BACKGROUND: Oral ulcers are a common side effect of chemotherapy and affect patients' quality of life. While stem cell transplantation is a potential treatment for oral ulcers, its efficacy is limited as the stem cells tend to remain in the affected area for a short time. This study aims to develop a treatment for oral ulcers by using trimethyl chitosan (TMC) hydrogel with human tonsil-derived stem cells (hTMSCs) to increase the therapeutic effect of stem cells and investigate their effectiveness. METHODS: Animals were divided into four experimental groups: Control, TMC hydrogel, hTMSCs, and hTMSCs loaded in TMC hydrogel (Hydrogel + hTMSCs) (each n = 8). Oral ulcers were chemically induced by anesthetizing the rats followed by injection of dilute acetic acid in the right buccal mucosa. After confirming the presence of oral ulcers in the animals, a single subcutaneous injection of 100 µL of each treatment was applied to the ulcer area. Histological analyses were performed to measure inflammatory cells, oral mucosal thickness, and fibrosis levels. The expression level of inflammatory cytokines was also measured using RT-PCR to gauge therapeutic the effect. RESULTS: The ulcer size was significantly reduced in the TMC hydrogel + hTMSCs group compared to the control group. The stem cells in the tissue were only observed until Day 3 in the hTMSCs treated group, while the injected stem cells in the TMC Hydrogel + hTMSCs group were still present until day 7. Cytokine analysis related to the inflammatory response in the tissue confirmed that the TMC Hydrogel + hTMSCs treated group demonstrated superior wound healing compared to other experimental groups. CONCLUSION: This study has shown that the adhesion and viability of current stem cell therapies can be resolved by utilizing a hydrogel prepared with TMC and combining it with hTMSCs. The combined treatment can promote rapid healing of oral cavity wounds by enhancing anti-inflammatory effects and expediting wound healing. Therefore, hTMSC loaded in TMC hydrogel was the most effective wound-healing approach among all four treatment groups prolonging stem cell survival. However, further research is necessary to minimize the initial inflammatory response of biomaterials and assess the safety and long-term effects for potential clinical applications.
Chitosan , Mesenchymal Stem Cells , Oral Ulcer , Humans , Rats , Animals , Oral Ulcer/therapy , Ulcer , Hydrogels , Palatine Tonsil , Quality of Life , Models, Animal , Cytokines
Neutropenic ulcerations are characterized by mucosal ulcerations which occur in the presence of neutropenia, suggesting a direct link between neutropenia and mucosal ulceration. An oral ulcer can be labeled as "neutropenic" only if the patients have primary (typically congenital) or secondary neutropenia, and neutropenia is the sole causative factor. Oral mucosal ulcers observed in patients undergoing oncologic therapy may also be termed as "neutropenic ulcers", but the pathogenesis of these oral ulcers more likely involves mucosal events related to trauma, microbial factors, and direct cytotoxicity. In cancer patients, the early appearance of oral ulcers is often attributed to oral mucositis which is a condition primarily caused by the direct mucosal cytotoxicity of chemotherapeutic agents and radiation therapy. Oral ulcers that develop later during or after active cancer therapy may result from intraoral trauma and typically manifest on non-keratinized areas of the oral mucosa which are more susceptible to mucosal damage. In patients undergoing chemotherapy, factors such as disturbances in mucosal barrier function as well as bone marrow suppression lead to reduced neutrophil count and function, and can contribute to the development of oral ulcers. While the etiology of oral ulcers in cancer therapy receiving patients can vary, it is important to emphasize that the host's response plays a crucial role in the progression and repair process of these lesions. This narrative review presents the etiopathogenesis, clinical presentation, and potential management approaches for oral ulcerations in neutropenic patients, with a particular focus on clarifying the usage of the term "neutropenic ulcer" since this term lacks diagnostic specificity and can be misleading in clinical practice regarding the underlying causes and treatment strategies.
Neoplasms , Neutropenia , Oral Ulcer , Humans , Ulcer , Oral Ulcer/diagnosis , Oral Ulcer/etiology , Oral Ulcer/therapy , Medical Oncology , Neutropenia/chemically induced , Neutropenia/diagnosis , Neoplasms/complications
The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis.
Oral Ulcer , Consensus , Humans , Oral Ulcer/diagnosis , Oral Ulcer/etiology , Oral Ulcer/therapy
Eosinophilic ulcer of the oral mucosa is a benign, reactive, self-limited lesion. Its pathogenesis is unclear, and it clinically manifests as a punched-out ulcer with surrounding indurated border, raising suspicion for a possible malignancy. On histology, an acute and chronic dense inflammatory infiltrate can be appreciated, which can extend to the deep underlying tissue (including skeletal muscle). Eosinophils are especially conspicuous on hematoxylin and eosin staining and might play an important role in the development of the ulcer. Removal of possible triggers followed by monitoring and possible biopsy are among the initial recommendations. Most lesions heal spontaneously without the need for intervention. This review aims at assisting dermatologists to easily recognize this entity, avoiding unnecessary interventions and apprehension.
Eosinophilia , Oral Ulcer , Eosine Yellowish-(YS) , Eosinophilia/diagnosis , Eosinophilia/etiology , Eosinophilia/therapy , Hematoxylin , Humans , Mouth Mucosa/pathology , Oral Ulcer/etiology , Oral Ulcer/therapy , Ulcer/complications , Ulcer/pathology
OBJECTIVE: To review common presentation of oral ulcers in children and discuss management of symptoms and subsequent investigation. CONCLUSION: Although a common presentation in children, diagnosis can be challenging. Thorough history taking is critical towards diagnosis and supports signposting to relevant specialities. Clinicians should be able to support first-line symptomatic management of oral ulceration.
Oral Ulcer , Child , Humans , Oral Ulcer/diagnosis , Oral Ulcer/etiology , Oral Ulcer/therapy , Referral and Consultation
The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis.
Humans , Consensus , Oral Ulcer/therapy
Ulceration of the oral cavity is common and a frequent reason for referral to secondary and tertiary centres. Epstein-Barr virus (EBV)-related mucocutaneous ulceration, however, is a rare cause of oral ulceration that has been described only recently. Histologically these lesions resemble lymphomas; however, their management and prognosis differ significantly. We present a case of EBV-induced oral ulceration and discuss the diagnosis and management of and available literature for the condition, which was treated successfully through conservative measures alone.
Epstein-Barr Virus Infections/complications , Herpesvirus 4, Human , Oral Ulcer/etiology , Adult , Biopsy , Epstein-Barr Virus Infections/diagnosis , Epstein-Barr Virus Infections/pathology , Epstein-Barr Virus Infections/therapy , Female , Humans , Mouth Mucosa/pathology , Mouth Mucosa/virology , Oral Ulcer/diagnosis , Oral Ulcer/therapy , Oral Ulcer/virology
Introducción: La úlcera eosinofílica es una lesión infrecuente y benigna de la mucosa oral, caracterizada por su rápida instauración y evolución crónica. Su localización, predominantemente lingual; su aspecto con fondo necrótico de bordes indurados, y largo período de cicatrización, hacen que sea imprescindible su diagnóstico diferencial con un cáncer oral de células escamosas. Se atribuye su causa a un agente traumático, siendo este ausente en la mitad de los casos. Histológicamente, presenta un denso infiltrado inflamatorio polimorfo, con eosinófilos de tamaño aumentado. Objetivo: Se presenta un caso clínico de úlcera eosinofílica y una revisión bibliográfica actualizada con el objetivo de analizar sus factores etiológicos y sus opciones terapéuticas. Caso clínico: Paciente, mujer de 75 años, con una úlcera en el borde lingual derecho, de 1 cm de diámetro y 4 meses de evolución acompañada de un dolor intenso. En un período de 3 meses, se biopsió dos veces por su recidiva. En ambas biopsias, el estudio anatomopatólogico confirma la presencia de una intensa displasia epitelial, con un denso infiltrado inflamatorio, sin evidencia de un proceso neoplásico. Posteriormente, se trató con la aplicación tópica en gel de acetónido de triamcinolona al 0,5%, con el que la lesión curó en tres meses. Conclusión: La úlcera eosinofílica posee una etiopatogenia indeterminada. El agente traumático, se establece como factor predisponente. La biopsia es la medida principal para el diagnóstico y tratamiento de la lesión. Aunque no queda demostrada la eficacia de la aplicación de corticoides tópicos, suponen una mejoría en la evolución y sintomatología de la lesión. (AU)
Introduction: The eosinophilic ulcer is a rare benign lesion of the oral mucosa. It is known for its rapid onset and chronic course. Due to its main location, the tongue, clinical features and its slowhealing process, a differential diagnosis with oral squamous cell carcinoma is necessary. It is suggested that it is caused by local trauma, yet it is missing in half of the cases. The histopathological findings include dense polymorphic inflammatory infiltrate, with large eosinophils. Objective: We aim to report a case of eosinophilic ulcer and an updated literature review to analyse its etiological factors and treatment options. Case report: We present a case of a 75-year-old woman, with a painful ulcer in the right border of the tongue, which appeared 4 months ago. It had a diameter of 1 cm. In a period of 3 months, it had been biopsied twice, due to its recurrence. Both histological findings confirm the presence of a dense polymorphic inflammatory infiltrate, epithelial dysplasia and no neoplastic evidence. Afterwards, the lesion was treated with topical application of triamcinolone acetonide 0.5% and it healed within 3 months. Conclusion: Eosinophilic ulcer has an undetermined etiopathogenesis. Trauma is considered as a contributing factor. Biopsy is the best approach for diagnosis and treatment. Although with no clear evidence, the application of topical corticosteroids improves lesion development and symptoms. (AU)
Humans , Female , Aged , Oral Ulcer/etiology , Oral Ulcer/therapy , Oral Ulcer/pathology , Mouth Mucosa/injuries , Granuloma
RESUMEN: Las úlceras orales (UO) son uno de los signos de toxicidad por metotrexato (Mtx) aún en pacientes con esquemas de dosis bajas para el control de artritis reumatoide (AR). En estos casos establecer un diagnóstico correlacionando UO con el medicamento puede ser un reto. Presentamos 2 casos clínicos de pacientes con AR en tratamiento con Mtx, las cuales desarrollaron UO. En los dos casos, interesantemente los pacientes fueron evaluados tanto por especialistas del área médica y oral sin tener un resultado satisfactorio después de múltiples tratamientos. Las UO resolvieron posterior a la suspensión del medicamento. Se estableció el diagnóstico de Estomatitis por Metotrexato (EMtx) por un especialista en medicina oral. El manejo multidisciplinario en estos casos es clave para el establecimiento de un diagnóstico y tratamiento oportuno.
ABSTRACT: Oral ulcers (OU) are a sign of methotrexate (Mtx) toxicity, even in patients with rheumatoid arthritis (RA) that are under a low-dose regime. In those cases, establishing a diagnosis correlating OU with the medication can be quite a challenge. Here we present 2 clinical cases of RA patients under Mtx treatment that developed OU. Interestingly, in both cases the patients were evaluated by two specialists in the medical and dentistry area, and following multiple treatments there was no satisfactory result. However, oral ulcers resolved after stopping the treatment. A diagnosis of Metotrexato stomatitis was established (SMtx) by a specialist in oral medicine. Multidisciplinary management in these cases is key for the establishment of an opportune diagnosis and treatment.
Humans , Female , Aged , Stomatitis, Aphthous/diagnosis , Methotrexate/adverse effects , Oral Ulcer/diagnosis , Oral Ulcer/therapy , Arthritis, Rheumatoid , Oral Ulcer/complications , Oral Ulcer/chemically induced , Toxicity
BACKGROUND: Oral ulcers (OU) is a common oral mucosal disease manifested with obvious pain; in some studies, the efficacy of acupuncture in OU has been confirmed, but the systematic reviews and meta-analyses for them are lacking. Our aim is to evaluate the efficacy and safety of acupuncture in the treatment of OU. METHODS: Relevant randomized controlled trials (RCTs), quasi RCTs and non-RCTs will be identified by systematic searching from the following electronic databases: PubMed, Embase, the Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, China Science and Technology Journal database, and Wanfang Data (since inception of the databases to present). In addition, ongoing trials will be retrieved from the Chinese Clinical Trial Register, World Health Organization International Clinical Trials Registry Platform, Clinical Trials, and The Clinical Trials Register. Grey literature will be also taken into consideration, including academic dissertation, minutes of the meeting from Chinese Biomedical Literature Database, China National Knowledge Infrastructure, China Science and Technology Journal database, and Wanfang Data. There are no language restrictions. RESULTS: Ethical approval is not required because this study is based on published papers. After peer-review, the study will be disseminated in scientific journals and conferences. CONCLUSION: This systematic review will provide evidence for the efficacy and safety of acupuncture for Oral ulcers. TRIAL REGISTRATION NUMBER: CRD42020144911.
Acupuncture Therapy , Oral Ulcer/therapy , Acupuncture Therapy/methods , Humans , Treatment Outcome
BACKGROUND: Primary care physicians have been reported to be the first choice for patients with oral ulcerations. This study investigates the health-seeking behaviour of lay public in Galicia (North-western Spain) if experiencing a long-standing oral ulceration. MATERIAL AND METHODS: Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016. RESULTS: A total of 5,727 pedestrians entered the study (response rate: 53%), mostly in the 45-64 age group (30.2%; n = 1,728), 47.7% of them (n = 2,729) were males. Most participants (42.1%; n = 2,411) reported to visit their dentist once a year and had secondary or compulsory education as their highest educational achievement (28.18%, n = 1,614; 28%, n = 1,600 respectively).When questioned what they would do if they had a wound/ulceration lasting longer than 3 weeks, most participants answered they would go to see their primary care physician (62.8%; n = 3,597) and less than one quarter of the sample (23.8%; n = 1,371) would seek consultation with their dentist. CONCLUSIONS: General Galician population would seek professional consultation about a long-standing oral ulceration, relying mostly on primary care physicians. Those neglecting these lesions are elderly, less-schooled people and unaware of oral cancer
Nodisponible
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Oral Ulcer/therapy , Patient Preference/statistics & numerical data , Physicians, Primary Care , Dentists , Cross-Sectional Studies , Surveys and Questionnaires , Sex Factors , Age Factors , Socioeconomic Factors , Spain
Caustic ingestion is a potentially detrimental event that can cause serious devastating damage on contact with tissues. Local exposure is associated with severe pain, swelling and ulceration. Caustics-induced oral ulcers can be painful enough to compromise the patient's quality of life. Treatment of oral ulcers is crucial in clinical practice. Albeit, some ulcers do not respond adequately to the conventional treatment. The current study was conducted to evaluate the potential healing effects of topical Salvadora persica (SP) extract, low-level laser (LLL) and high-level laser (HLL) therapies in a rabbit model of caustic-induced tongue ulcers and explore the underlying mechanisms. Fifty male rabbits with a caustic induced tongue ulcers were included in the study. Rabbits were equally divided into four groups: positive control (ulcer) group, SP, LLL and HLL groups in addition to the negative control (healthy) group. All treatments were given thrice weekly for 14 days. Results showed that acetic acid-induced tongue ulcers caused extensive structural tongue damage secondary to overexpression of apoptotic BAX, pathological angiogenesis indicated by VEGF overexpression, marked collagen fibers deposition as well as upregulation of tissue pro-inflammatory TNF-α and upregulation of tissue anti-inflammatory IL-10. The healing potential of topical SP, LLL and HLL therapy are mostly comparable. In conclusion, acetic acid-induced extensive tongue damage. Topical SP extract, LLL and HLL are equally effective therapies against caustics-induced tongue ulcers. However, we recommend SP extract, owing to its safety, non-invasiveness, availability and low cost.
Caustics/pharmacology , Oral Ulcer/drug therapy , Oral Ulcer/therapy , Plant Extracts/pharmacology , Salvadoraceae/chemistry , Animals , Anti-Inflammatory Agents/pharmacology , Laser Therapy/methods , Male , Oral Ulcer/chemically induced , Quality of Life , Rabbits , Tongue/drug effects , Wound Healing/drug effects
Introduction: The aim of this study was to investigate the effects of a topical mucoadhesive formulation with Curcuma longa L. extract (MFC) on oral wound healing. Methods: Seventy-two Wistar rats were randomly assigned to 3 groups: Control, Vehicle, and MFC. Traumatic ulcers were made on the dorsum of the tongue with a 3-mm diameter punch. Vehicle and MFC groups received application of the products twice a day, while animals in the control group were cared for in identical conditions but received no product application. Six rats in each group were euthanized at days 3, 5, 10, and 14. Percentage of repair was calculated based on wound area. HE-stained histological sections were obtained for semi-quantitative analysis of re-epithelization and inflammation. Results: Clinical findings revealed that at days 3 and 5, animals from the MFC group exhibited a significantly higher percentage of wound repair. At day 5, animals from this group also demonstrated a significant increase in the degree of re-epithelization and inflammation. Conclusions: MFC is capable of accelerating oral wound repair in an in vivo model by modulating the inflammatory process and stimulating epithelial proliferation. (AU)
Animals , Mice , Oral Ulcer/therapy , Curcuma , Phytotherapeutic Drugs , Skin Cream/therapeutic use
Electrospinning provides a simple and convenient method to fabricate nanofibrous meshes. However, the nanofiber productivity is often limited to the laboratory scale, which cannot satisfy the requirements of practical application. In this study, we developed a novel needleless electrospinning spinneret based on a double-ring slit to fabricate drug-loaded nanofibrous meshes. In contrast to the conventional single-needle electrospinning spinneret, our needless spinneret can significantly improve nanofiber productivity due to the simultaneous formation of multiple jets during electrospinning. Curcumin-loaded poly(l-lactic acid) (PLLA) nanofiber meshes with various concentrations and on the large scale were manufactured by employing our developed needleless spinneret-based electrospinning device. We systematically investigated the drug release behaviors, antioxidant properties, anti-inflammatory attributes, and cytotoxicity of the curcumin-loaded PLLA nanofibrous meshes. Furthermore, a bilayer nanofibrous composite mesh was successfully generated by electrospinning curcumin-loaded PLLA solution and diclofenac sodium loaded poly(ethylene oxide) solution in a predetermined time sequence, which revealed potent antibacterial properties. Subsequently, novel mucoadhesive patches were assembled by combining the bilayer composite nanofibrous meshes with (hydroxypropyl)methyl cellulose based mucoadhesive film. The multilayered mucoadhesive patch has excellent adhesion properties on the porcine buccal mucosa. Overall, our double-ring slit spinneret can provide a novel method to rapidly produce large-scale drug-loaded nanofibrous meshes to fabricate mucoadhesive patches. The multiple-layered mucoadhesive patches enable the incorporation of multiple drugs with different targets of action, such as analgesic, anti-inflammatory, and antimicrobial compounds, for mouth ulcer or other oral disease treatments.
Adhesives , Curcumin , Hypromellose Derivatives , Nanofibers/chemistry , Oral Ulcer/therapy , Adhesives/chemistry , Adhesives/pharmacology , Animals , Curcumin/chemistry , Curcumin/pharmacology , Humans , Hypromellose Derivatives/chemistry , Hypromellose Derivatives/pharmacology , Mouth Mucosa/metabolism , Mouth Mucosa/pathology , Oral Ulcer/metabolism , Oral Ulcer/pathology , Swine
A 39-year-old woman sought specialized treatment complaining of a large, painful oral ulcer in the right buccal vestibule after receiving emergency endodontic treatment 3 days earlier. The patient reported that the tooth, the mandibular right first premolar, was not isolated with a rubber dam and that she felt the extrusion of a liquid in the buccal tissues. Clinically, a necrotic area with raised erythematous borders was observed in the mandibular right side. The clinical diagnosis was a chemically induced ulcer caused by a sodium hypochlorite accident. Dexamethasone and amoxicillin were prescribed to control pain and prevent secondary infection. The large size of the lesion was an indication for application of low-level laser therapy (LLLT), which was delivered at a wavelength of 685 nm (output power, 30 mW; power density, 0.5 mW/cm2 ; energy density, 6 J/cm2 ) every 2 days for a total of 6 sessions. The LLLT was applied to the necrotic area with a punctual mode (2 points) for 12 seconds per point. The patient reported a substantial reduction in pain after the second application, and the wound was completely healed after 6 sessions. The results observed in this patient suggest that LLLT could aid patients in recovering from NaOCl-related lesions.
Low-Level Light Therapy , Oral Ulcer , Sodium Hypochlorite/adverse effects , Accidents , Adult , Bicuspid , Female , Humans , Oral Ulcer/etiology , Oral Ulcer/therapy
BACKGROUND: There is no mainstay protocol for management of Methotrexate-induced oral ulcers; commonly used protocols are cessation of Methotrexate, folic acid treatment, corticosteroids or combination. A new era of oral ulcers management is represented by platelet concentrates. The current study assessed the effect of topical human platelet lysate compared to topical Clobetasol Propionate in management of methotrexate-induced oral ulceration in rheumatoid arthritis patients. METHODS: This randomized controlled clinical trial include 30 patients in two parallel groups (intervention - human platelet lysate, control - Clobetasol Propionate), with allocation ratio 1:1. Outcome measures were pain intensity using numerical rating scale, WHO scale for oral mucositis, measuring size of the largest ulcer and total number of oral ulcers. RESULTS: A statistically significant difference was detected between HPL and Clobetasol groups on comparing numerical rating scale, WHO mucositis scale, size and total number of oral ulcers throughout all visits. A considerable quick pain reduction and clinical improvement were noticed in HPL group compared to Clobetasol. CONCLUSION: Human platelet lysate has superior effect when compared to one of the most potent topical corticosteroids, Clobetasol Propionate, in reducing pain and clinical signs of Methotrexate-induced oral ulcers in patients with rheumatoid arthritis.
Antirheumatic Agents/adverse effects , Blood Platelets , Methotrexate/adverse effects , Oral Ulcer/chemically induced , Oral Ulcer/therapy , Administration, Topical , Adult , Arthritis, Rheumatoid/drug therapy , Clobetasol/therapeutic use , Glucocorticoids/therapeutic use , Humans , Middle Aged
We sought to examine the management and referral of nonhealing mouth ulcer presentations in Australian community pharmacies in the Greater Brisbane region. Trained simulated patients visited 220 randomly selected community pharmacies within the Greater Brisbane region in 2016. Simulated patients enacted two nonhealing (>1 month) mouth ulcer scenarios: A direct product request (DPR) (n = 110) and a symptom-based request (SBR) (n = 110). Results were documented and evaluated against Australian national pharmacy practice standards. Referral rates for pharmacy staff (pharmacist, pharmacy assistant or mixed-pharmacist and assistant) were also assessed. Australian pharmacy practice standards recommend staff ask six key questions during SBR and DPR consultations to enable informed decision-making. Two questions relating to identifying the patient and their symptoms were asked in the majority of interactions (76% and 69% respectively); the remaining four questions relating to symptom duration, treatments tried, other medications, and medical conditions were enquired in only 32%, 53%, 31%, and 27% of interactions, respectively. Simulated patients were referred to the doctor/dentist in only 11.8% of all interactions (both scenarios requiring referral). Overall, staff handling of nonhealing mouth ulcer consultations was suboptimal compared to national professional standards. In particular, duration of the nonhealing mouth ulcer was enquired in less than one-third of consultations potentially resulting in low referral rates by staff. This study identifies the need for increased oral cancer awareness and education for community pharmacy staff and reinforcing the importance of practising according to professional standards to effectively screen for potentially cancerous nonhealing mouth lesions.
Community Pharmacy Services/organization & administration , Oral Ulcer/therapy , Patient Simulation , Pharmacists/standards , Australia , Female , Humans , Male , Mouth Neoplasms/prevention & control , Patient Acceptance of Health Care/statistics & numerical data , Patient Education as Topic , Pharmacies
The current use of steroids or pharmacological immunomodulators for the treatment of intractable oral ulceration is ineffective, necessitating newer cell-based therapeutic approaches. We examined the potential efficacy of an oral mucosa equivalent developed in this study in an in vivo model of repeat major oral ulceration mimicking the intractable oral ulceration observed clinically. Oral mucosal samples and plasma fibrin were obtained from Sprague-Dawley rats. The oral mucosa equivalents were prepared with cultured mucosal keratinocytes and plasma fibrin mixed with cultured fibroblasts. Ulcers were chemically induced on the rat buccal mucosa thrice in 3 weeks and covered with or without mucosa equivalents. Gross and microscopic findings and mRNA expression levels were compared between the ulcer control and mucosa equivalent groups. Oral mucosal keratinocytes and fibroblasts were cultured in vitro to achieve high viability and colony-forming efficiency. The equivalents showed epithelial and subepithelial structures similar to those of oral mucosa and exhibited high p63 positivity. In the in vivo study, ulceration was resolved earlier without significant granulation or scarring in the equivalent group than in control group (p < 0.05). Microscopic examinations revealed rapid re-epithelialization and less fibrosis in the equivalent group than in the control group (p < 0.05). Mucosa equivalent-covered ulcers showed histological characteristics similar to those of the normal buccal mucosa and exhibited lower expression of TGFB1, ACTA2, and FN1 mRNAs than the control group. The in vitro-engineered oral mucosa equivalent promotes ulcer healing without scarring and functional deficits. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1779-1785, 2019.
Mouth Mucosa/metabolism , Oral Ulcer/metabolism , Oral Ulcer/therapy , Wound Healing , Animals , Fibrin/pharmacology , Fibroblasts/metabolism , Fibroblasts/pathology , Keratinocytes/metabolism , Keratinocytes/pathology , Male , Mouth Mucosa/pathology , Oral Ulcer/pathology , Rats , Rats, Sprague-Dawley
Introducción: Las úlceras de la mucosa oral son comunes en los pacientes con ventilación artificial mecánica. Objetivo: Determinar la utilidad del Oleozón® tópico en el tratamiento de las úlceras de la mu cosa oral en pacientes tratados con ventilación artificial mecánica en la Unidad de Cuidados Intensivos (UCI) del Hospital General Docente Dr Agostinho Neto. Método: Se realizó un estudio tipo caso-control durante enero-julio de 2018. El universo lo conformaron 70 pacientes, de los que se seleccionó una muestra aleatoria y se agruparon en un grupo control (n=20) que se les realizó limpieza de la cavidad bucal con solución salina fisiológica 0,9 por ciento y un grupo estudio (n=20) que se les realizó cura de la úlcera con Oleozón® tópico. Se analizó la localización, área, forma de presentación y magnitud de la úlcera y la evolución clínica de acuerdo al tratamiento que se aplicó. Resultados: La evolución satisfactoria de este tipo de úlcera se precisó en el 40,0 por ciento de los pacientes que conformaron el grupo control y el 90,0 por ciento de los que integraron el grupo estudio (p < 0,01). En este último grupo la ventana entre el inicio del tratamiento y control de la úlcera oral fue de 4,5 ± 1,1 días y para el primero fue 8,1 ± 2,7 días (p < 0,01). Conclusión: Se revela la conveniencia de la aplicación de Oleozón® tópico al tratamiento de las úlceras de la mucosa oral que se presentan en los pacientes tratados con ventilación artificial mecánica(AU)
Introduction: Ulcers of the oral mucosa are common in patients with mechanical artificial ventilation. Objective: To determine the usefulness of topical Oleozón® in the treatment of oral mucosal ulcers in patients treated with mechanical artificial ventilation in the Intensive Care Unit (ICU) of the General Teaching Hospital "Dr. Agostinho Neto". Method: A case-control study was carried out during January-July 2018. The universe was made up of 70 patients, from which a random sample was selected and grouped in a control group (n=20) who were cleaned the oral cavity with 0.9per cent physiological saline solution and a study group (n=20) who were cured of the ulcer with topical Oleozón®. The location, area, form of presentation and magnitude of the ulcer and the clinical evolution were analyzed according to the treatment that was applied. Results: The satisfactory evolution of this type of ulcer was required in 40.0por cento of the patients that formed the control group and 90.0per cent of those who made up the study group (p<0.01). In this last group, the window between the start of treatment and control of the oral ulcer was 4.5 ± 1.1 days and for the first one it was 8.1 ± 2.7 days (p<0.01). Conclusion: The convenience of the application of topical Oleozón® to the treatment of oral mucosal ulcers that occur in patients treated with mechanical artificial ventilation is revealed(AU)
Introdução: Úlceras da mucosa oral são comuns em pacientes com ventilação artificial mecânica. Objetivo: Determinar a utilidade do Oleozón® tópico no tratamento de úlceras na mucosa oral em pacientes tratados com ventilação artificial mecânica na Unidade de Terapia Intensiva (UTI) do Hospital Geral de Ensino "Dr. Agostinho Neto". Método: Foi realizado um estudo de caso-controle no período de janeiro a julho de 2018. O universo foi constituído por 70 pacientes, dos quais uma amostra aleatória foi selecionada e agrupada em um grupo controle (n=20) que foi limpo de cavidade oral com solução salina fisiológica a 0,9por cento e um grupo de estudo (n=20) curado da úlcera com Oleozón® tópico. A localização, área, forma de apresentação e magnitude da úlcera e a evolução clínica foram analisadas de acordo com o tratamento aplicado. Resultados: A evolução satisfatória desse tipo de úlcera foi necessária em 40,0por cento dos pacientes que formaram o grupo controle e em 90,0por cento daqueles que fizeram parte do grupo de estudo (p<0,01). Neste último grupo, a janela entre o início do tratamento e o controle da úlcera oral foi de 4,5 ± 1,1 dias e no primeiro foi de 8,1 ± 2,7 dias (p<0,01). Conclusão: É revelada a conveniência da aplicação tópica de Oleozón® no tratamento de úlceras na mucosa bucal que ocorrem em pacientes tratados com ventilação artificial mecânica(AU)
Humans , Ozone/therapeutic use , Respiration, Artificial/adverse effects , Oral Ulcer/drug therapy , Oral Ulcer/therapy , Intensive Care Units
Ulcerations and erosions of the oral mucosa are common and occur at any age. Their knowledge and recognition are essential to ensure optimal care at the earliest stage. Etiologies are numerous and the subject of different classifications. In this work, the authors address the most frequently encountered lesions, describing their main clinical presentations. A review of treatments is then proposed.
Les ulcérations et érosions de la muqueuse buccale sont fréquentes et surviennent à tout âge. Leurs connaissance et reconnaissance sont essentielles afin d'assurer une prise en charge optimale et la plus précoce possible. Les étiologies sont très nombreuses et font l'objet de différentes classifications. Dans ce travail, les auteurs abordent les lésions les plus fréquemment rencontrées, en décrivant leurs principales présentations cliniques. Une revue des traitements est ensuite proposée.
Oral Ulcer , Humans , Mouth Mucosa , Oral Ulcer/diagnosis , Oral Ulcer/etiology , Oral Ulcer/therapy
