodins by modifying a traditional Chinese medicine component, emodin. The novel haloemodin exerts strong inhibitory activity on bacterial topoisomerase I and DNA gyrase, and not on the topoisomerases of human origin. In principle, it shows remarkable antibacterial activities against laboratory and clinically isolated Gram-positive bacteria, including vancomycin-resistant Enterococcus faecium and methicillin-resistant Staphylococcus aureus. We further expanded its antibacterial spectrum into against Gram-negative bacteria with the assistance of polymyxin B nonapeptide, which helps haloemodin to penetrate through the bacterial outer membrane. Finally, the therapeutic effect of haloemodin in vivo was confirmed in curing S. aureus-induced keratitis on rabbit model. With distinctive structural difference from the antibiotics we used, the haloemodins are of value as promising antibacterial pharmacophore, especially for combat the infections caused by drug-resistant pathogens.

Determination of deltonin in rat plasma by using HPLC-MS/MS and the application of this method in pharmacokinetic studies.

Deltonin is a naturally occurring spirostanol glycoside from Dioscorea zingiberensis C.H. Wright, which is used in traditional Chinese medicine. It exerts strong cytotoxic effect on C26 cells, inhibits C26 derived-tumor growth, and prolongs the survival of tumor-bearing mice after its oral administration, indicating its potential for use as an anti-tumor drug. To investigate the pharmacokinetic profiles of deltonin, a rapid, sensitive, and simplified high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) assay was developed and validated for the determination of deltonin in rat plasma. After acetonitrile-mediated plasma protein precipitation, chromatographic separation of deltonin was achieved using a reversed phase Hypersil Gold column (150mm×2.1mm, 5µm), with gradient elution using 0.1% formic acid and acetonitrile. Thereafter, deltonin was quantified using MS/MS with electrospray ionization (ESI) in positive multiple reaction monitoring (MRM) mode. The flow rate of the mobile phase was 200µL/min, and the retention time was 9.03min for deltonin and 6.31min for the internal standard (IS: 20(S)-ginsenoside Rb1). The linear range of the calibration curve was 2-5000ng/mL (r(2)>0.99), and the limit of detection (LOD) was 0.46ng/mL. The intra- and inter-day accuracies ranged from -2.8% to 11.1% and precisions (RSD) were within 13.1%. Deltonin was found to be stable under short-term temperature conditions, post-preparative temperature conditions, and after 3 freeze-thaw cycles conditions. The validated method was successfully applied to a pharmacokinetic study in rats after oral administration of deltonin (50 and 100mg/kg). The pharmacokinetics is characterized by high apparent clearance (CL/F) and apparent volume of distribution (Vd/F).

Magnolol protects against oxidative stress-mediated neural cell damage by modulating mitochondrial dysfunction and PI3K/Akt signaling.

Magnolol, an orally available compound from Magnolia officinalis used widely in traditional herbal medicine against a variety of neuronal diseases, possesses potent antioxidant properties and protects the brain against oxidative damage. The aim of the work is to examine the protective mechanisms of magnolol on human neuroblastoma SH-SY5Y cells against apoptosis induced by the neurotoxin acrolein, which can cause neurodegenerative disorders by inducing oxidative stress. By investigating the effect of magnolol on neural cell damage induced by the neurotoxin acrolein, we found that magnolol pretreatment significantly attenuated acrolein-induced oxidative stress through inhibiting reactive oxygen species accumulation caused by intracellular glutathione depletion and nicotinamide adenine dinucleotide phosphate oxidase activation. We next examined the signaling cascade(s) involved in magnolol-mediated antiapoptotic effects. The results showed that acrolein induced SH-SY5Y cell apoptosis by activating mitochondria/caspase and MEK/ERK signaling pathways. Our findings provide the first evidence that magnolol protects SH-SY5Y cells against acrolein-induced oxidative stress and prolongs SH-SY5Y cell survival through regulating JNK/mitochondria/caspase, PI3K/MEK/ERK, and PI3K/Akt/FoxO1 signaling pathways.

Lycopene: features and potential significance in the oral cancer and precancerous lesions.

Data from epidemiological studies have indicated that diets rich in fruits and vegetables are likely to benefit many aspects of the prevention of oral malignancy. Lycopene is a red-coloured carotenoid predominantly accumulated in tomatoes as well as other fruits and vegetables. It has been claimed to alleviate chronic diseases such as cancers and cardiovascular disease. Hence, the aim of this review is to summarize the features and its potential significance of lycopene in the development, prevention and treatment of oral premalignant lesions and oral cancer. Studies showed that lycopene might have beneficial effects in the management of some premalignant lesions in the oral cavity including oral submucous fibrosis and oral leukoplakia and may be an adjunct in the prevention and therapy of oral cancer. However, more mechanistic studies and randomized controlled trials of large sample size are necessary to further confirm these effects and to eventually make lycopene to be used in the community prevention and clinically routine management of these diseases.

[Application of Cochrane systematic reviews in diagnosis and treatment for oral mucosal diseases].

OBJECTIVE: To collect evidence in diagnosis and treatment of oral mucosal diseases. METHODS: The Cochrane library (Issue 3, 2009) was searched to get the full texts of published related Cochrane systematic reviews. The results were summarized for recommendation to dentists. The current status of evidence based medicine in this field was analyzed. RESULTS: Reliable evidence for management of oral submucous fibrosis is still limited; amifostine, hydrolytic enzymes, ice chips and Chinese medicine may be effective in preventing oral mucositis for patients with cancer receiving radiotherapy or chemotherapy; the evidence in treating oral mucositis with allopurinol mouthwash, granulocyte macrophage-colony stimulating factor, immunoglobulin or human placentral extract for patients with cancer receiving treatment is weak and unreliable yet; there is evidence that acyclovir is efficacious in prevention and treatment of herpes simplex virus infections in patients being treated for cancer; there is strong evidence that drugs absorbed or partially absorbed from the gastrointestinal tract prevent oral candidiasis in patients receiving treatment for cancer; relapses and adverse effects are common in using beta carotene, lycopene, vitamin A or retinoids to treat oral leukoplakia; only some weak evidence is provided in using cyclosporines, retinoids, steroids or phototherapy for treating oral lichen planus; the evidence about acyclovir for treating primary herpetic gingivostomatitis is insufficient; there is little research evidence for treatment of burning mouth syndrome. CONCLUSION: It is essential to raise the quality of design and conduction of clinical trials in the field of oral mucosal disease to provide solid bases for systematic review, so that to improve evidence based treatment of these diseases.