Salivary proteins offer insights into keratinocyte death during aphthous stomatitis. A case-crossover study.

BACKGROUND: The death of oral keratinocytes is a crucial step in the emergence of recurrent aphthous stomatitis (RAS, also known as aphthae or aphthous ulcers). Since there are no experimental models available to research aphthous ulcers, little is understood about this process. We hypothesize that saliva can be a data bank of information that offers insights on epithelial damage. METHODS: In this case-crossover study, we assessed the salivary proteome of patients with RAS (n = 36) in the presence and absence of ulcers using discovery proteomics and bioinformatics. Additionally, we contrasted these patterns with those of healthy individuals (n = 31) who had no prior aphthous ulceration. RESULTS: Salivary proteome showed that during the ulcerative phase, controlled cell death was downregulated. Due to its ability to distinguish between individuals with and without ulcers, the ATF6B protein raises the possibility that endoplasmic reticulum (ER) stress is responsible for the damage that leads to the death of oral keratinocytes. The high abundance of TRAP1 and ERN1 matches with this biological discovery. The type of death is immunogenic, according to the functional data found in a cell death database. CONCLUSION: We identified a cellular process that can lead to the death of oral keratinocytes in the etiopathogenesis process of RAS. Future studies should be conducted to identify what is responsible for the increase in ER stress signaling that would lead to an anti-cell death response.

Healing of Recurrent Aphthous Stomatitis by Non-Thermal Plasma: Pilot Study.

Recurrent aphthous stomatitis (RAS) is a common disease in the oral cavity characterized by recurrent ulcers (RU). Usually, these cause acute pain without definitive treatment. The present study determines the efficacy of non-thermal plasma (NTP) for treating RU. NTP is applied to the patient's RU using a radiofrequency generator connected to a point reactor. The power density applied to the ulcer is 0.50 W/cm2, less than 4 W/cm2, which is the maximum value without biological risk. Each patient received two treatments of three minutes each and spaced 60 min apart at a distance of 5 mm from the RU. From a sample of 30 ulcers in patients treated for RU with an average age of 37 years, they stated that the pain decreased considerably and without the need for ingestion of analgesics and antibiotics. Regeneration took place in an average of three days. The NTP proved to be an excellent therapeutic alternative for the treatment of RU since it has a rapid effect of reducing pain and inflammation, as well as adequate tissue regeneration.

Systemic immune inflammation index in patients with recurrent aphthous stomatitis / Índice de inflamação imune sistêmica em pacientes com estomatite aftosa recorrente

Abstract Objectives: Recurrent Aphthous Stomatitis (RAS) a chronic idiopathic oral mucosal disease. But yet the etiology and pathogenesis of RAS are not exactly known, it is thought that inflammation play an important role in the pathogenesis. The aim of this study is to demonstrate the role of systemic inflammation among the possible etiological factors of RAS and to find the possible diagnostic correlation between Systemic Immune Inflammation Index (SII). Methods: Patients who were consulted the otolaryngology outpatient clinic and diagnosed with RAS between 2019-2021 were retrospectively analyzed. Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR) and SII values were calculated based on the results of complete blood count. Demographic and hematological parameters between control and RAS groups were compared. The statistical significance level was considered as <0.05. Results: There was no statistically significant difference between the control and RAS groups in terms of sex and age distributions (p = 0.566 and p = 0.173, respectively). SII, NLR and PLR values were significantly higher in the RAS group compared to the controls (p < 0.001, p < 0.001 and p = 0.001, respectively). A very strong correlation between SII and NLR, moderately strong correlation between SII and PLR and moderate correlation between NLR and PLR values were detected (respectively ρ: 0.813, 0.719, 0.532; p-values <0.001). Conclusion: SII, NLR and PLR has significantly higher levels in the RAS group compared to the control group, that it supports the role of systemic inflammation in the etiopathogenesis of RAS. In addition, the results show that SII is a valuable marker for inflammation. Level of evidence: 4. HIGHLIGHTS RAS is a chronic, idiopathic, ulcerative oral mucosal disease. SII is a new and inexpensive biomarker that can easily be calculated using the platelet, neutrophil, and lymphocyte count. SII may be a valuable marker to demonstrate the role of systemic inflammation in RAS etiopathogenesis. Vascular, thrombotic, and inflammatory processes are thought to have a role in RAS activation.

Resumo Objetivo: A estomatite aftosa recorrente (EAR) é uma doença crônica idiopática da mucosa oral. Embora sua etiologia e patogênese não sejam totalmente conhecidas, acredita-se que a inflamação possa desempenhar um papel importante. O objetivo deste estudo é demonstrar o papel da inflamação sistêmica entre os possíveis fatores etiológicos da estomatite aftosa recorrente e encontrar uma possível correlação diagnóstica com o índice de inflamação imunológica sistêmica, SII. Método: Foram analisados retrospectivamente pacientes avaliados no ambulatório de otorrinolaringologia e diagnosticados com estomatite aftosa recorrente entre 2019-2021. A relação neutrófilos/linfócitos, a relação plaquetas/linfócitos e os valores de SII foram calculados com base nos resultados do hemograma completo. Parâmetros demográficos e hematológicos dos grupos controle e de pacientes foram comparados. O nível de significância estatística foi considerado como <0,05. Resultados: Não houve diferença estatisticamente significante entre os grupos controle e com estomatite aftosa recorrente quanto à distribuição por sexo e idade (p = 0,566 e p = 0,173, respectivamente). Os valores de SII, a relação neutrófilos/linfócitos e a relação plaquetas/linfócitos foram significantemente maiores no grupo de pacientes em relação aos controles (p <0,001, p <0,001 e p = 0,001, respectivamente). Foi detectada uma correlação muito forte entre SII e relação neutrófilos/linfócitos, uma correlação moderadamente forte entre SII e relação plaquetas/linfócitos e uma correlação moderada entre valores da relação neutrófilos/linfócitos e relação plaquetas /linfócitos (ρ: 0,813, 0,719, 0,532 respectivamente; p-valores <0,001). Conclusão: SII, relação neutrófilos/linfócitos e relação plaquetas/linfócitos apresentam níveis significantemente maiores no grupo com estomatite aftosa recorrente quando comparados ao grupo controle, o que corrobora o papel da inflamação sistêmica na sua etiopatogênese. Além disso, os resultados mostram que o SII é um marcador inflamatório valioso. Nível de evidência: 4. HIGHLIGHTS A estomatite aftosa recorrente é uma doença ulcerativa crônica idiopática da mucosa oral. O SII (do inglês Systemic Immune Inflammation Index) é um biomarcador novo e de baixo custo que pode ser facilmente calculado que usa a contagem de plaquetas, neutrófilos e linfócitos. O SII pode ser um marcador valioso para demonstrar o papel da inflamação sistêmica na etiopatogênese da estomatite aftosa recorrente. Acredita-se que processos vasculares, trombóticos e inflamatórios tenham um papel na ativação da estomatite aftosa recorrente.

Systemic immune inflammation index in patients with recurrent aphthous stomatitis.

OBJECTIVES: Recurrent Aphthous Stomatitis (RAS) a chronic idiopathic oral mucosal disease. But yet the etiology and pathogenesis of RAS are not exactly known, it is thought that inflammation play an important role in the pathogenesis. The aim of this study is to demonstrate the role of systemic inflammation among the possible etiological factors of RAS and to find the possible diagnostic correlation between Systemic Immune Inflammation Index (SII). METHODS: Patients who were consulted the otolaryngology outpatient clinic and diagnosed with RAS between 2019-2021 were retrospectively analyzed. Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR) and SII values were calculated based on the results of complete blood count. Demographic and hematological parameters between control and RAS groups were compared. The statistical significance level was considered as <0.05. RESULTS: There was no statistically significant difference between the control and RAS groups in terms of sex and age distributions (p = 0.566 and p = 0.173, respectively). SII, NLR and PLR values were significantly higher in the RAS group compared to the controls (p < 0.001, p < 0.001 and p = 0.001, respectively). A very strong correlation between SII and NLR, moderately strong correlation between SII and PLR and moderate correlation between NLR and PLR values were detected (respectively ρ: 0.813, 0.719, 0.532; p-values <0.001). CONCLUSION: SII, NLR and PLR has significantly higher levels in the RAS group compared to the control group, that it supports the role of systemic inflammation in the etiopathogenesis of RAS. In addition, the results show that SII is a valuable marker for inflammation.

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.

Effect of Dentoxol® in the treatment of recurrent mild aphthous ulcers. A prospective observational pilot study

ABSTRACT: Background: Recurrent aphthous stomatitis (RAS) is the most common oral ulceration. Its prevalence in the general population varies between 5% and 60%, and during the acute period, it causes pain and interferes with basic activities, such as eating, swallowing and talking. Dentoxol® is a medical mouthrinse that cleans, moisturizes and lubricates the mouth, mechanically stimulating local epithelial regeneration. The aim of this study was to evaluate the efficacy of Dentoxol® in improving the general state of patient with minor RAS using two different treatment schemes. Material and methods: Thirty-nine patients with RAS were recruited in a prospective observational pilot study. Two dosing regimens, 5 ml of Dentoxol® twice daily and 5 ml of Dentoxol® three times daily were evaluated. Results: Efficacy to improve the general state was significant superior in "Three time daily" group compared with "twice daily" at 72 h (66% vs 33% respectively). No pain was reported in approximately 90% of cases at 96 h of use in both group without significant differences between the groups in any evaluation time-point. Conclusion: Despite the limitations of these preliminary data, Dentoxol® shows promising beneficial properties for the management of minor RAS.

Eficacia clínica del extracto de Matico (Piper angustifolium) en la evolución de la cicatrización de heridas por estomatitis aftosa recidivante / Clinical efficacy of Matico extract (Piper angustifolium) in the evolution of wound healing due to recurrent aphthous stomatitis

La estomatitis aftosa recurrente (EAR) es un trastorno ulcerativo doloroso cíclico que comúnmente afecta la mucosa oral. Factores locales y sistémicos como trauma, sensibilidad alimentaria, deficiencias nutricionales, condiciones sistémicas y desórdenes inmunológicos están asociados con el desarrollo de la enfermedad. Debido a las similitudes en las características de las úlceras pépticas y las úlceras aftosas orales, parece razonable suponer que Helicobacter pylori podría desempeñar un papel en el desarrollo de la EAR. Las especies de Piper son plantas aromáticas que se utilizan como especias en la cocina, pero sus metabolitos secundarios también han mostrado efectos biológicos sobre la salud humana. El objetivo del presente estudio fue determinar la relación entre H. pylori y EAR y el efecto cicatrizante del extracto Matico sobre las ulceras bucales. Se reclutó a cuarenta sujetos con EAR. Los participantes fueron asignados al azar al grupo de prueba o al grupo de control. El tamaño y número de las úlceras se registraron el día 1 (valor inicial) y el día 30 (valor final). El tamaño de la ulceras, presencia de pseudomembranas y halos eritematosos fueron estadisticamente significativas en relación a la positividad de H. pylori (p <0,05). No hubo diferencias significativas entre la morfología, número y localización de las aftas (p> 0,05). El grupo que recibió el extracto tuvo un porcentaje de mejoría en la reducción del número de aftas del 65% el día final de evaluación en comparación de sólo un 25% del grupo que no recibió el extracto Matico(AU)

Recurrent aphthous stomatitis (RAS) is a cyclic painful ulcerative disorder that commonly affects the oral mucosa. Local and systemic factors such as trauma, food sensitivity, nutritional deficiencies, systemic conditions, immunological disorders and genetic polymorphisms are associated with the development of the disease. Because of similarities in the characteristics of peptic ulcers and oral aphthous ulcers, it seems reasonable to hypothesize that Helicobacter pylori could play a role in the development of RAS. Piper species are aromatic plants used as spices in the kitchen, but their secondary metabolites have also shown biological effects on human health. The aim of the present study was to determine the relationship between H. pylori and RAS and the healing effect of Matico extract on mouth ulcers. Fuorty subjects with RAS were recruited. The participants were randomly allocated to the test group or the control group. The size and number of ulcers were recorded on day 1 (initial value) and day 30 (final value). The size of the ulcers, the presence of pseudomembranes and erythematous halos were statistically significant in relation to the positivity of H. pylori (p <0.05). There were no significant differences between the morphology, number and location of the canker sores (p> 0.05). The group that received the extract had a percentage improvement in the reduction of the number of canker sores of 65% on the final day of evaluation compared to only 25% of the group that did not receive the Matico extract(AU)

Manifestaciones bucales de la enfermedad celíaca y alergia al trigo: Reporte de tres casos y revisión literatura / Oral Manifestations of Celiac Disease and Wheat Allergy: Report of Three Cases and Review of Literature

Resumen: La Enfermedad Celíaca (EC) es una enfermedad sistémica inmunomediada, provocada por el gluten y prolaminas relacionadas, en individuos genéticamente susceptibles. Se caracteriza por manifestaciones clínicas dependientes del gluten, anticuerpos específicos de EC, haplotipos HLA DQ2 o DQ8 y enteropatía. La mayoría de los pacientes son asintomáticos o con manifestaciones leves. Afecta principalmente el sistema gastrointestinal causando síntomas y signos como diarrea, dolor abdominal recurrente y distensión abdominal; además manifestaciones extradigestivas. Los pacientes con EC pueden tener manifestaciones bucales que incluyen estomatitis aftosa recurrente (EAR), hipoplasia del esmalte, glositis atrófica, entre otras. El diagnóstico de EC se basa en la historia clínica, serología, endoscopía e histología. Existen otras entidades que deben diferenciarse de la EC, como la sensibilidad al gluten no celíaca y la alergia al trigo. El objetivo de este trabajo es presentar tres pacientes con antecedentes de EAR y otras manifestaciones clínicas asociadas al diagnóstico precoz de EC y alergia alimentaria.

Abastract: Celiac Disease (CD) is an immune-mediated systemic disease, caused by gluten and related prolamins, in genetically susceptible individuals. It is characterized by gluten-dependent clinical manifestations, CD-specific antibodies, HLA DQ2 or DQ8 haplotypes, and enteropathy. Most patients are asymptomatic or with mild manifestations. It mainly affects the gastrointestinal system causing symptoms and signs such as diarrhea, recurrent abdominal pain and abdominal distension; also extradigestive manifestations. Patients with CD may have oral manifestations that include recurrent aphthous stomatitis (RAS), enamel hypoplasia, atrophic glossitis, among others. The diagnosis of CD is based on clinical history, serology, endoscopy and histology. There are other entities that should be differentiated from CD, such as non-celiac gluten sensitivity and wheat allergy. The aim of this study is to present three patients with a history of RAS and other clinical manifestations associated with the early diagnosis of CD and food allergy.

Impacto de enfermedades orales asociadas a estrés sobre la calidad de vida / Impact on Quality of Life of Oral Diseases Related to Stress

Resumen: Se ha sugerido que enfermedades de la mucosa oral asociadas a estrés impactan negativamente la calidad de vida. Sin embargo, la información no es concluyente. El objetivo fue comparar la calidad de vida asociada a salud bucal en dos grupos: Casos (21 pacientes de una clínica de enseñanza de medicina bucal con diagnóstico de liquen plano oral, estomatitis aftosa recurrente y síndrome de boca dolorosa; Control (42 sujetos sanos) pareados por edad y género. Se aplicó el cuestionario perfil de impacto de salud oral. Resultados: El análisis estadístico mostró que el grupo casos tiene peor calidad de vida (p 0.03) comparado con el de los controles, específicamente en las dimensiones incomodidad psicológica (p 0.027); inhabilidad física (p 0.004); e incapacidad (p 0.002; RM 5.63 IC 1.58-20.80). Se concluye que los sujetos que padecen enfermedades de la mucosa oral relacionada a estrés tienen mala calidad de vida.

Abstract: It has been suggested that oral mucosa diseases related to stress have a negative impact on the quality of life. However, the information regarding which aspects are the most affected is inconclusive. The objective was to compare the quality of life associated with oral health in two groups: Cases formed by 21 patients coming from a teaching clinic, suffering oral lichen planus, recurrent aphthous stomatitis, and burning mouth syndrome; Control formed by 42 healthy subjects matched for age and gender. Oral Health Impact Profile questionnaire was applied. Statistical analysis showed that group Cases has worse quality of life (p 0.03) than the one of controls, specifically on psychological discomfort (p 0.027), physical disability (p 0.004); and handicap dimensions (p 0.002; RM 5.63 IC1.58-20.80). It was concluded that patients suffering oral mucosa disease related to stress showed poor quality of life.

Estomatitis aftosa recurrente y deficiencias nutricionales: Reporte de tres casos y revisión de literatura / Recurrent Aphthous Stomatitis and Nutritional Deficiencies: Report of Three Cases with Literature Review

RESUMEN Introducción: La estomatitis aftosa recurrente (EAR) es la enfermedad ulcerativa más común que afecta la mucosa oral no queratinizada. La etiología aún se desconoce, pero se han propuesto varios factores locales y sistémicos como agentes causales. Descripción del caso: se informa tres pacientes con presencia de EAR asociada a deficiencias nutricionales, debidas a dietas de restricción alimentaria. El primer caso, una mujer de 19 años con deficiencia de hierro, refirió tomar té verde a diario y consumir poca cantidad de carbohidratos, grasas y carne. El segundo caso, un hombre de 32 años con deficiencia de hierro y vitamina B12 asociada a dieta tipo vegana, aunque a veces si consumía carne. El tercer caso, hombre de 50 años, vegano y exfumador desde hace un año, presentó deficiencia de hierro, vitamina B12 y ácido fólico. En los tres casos un detallado interrogatorio, examen clínico y análisis sanguíneo completo, permitió establecer un adecuado diagnóstico, manejo odontológico y derivación con un nutricionista, con el fin de tratar la patología de base y no sólo brindarles un tratamiento sintomático de las lesiones. Discusión: Ante un cuadro de EAR es recomendable realizar un análisis que incluya hemograma, ácido fólico, hierro y vitamina B12, para descartar posibles causas sistémicas y eventualmente tratarlas. El manejo clínico tiene como objetivo mejorar la función del paciente y la calidad de vida mediante terapias tópicas y sistémicas; sin embargo, es fundamental identificar y controlar los factores causales que contribuyen; así como, la exclusión o tratamiento de la enfermedad sistémica subyacente.

ABSTRACT Introduction: Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects the non-keratinized oral mucosa. The etiology is still unknown, but several local and systemic factors have been proposed as causal agents. Case description: three patients are reported with RAS associated with nutritional deficiencies, due to dietary restriction diets. The first case, a 19-year- old woman with iron deficiency, reported taking green tea daily and consuming a small amount of carbohydrates, fats and meat. The second case, a 32-year-old man with iron deficiency and vitamin B12 associated with vegan diet, although sometimes if he consumed meat. The third case, man of 50 years, vegan and ex-smoker for a year, presented deficiency of iron, vitamin B12 and folic acid. In all three cases a detailed questioning, clinical examination and complete blood analysis allowed to establish an adequate diagnosis, dental management and referral with a nutritionist, in order to treat the underlying pathology and not only provide a symptomatic treatment of the injuries. Discussion: In the setting of RAS, it is advisable to perform an analysis that includes a blood count, folic acid, iron and vitamin B12, to rule out possible systemic causes and eventually treat them. Clinical management aims to improve patient function and quality of life through topical and systemic therapies; however, it is essential to identify and control the causal factors that contribute; as well as, the exclusion or treatment of the underlying systemic disease.

La efectividad de la crema Calendula officinalis L como tratamiento de la estomatitis aftosa recurrente / Calendula officinalis L cream effective treatment for recurrent aphthous stomatitis

RESUMEN Introducción: la estomatitis aftosa recurrente es una enfermedad habitual en las urgencias de Periodontología. Objetivo: evaluar la efectividad de la crema de Calendula officinalis L. al 10%, en el tratamiento de la estomatitis aftosa recurrente, en una clínica estomatológica. Método: se realizó un ensayo no controlado- no aleatorizado, en una población de 15 a 34 años de edad; que acudieron a la consulta de periodoncia de la Clínica Estomatológica Docente "Manuel Angulo Farrán" en Holguín, Cuba, en el período comprendido del año 2015 al 2017. La muestra fue de 100 pacientes, tratada durante 6 días, con consultas cada 48 horas. Resultados: el 59% de los pacientes fueron del sexo femenino, el 63% entre los 25 y 34 años, y en el 97% predominaron las aftas menores. La crema en estudio mejoró los síntomas en el 97% de los pacientes, y el 94% se curó. Conclusiones: la crema de Calendula officinalis L al 10% parece eficaz en el tratamiento de la estomatitis aftosa recurrente, aunque se requieren ensayos clínicos controlados y aleatorizados que lo demuestren de forma definitiva.

ABSTRACT Introduction: recurrent aphthous stomatitis is a frequent disease in periodontology emergencies. Objective: to evaluate the Calendula officinalis L at 10% cream effectiveness, as treatment for recurrent aphthous stomatitis, in a stomatological clinic. Method: non-control, non-randomized trial was conducted in a population between 15 and 34 years old, who attended "Manuel Angulo Farrán" Stomatological Teaching Clinic in Holguín, Cuba, from 2015 to 2017. Sample was 100 patients, treated in consultations every 48 hours, for 6 days. Results: the 59% of the patients were female, 63% between 25 to 34 years, and minor aphthae predominated in the 97%. The studied cream improved symptoms in 97% of patients and 94% were completely cured. Conclusions: Calendula officinalis L at 10% cream seems effective in the treatment of recurrent aphthous stomatitis, although controlled and randomized clinical trials would definitively demonstrate it.

Eficacia del láser en el tratamiento de la estomatitis aftosa recurrente / Laser effectiveness for recurrent aphthous stomatitis treatment

RESUMEN La estomatitis aftosa recurrente es una enfermedad inflamatoria crónica. Se caracteriza por lesiones aftosas en la mucosa bucal. Para su tratamiento, se han introducido variadas terapéuticas como la terapia láser; un método sencillo, indoloro, no invasivo y cada vez más aceptado por los pacientes. Se presenta una paciente de 37 años de edad, atendida en la consulta estomatológica del Hospital Clínico-Quirúrgico Docente "Celia Sánchez Manduley", de Manzanillo, Granma; con aftas bucales de pequeño tamaño, de forma redondeada y bien delimitadas en la mucosa interna del labio inferior y en el surco vestibular a nivel de incisivos inferiores. Se comprueba la eficacia del láser en el tratamiento de la estomatitis aftosa recurrente; para brindar al paciente un estado general satisfactorio, contribuir a su mejoría definitiva en un período de 5 días en aftas menores y mejorar la calidad de vida de los pacientes durante su curación.

ABSTRACT Recurrent aphthous stomatitis is a chronic inflammatory disease characterized by aphthous lesions in the buccal mucosa. Various therapeutic methods like laser therapy have been recently introduced. This is a simple, painless, non-invasive method very much accepted by patients. We present a 37-year-old woman with small mouth sores, rounded and well-defined on the internal mucosa of the lower lip and in vestibular groove at the level of lower incisors, attended at the Stomatological Clinic of "Celia Sánchez Manduley" Clinical Surgical Teaching Hospital of Manzanillo, Granma. The effectiveness of laser in the recurrent aphthous stomatitis treatment was verified, to obtain a satisfactory general patient´s state and a 5 days effective improvement in minor aphthae, considering patients´ life quality during healing period.

Comparison of therapeutic effect of mucoadhesive Nanotriamcinolone gel and conventional triamcinolone gel on recurrent aphthous stomatitis / Comparação do efeito terapêutico do gel mucoadesivo de nano-triancinolona e do gel convencional de triancinolona na estomatite aftosa recorrente

Objective: Recurrent aphthous stomatitis (RAS) is characterized by recurring ulcers, with well-defined margins. The lesions are confined to the oral mucosa (usually seen in non-keratinized mucosa). The disease manifests in the form of outbreaks, with a chronic and self-limiting course in most cases. Since the cause of the disease is unknown, many drugs have been studied to palliate the symptoms. Treatment used is multifocal and varies according to the predisposing factors. The aim of this study was to investigate the effect of recombinant Nano-based triamcinolone acetonide gel and compare it with conventional triamcinolone gel on RAS. Material and methods: In this triple-blind randomized clinical trial study, sixty patients with minor aphthous lesions were divided into two groups receiving conventional triamcinolone (CT) and Nano-based triamcinolone (NT). The patients were requested to apply drug four times a day for a week. The severity of pain (through VAS) and the size of the lesions (mean of the largest diameter of the lesions) were evaluated on starting day and days 2, 4, 6 after the intervention. Statistical analysis was performed using chi square and independent t-test. Findings were significant with P < 0.05. Results: Of the 60 patients enrolled in the study, 5 patients did not continue; 21 (38.2%) cases were female and 34 (61.8%) cases were male (P=0.6). The severity of pain in NT group before and after the study was 1.4 ± 5.2 and 1.8 ± 1.3 cm, respectively and in CT group was 48.1 ± 1 and 1.8 ± 1.3 cm. The size of the lesions in NT group before and at the end of the study was 0.96 ± 0.1 and 0.18 ± 0.1 cm, respectively and in CT group was 0.93 ± 0.1 and 0.19 ± 0.1 cm. Among the mentioned variables, only size of lesions on the 2nd and 4th days had a significant reduction in NT group in comparison with CT group. Conclusion: The size of lesions showed a significant reduction on the 2nd and 4th days in NT group in comparison with CT group, therefore NT has a better impact on RAS in comparison with CT. (AU)

Objetivos: A estomatite aftosa recorrente (EAR) é caracterizada por úlceras recorrentes, com margens bem definidas. As lesões estão confinadas à mucosa oral (geralmente vista em mucosa não queratinizada). A doença se manifesta na forma de surtos, com um curso crônico e autolimitado na maioria dos casos. Como a causa da doença é desconhecida, muitos medicamentos foram estudados para aliviar os sintomas. O tratamento utilizado é multifocal e varia de acordo com os fatores predisponentes. O objetivo deste estudo foi investigar o efeito do gel acetonido de triancinolona recombinante baseado em Nano e compará-lo com o gel de triancinolona convencional no EAR. Material e métodos: Neste estudo clínico randomizado triplocego, sessenta pacientes com lesões aftosas menores foram divididos em dois grupos que receberam triancinolona convencional (CT) e triancinolona Nano (NT). Os pacientes foram solicitados a aplicar droga quatro vezes ao dia durante uma semana. A gravidade da dor (por meio da EVA) e o tamanho das lesões (média do maior diâmetro das lesões) foram avaliados no dia inicial e nos dias 2, 4 e 6 após a intervenção. A análise estatística foi realizada utilizando teste qui quadrado e teste t independente. Os achados foram significativos com P < 0.05. Resultados: Dos 60 pacientes incluídos no estudo, 5 pacientes não deram continuidade; 21(38,2%) casos foram mulheres e 34 (61,8%) casos foram homens (P=0,6). A gravidade da dor no grupo NT antes e depois do estudo foi de 1,4 ± 5,2 e 1,8 ± 1,3 cm. O tamanho das lesões no grupo NT antes e ao final do estudo foi de 0,96 ± 0,1 e 0,18 ± 0,1 cm, respectivamente, e no grupo de TC foi de 0,93 ± 0,1 e 0,19 ± 0,1 cm. Entre as variáveis mencionadas, somente o tamanho das lesões no segundo e quarto dias tiveram uma redução significativa no grupo NT em comparação com o grupo CT. Conclusão: O tamanho das lesões mostrou uma redução significativa nos 2º e 4º dias no grupo NT em comparação ao grupo CT, portanto o NT tem um impacto melhor no RAS em comparação com o TC. (AU)

Clinical study of 200 patients with recurrent aphthous stomatitis. / Estudio clínico de 200 pacientes con estomatitis aftosa recurrente.

Introduction: Recurrent aphthous stomatitis (RAS) affects approximately 20% of the general population. Its etiology is still unknown. Objective: To analyze this entity's clinical features. Method: Data such as age, gender, family history of RAS, age at first episode onset, prodromal symptoms, number, size, morphology and localization of lesions, RAS clinical form, annual rate of recurrence, predisposing factors, symptoms and time for symptoms and lesions disappearance were assessed in 200 patients with RAS. Results: Patients had RAS minor forms. Main clinical characteristics were family history of RAS (89%), first episode at ≥ 10 years of age (69%), prodromal symptoms (66%), one lesion per episode (63%), < 0.5 cm lesions (64%), rounded morphology (55%), localization at the tongue (27%), 3 recurrent episodes per year (36%), stress as predisposing factor (34%), symptom disappearance in 2 days (54%) and healing of lesions in 8 days (40%). Conclusion: Even when RAS is a common disorder of the oral mucosa, there is no curative treatment available. Therapeutic measures seek to reduce the pain and size of lesions, accelerate the time of recovery and decrease the rate of relapses.

Introducción: La estomatitis aftosa recurrente (EAR) afecta aproximadamente a 20 % de la población general. Su etiología aún se desconoce. Objetivo: Analizar las características clínicas de esta entidad. Método: En 200 pacientes con EAR se analizó edad, sexo, historia familiar de EAR, edad de aparición del primer episodio, síntomas prodrómicos, número, tamaño, morfología y localización de las lesiones, forma clínica de EAR, tasa anual de recurrencia, factores predisponentes, sintomatología, tiempo de desaparición de los síntomas y las lesiones. Resultados: Los pacientes tenían formas menores de EAR. Las principales características clínicas fueron historia familiar de EAR (89 %), primer episodio con ≥ 10 años de edad (69 %), síntomas prodrómicos (66 %), lesión por episodio (63 %), lesiones de < 0.5 cm (64 %), morfología redondeada (55 %), localización en lengua (27 %), tres episodios recurrentes anuales (36 %), estrés predisponente (34 %), desaparición de síntomas a los dos días (54 %) y curación de lesiones a los ocho días (40 %). Conclusión: Aun cuando la EAR es un trastorno común de la mucosa bucal, no se dispone de un tratamiento curativo. Las medidas terapéuticas buscan reducir el dolor y tamaño de las lesiones, acelerar el periodo de recuperación y disminuir la recidiva.

Immune system and zinc are associated with recurrent aphthous stomatitis: an assessment using a network-based approach

OBJECTIVE: The aim of this research was to identify genes, proteins and processes from the biomedical information published on recurrent aphthous stomatitis (RAS) using network-based foci. METHODS: The clinical context was defined using MeSH terms for RAS and biomarkers, combined with words associated with risk. A set of protein coding genes was prioritized using the Génie web server and classified with PANTHER. For defining biologically relevant proteins, protein-protein interaction networks were constructed using Reactome database and Cytoscape. Top 20 proteins were then subjected to functional enrichment using STRING. RESULTS: From 1,075,576 gene-abstract links, 1,491 genes were prioritized. Proteins were related to signaling molecule proteins (n=221), receptor proteins (n=221) and nucleic acid binding proteins (n=169). The network constructed with these proteins included 3,963 nodes and functional analysis showed that main processes involved immune system and zinc ion binding function. CONCLUSIONS: For the first time, bioinformatics tools were used for integrating pathways and networks associated with RAS. Molecules and processes associated with immune system recur robustly in all analyzed information. The molecular zinc ion binding function could be an area for exploring more specific and effective therapeutic interventions

Immune response of patients with recurrent aphthous stomatitis challenged with a symbiotic.

BACKGROUND: There are indications that Th1 polarization of immune response plays an important role in the pathogenesis of recurrent aphthous stomatitis (RAS), and that the use of probiotics can stimulate immune regulatory activity, influencing the course of the disease. The aim of this study was to characterize the initial immune profile of RAS patients and evaluate clinical and serological response following a challenge with symbiotic treatment containing fructooligosaccharide, Lactobacillus, and Bifidobacterium. METHODS: The immune responses of the 45 patients with RAS, submitted to symbiotic or placebo for 120 days, in relation to 30 RAS-free controls, were evaluated over a period of 6 months. Peripheral blood was collected from all patients at 0 (T0), 120 (T4), and 180 days (T6) after the start of treatment and Th1 (IL12-p70, IFN-γ), Th2 (IL-4), Treg (IL-10), Th17 (IL-17A), inflammatory (TNF-α, IL-6)-associated cytokines, and clinical parameters were quantified. RESULTS: At T0, significant differences were found in the serological levels of the IFN-γ, IL-4, and IL-6 cytokines of the RAS patients in comparison with the controls. It was observed that the cytokine profile of the RAS group was comprised of 2 distinct clusters: a pure Th2 and a Mixed (Th1/Th2) subtype and that symbiotic treatment induced an improvement in pain and an increase in IFN-γ levels, producing a reduction in Th2 response. CONCLUSIONS: In RAS, symbiotic treatment based on a fructooligosaccharide, Lactobacillus, and Bifidobacterium composition produced an alteration in the Th2 serological immune profile in the direction of Th1 and improved pain symptomatology.

Evaluation of antioxidant efficacy of Purslane extract in Patients with Recurrent Aphthous Stomatitis: a randomized, placebo-controlled, triple-blinded, clinical trial

Background: This herbal medicine is considered a rich source of antioxidants with anti-inflammatory effects. The purpose of this study was to evaluate the effectiveness of purslane in treatment of recurrent aphthous stomatitis (RAS) and also it ̓s effect on antioxidant level. Materials and methods: 50 patients were selected for this randomized triple-blind placebo-controlled trial. All subjects were randomly divided in to two groups, one group received purslane (n=25) and another group, placebo (n=25) for 3 month. Superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and total antioxidant status (TAS) was measured in plasma at baseline and after 3 month of treatment. Also pain intensity based on the visual analogue scale (VAS), the mean interval between lesion, number of lesions and the mean duration of complete healing at baseline and in month 1, 2 and 3 were recorded. Statistical analysis was performed by using Mann-Whitney and T-test. Results: A significant decrease in pain intensity in VAS scores was seen after treatment in intervention group (p<0.001). The mean duration of complete healing showed significant differences (P<0.001) between the two groups. The mean interval between lesions also showed significant differences (P<0.001) among the intervention group (33.12 days) compared with the placebo group (17.88 days). No significant differences were found regarding the number of lesions, level of erythrocyte GSHPx, TAS and SOD. No serious side-effects occurred in either of groups. Conclusions: According to this study, purslane is clinically effective in treatment of RAS (number of lesions, pain intensity and duration of healing) although it is unable to change the level of antioxidants. (AU)

Mercurius solubilis en el tratamiento de pacientes con estomatitis aftosa recurrente / Mercurius solubilis in the treatment of patients with recurrent aphthous estomatitis

Se realizó ensayo clinicoterapéutico controlado, de fase II B, de 112 pacientes con estomatitis aftosa recurrente, atendidos en la Clínica Estomatológica "José Luis Tassende" de Santiago de Cuba, desde enero hasta diciembre de 2013, para evaluar la eficacia del Mercurius solubilis en el tratamiento de estos. La muestra fue distribuida de forma aleatoria, mediante orden de llegada, en 2 grupos (uno de estudio y uno control), con 56 integrantes cada uno. Los primeros fueron tratados con Mercurius solubilis y los segundos con los remedios homeopáticos habituales. Para la validación estadística de la información obtenida se emplearon el porcentaje, el test de Ji al cuadrado, con 95 % de confiabilidad, y la probabilidad exacta de Fisher. Entre los grupos estudiados no existieron diferencias significativas en relación con la remisión de la intensidad del dolor, la recuperación de la integridad epitelial y la curación al tercer, quinto y séptimo días de tratamiento. Se demostró que esta terapia alternativa fue tan eficaz como el bórax.

A controlled clinical and therapeutical trial, of phase II B, was carried out on 112 patients with recurrent aphthous stomatitis, assisted in "José Luis Tassende" Stomatological Clinic in Santiago de Cuba from January to December, 2013, to evaluate the effectiveness of the Mercurius solubilis in their treatment. The sample was randomly distributed, through arrival order, in 2 groups (a study group and a control group), with 56 members each. The first ones were treated with Mercurius solubilis and the seconds with the habitual homeopathic remedies. For the statistical validation of the obtained information, the percentage, the chi square test, with 95% of confidence, and the exact probability of Fisher were used. There were no significant differences among the studied groups in relation to the remission of the pain intensity, the recovery of the epithelial integrity and the cure at the third, fifth and seventh days of treatment. It was demonstrated that this alternative therapy was as effective as borax.

La estomatitis aftosa recurrente y las situaciones de estrés como factor de riesgo / Recurrent aphthous stomatitis and stress situation as risk factors

La estomatitis aftosa, también llamada aftosis bucal o aftas, se caracteriza por la aparición de una o más úlceras dolorosas con pérdida de la continuidad del epitelio, variable en forma, número y tamaño. Se considera la enfermedad más frecuente de la mucosa bucal, ocupa el segundo lugar, y es más frecuente en niños y adolescentes; la ocurrencia de esta afección es considerada alta, aporta cifras de 5 a 66 %, con una media del 20 %. A la consulta del servicio de urgencia del Policlínico Universitario "Dr. Carlos J. Finlay", en Colón, acuden pacientes con síntomas y signos relacionados con esta enfermedad. La finalidad de este estudio fue determinar el nivel de afectación por situaciones de estrés en pacientes con estomatitis aftosa recurrente que acuden a dicha consulta. La muestra quedó conformada por 119 pacientes que tenían la presencia clínica de estomatitis aftosa recurrente, de ella 81 personas del sexo femenino para un 68,1 %, el grupo de edades más representado fue el de 15 a 24 años con 61 individuos para un 51,3 %; la forma menor fue la más observada desde el punto de vista clínico, las situaciones de estrés estaban presentes en la mayoría de los casos. Se arribó a las conclusiones de que la mayoría de las personas atendidas presentaron rasgo de ansiedad, los modos de afrontamiento al estrés más representados fue la búsqueda de apoyo social y los pacientes son vulnerables ante situaciones de estrés.

Aphthous stomatitis, also called buccal aphthosis or aphthae, is characterized by the emergence of one or more painful ulcers with lose of the epithelial continuity, varied in form, number and size. It is considered the most frequent buccal mucosa disease, being in the second place, and it is more frequent in children and teenagers; this disease’s occurrence is considered high, amounting between 5 and 60 %, with a 20 % media. Many patients showing symptoms and signs of this disease assist to the emergency service consultation of the University Polyclinic "Dr. Carlos J. Finlay", in Colon; the aim of this study was determining in what level stress situation affected patients assisting this consultation with recurrent aphthous stomatitis. The sample was formed by 119 patients having the clinical presence of recurrent aphthous stomatitis. 81 of them were female, for 68,1 %; the most represented age group was the one formed by 61 individuals aged 15-24 years, with 51,3 %; from the clinical point of view the less form was the most observed one. In most of the cases, stress situation were present. We arrived to the conclusion that most of the attended persons showed stress characteristics. The most represented way of affronting stress was looking for social support and patients are vulnerable to stress situations.

Helicobacter pylori and oral pathology: relationship with the gastric infection.

Helicobacter pylori (H. pylori) has been found in the oral cavity and stomach, and its infection is one of the most frequent worldwide. We reviewed the literature and conducted a Topic Highlight, which identified studies reporting an association between H. pylori-infection in the oral cavity and H. pylori-positive stomach bacterium. This work was designed to determine whether H. pylori is the etiologic agent in periodontal disease, recurrent aphthous stomatitis (RAS), squamous cell carcinoma, burning and halitosis. Record selection focused on the highest quality studies and meta-analyses. We selected 48 articles reporting on the association between saliva and plaque and H. pylori-infection. In order to assess periodontal disease data, we included 12 clinical trials and 1 meta-analysis. We evaluated 13 published articles that addressed the potential association with RAS, and 6 with squamous cell carcinoma. Fourteen publications focused on our questions on burning and halitosis. There is a close relation between H. pylori infection in the oral cavity and the stomach. The mouth is the first extra-gastric reservoir. Regarding the role of H. pylori in the etiology of squamous cell carcinoma, no evidence is still available.