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Journal of Multidisciplinary Healthcare 2020The study compares low-level laser therapy with topical medications for treating aphthous ulcers. (Review)
Review
OBJECTIVE
The study compares low-level laser therapy with topical medications for treating aphthous ulcers.
METHODS
A search of articles in this systematic review was completed in six databases. Treatment and comparative groups comprised of patients subjected to laser therapy and topical medications, respectively. Two different treatment outcomes were considered; pain and size of the lesion. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials.
RESULTS
From 109 articles, five randomized control trials fulfilled the selection criteria. The overall sample comprised of 98 males and 232 females, with a mean age of 32.4 years. The laser therapies in each included study had different active media and varying wavelengths. Topical medication used in the comparative group were triamcinolone acetonide, amlexanox, granofurin, and solcoseryl. Findings showed that patients who reported lower pain and decreased aphthous ulcer lesions were more in the laser therapy group than in the topical medication group.
CONCLUSION
Low-level laser therapy was better in treating aphthous ulcer lesions in comparison to topical medications, and all laser wavelengths in the included reports were seen to be effective. However, the results should be interpreted with caution, because no study demonstrated low-risk of bias in all the assessed domains.
PubMed: 33239881
DOI: 10.2147/JMDH.S281495 -
Iranian Journal of Medical Sciences Sep 2023Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects oral mucosa. The coating agents, topical analgesics, and topical steroids are... (Review)
Review
BACKGROUND
Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects oral mucosa. The coating agents, topical analgesics, and topical steroids are usually used as treatment methods. has been used for RAS treatment based on its anti-inflammatory, antioxidant, and immunomodulatory properties. In this study, a systemic review on the therapeutic effect of topical licorice on RAS management was performed.
METHODS
Science Direct, Scopus, Cochrane databases, PubMed Google Scholar, and ResearchGate were searched up to September 2021 to find all English randomized clinical trials studying the effect of , or its compositions on RAS. Meta-analysis was not conducted because of data heterogeneity. Articles were reviewed qualitatively, and only those with a Jadad score ≥3 were included. Animal studies, , review papers, non-English papers, and case reports were excluded.
RESULTS
Six studies with 314 subjects were included after screening. The result showed licorice has significant effects on RAS pain reduction, ulcer size, and healing time. Its effectiveness is related to its dose-dependent anti-inflammatory and antioxidant effects through several mechanisms. It also has antibacterial effects against and as another mechanism of action in RAS treatment. In addition, licorice can elevate the epidermal growth factor (EGF) level compared to the control group, which has an essential role in oral mucosal tissue integrity.
CONCLUSION
Licorice extract has been used in different dosage forms, including paste, patch, and mouthwash with concentrations of 1% or 5%. The healing time after licorice therapy is expected to be within 4-8 days. Licorice did not show any adverse effect in the intervention groups, indicating its effectiveness and safety in RAS treatment.
Topics: Animals; Humans; Stomatitis, Aphthous; Glycyrrhiza; Anti-Inflammatory Agents
PubMed: 37786470
DOI: 10.30476/IJMS.2022.94467.2576 -
Medicina (Kaunas, Lithuania) 2016The exact etiology of recurrent aphthous ulcers (RAS) is unknown. The management of RAS is not always straightforward. The aim of this review is to critically analyze... (Review)
Review
BACKGROUND AND OBJECTIVE
The exact etiology of recurrent aphthous ulcers (RAS) is unknown. The management of RAS is not always straightforward. The aim of this review is to critically analyze and summarize the clinical literature focusing on the management of aphthous ulcers using low-level lasers.
MATERIALS AND METHODS
The Medline (PubMed), Web of Knowledge (ISI), Cochrane Central Register of Controlled Trials (CENTRAL) and Embase databases were searched electronically for studies published in last 20 years (1995-2015) using the keywords "recurrent aphthous stomatitis," "aphthous ulcers," and "laser."
RESULTS
A total of 85 articles were found during the initial search; 76 studies were excluded for not fulfilling the criteria whereas nine studies were deemed suitable for this review. Among the included studies, two articles were case reports and seven were randomized clinical trials. Study design, sample size, type of intervention and control of each study were critically analyzed and summarized according to the CONSORT protocol. In majority of the patients, immediate pain relief and accelerated ulcer healing was observed following irradiation with lasers.
CONCLUSIONS
Although various types of lasers have succeeded in providing immediate pain relief to patients, carbon dioxide (CO) lasers have the unique advantage of requiring a short exposure time (5-10s). In order to ascertain the efficacy of laser for treating ulcers in the clinical setting, more clinical trials are required.
Topics: Adult; Chronic Pain; Humans; Lasers, Gas; Low-Level Light Therapy; Middle Aged; Randomized Controlled Trials as Topic; Stomatitis, Aphthous; Time Factors
PubMed: 27717563
DOI: 10.1016/j.medici.2016.07.006 -
The Cochrane Database of Systematic... Sep 2014Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is a rare clinical syndrome of unknown cause usually identified in children.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is a rare clinical syndrome of unknown cause usually identified in children. Tonsillectomy is considered a potential treatment option for this syndrome. This is an update of a Cochrane review first published in 2010.
OBJECTIVES
To assess the effectiveness and safety of tonsillectomy (with or without adenoidectomy) in children with PFAPA.
SEARCH METHODS
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 30 October 2013.
SELECTION CRITERIA
Randomised controlled trials comparing tonsillectomy (with or without adenoidectomy) with non-surgical treatment in children with PFAPA.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial quality and extracted data. We used the standard methodological procedures expected by The Cochrane Collaboration.
MAIN RESULTS
Two trials were included with a total of 67 children randomised (65 analysed); we judged both to be at low risk of bias.One trial of 39 participants recruited children with PFAPA syndrome diagnosed according to rigid, standard criteria. The trial compared adenotonsillectomy to watchful waiting and followed up patients for 18 months. A smaller trial of 28 children applied less stringent criteria for diagnosing PFAPA and probably also included participants with alternative types of recurrent pharyngitis. This trial compared tonsillectomy alone to no treatment and followed up patients for six months.Combining the trial results suggests that patients with PFAPA experience less fever and less severe episodes after surgery compared to those receiving no surgery. The risk ratio (RR) for immediate resolution of symptoms after surgery that persisted until the end of follow-up was 4.38 (95% confidence interval (CI) 0.64 to 30.11); number needed to treat to benefit (NNTB) = 2, calculated based on an estimate that 156 in 1000 untreated children have a resolution).There was a large overall reduction in the average number of episodes over the total length of follow-up in these studies (rate ratio 0.08, 95% CI 0.05 to 0.13), reducing the average frequency of PFAPA episodes from one every two months to slightly less than one every two years. The severity, as indicated by the length of PFAPA symptoms during these episodes, was also reduced. One study reported that the average number of days per PFAPA episode was 1.7 days after receiving surgery, compared to 3.5 days in the control group. The proportion of patients requiring corticosteroids was also lower in the surgery group compared to those receiving no surgery (RR 0.58, 95% CI 0.37 to 0.92).Both trials reported that there were no complications of surgery. However, the numbers of patients randomly allocated to surgery (19 and 14 patients respectively) were too small to detect potentially important complications such as haemorrhage. Other outcomes such as quality of life, number of days with pain after surgery and absence from school were not measured or reported.
AUTHORS' CONCLUSIONS
The evidence for the effectiveness of tonsillectomy in children with PFAPA syndrome is derived from two small randomised controlled trials. These trials reported significant beneficial effects of surgery compared to no surgery on immediate and complete symptom resolution (NNTB = 2) and a substantial reduction in the frequency and severity (length of episode) of any further symptoms experienced. However, the evidence is of moderate quality (further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate) due to the relatively small sample sizes of the studies and some concerns about the applicability of the results. Therefore, the parents and carers of children with PFAPA syndrome must weigh the risks and consequences of surgery against the alternative of using medications. It is well established that children with PFAPA syndrome recover spontaneously and medication can be administered to try and reduce the severity of individual episodes. It is uncertain whether adenoidectomy combined with tonsillectomy adds any additional benefit to tonsillectomy alone.
Topics: Adenoidectomy; Adolescent; Child; Child, Preschool; Fever; Humans; Infant; Lymphadenitis; Neck; Periodicity; Pharyngitis; Randomized Controlled Trials as Topic; Remission, Spontaneous; Stomatitis, Aphthous; Syndrome; Tonsillectomy; Watchful Waiting
PubMed: 25209127
DOI: 10.1002/14651858.CD008669.pub2 -
Journal of Paediatrics and Child Health Oct 2023Apart from various typical gastrointestinal symptoms, coeliac disease may have its clinical manifestations in the oral cavity which is the entrance of the... (Review)
Review
AIM
Apart from various typical gastrointestinal symptoms, coeliac disease may have its clinical manifestations in the oral cavity which is the entrance of the gastrointestinal tract.
METHODS
A systematic review of literature was performed using the following databases: Medline, Scopus, EBSCOhost and Cochrane Library for Systematic Review.
INCLUSION CRITERIA
observational or experimental original studies published in English with full text available between January 2000 and December 2022, regarding children and adolescents under the age of 20. Risk of bias was determined with the use of Risk Of Bias In Non-randomised Studies of Exposure.
RESULTS
Thirty-four studies were included in the review. The analysis confirmed a higher prevalence of numerous oral manifestations in coeliac disease concerning both hard and soft tissues. Our study found the prevalence of dental enamel defects to be at the level of 17.9%-83.5% (P value <0.047) and recurrent aphthous stomatitis of 8.3%-69% (P value <0.039).
CONCLUSION
Oral manifestations may precede gastrointestinal symptoms. Patients presenting such manifestations should be screened for coeliac disease. The cooperation of gastroenterologists and dentists could lead to an increased detectability of coeliac disease.
Topics: Adolescent; Humans; Child; Celiac Disease; Oral Health; Stomatitis, Aphthous; Prevalence
PubMed: 37712495
DOI: 10.1111/jpc.16494 -
Journal of the American Dental... Jan 2017Recurrent aphthous stomatitis (RAS) is the most common chronic oral mucosal condition of the oral cavity. Investigators in clinical trials have evaluated the... (Review)
Review
BACKGROUND
Recurrent aphthous stomatitis (RAS) is the most common chronic oral mucosal condition of the oral cavity. Investigators in clinical trials have evaluated the effectiveness of Chinese patent medicines in the treatment of RAS. However, the results are conflicting rather than conclusive. To evaluate the efficacy and safety of Chinese patent medicines for the treatment of RAS, the authors conducted a systematic review.
TYPES OF STUDIES REVIEWED
The authors searched 9 electronic databases to identify randomized controlled trials (RCTs) or potential clinical controlled trials (CCTs), published in any language, in which the investigators compared Chinese patent medicines with vitamin tablets or placebos for the treatment of RAS.
RESULTS
The authors included 11 RCTs and 1 CCT in the review. Results showed that Chinese patent medicines were beneficial for patients with RAS in relieving ulcer pain and reducing the duration and frequency of attacks. The reported adverse effects of Chinese patent medicines included stomachache, abdominal distention, diarrhea, mild nausea, and gastrointestinal discomfort, which were either self-limiting or could be relieved by treatment cessation.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Chinese patent medicines may be effective for treatment of RAS by means of relieving pain and reducing ulcer size and episode duration and frequency.
Topics: Drugs, Chinese Herbal; Humans; Recurrence; Stomatitis, Aphthous; Treatment Outcome
PubMed: 28062049
DOI: 10.1016/j.adaj.2016.08.025 -
Journal of Trace Elements in Medicine... Dec 2021Recurrent aphthous stomatitis (RAS) is a very common oral ulcerative disease with no definitive cure. Growing evidence suggests a significant association between zinc...
BACKGROUND
Recurrent aphthous stomatitis (RAS) is a very common oral ulcerative disease with no definitive cure. Growing evidence suggests a significant association between zinc deficiency and RAS.
OBJECTIVES
To assess the efficacy of systemic zinc supplementations in the prevention and management of RAS.
METHODS
Five databases were searched for all English and Chinese studies published up to November 2020. All clinical trials that assessed the efficacy of zinc supplementations in the management and/or prevention of RAS were included.
RESULTS
Seven clinical trials comprising 482 RAS patients (250 in zinc group) fulfilled the inclusion criteria. The follow-up period ranged from three months to one year. Five studies showed significantly better efficacy of zinc in reducing the recurrence rates of RAS, whereas two studies did not report any significant differences compared to the controls. Four studies reported on signs/symptoms of RAS, three of which showed superior outcomes in favour of zinc, while one study reported comparable results.
CONCLUSION
Zinc supplementation seems to be efficacious in the management and prevention of RAS. However, further clinical trials with standardized methodologies and adequate follow-up periods are required to confirm the efficacy of zinc supplementations.
Topics: Asian People; Dietary Supplements; Humans; Recurrence; Stomatitis, Aphthous; Zinc
PubMed: 34146924
DOI: 10.1016/j.jtemb.2021.126811 -
Archives of Oral Biology Sep 2021This study aimed to investigate that these bacteria counts in the oral cavity were modulated by the recurrent aphthous stomatitis (RAS) status according to age and... (Meta-Analysis)
Meta-Analysis Review
Quantitative changes of Veillonella, Streptococcus, and Neisseria in the oral cavity of patients with recurrent aphthous stomatitis: A systematic review and meta-analysis.
OBJECTIVE
This study aimed to investigate that these bacteria counts in the oral cavity were modulated by the recurrent aphthous stomatitis (RAS) status according to age and ethnicity with a systematic review and meta-analysis.
DESIGN
The relevant case-control studies were searched in the literature database in English, Korean, and Chinese until June 2020 using keywords, and the literature was screened and collated for Review Manager analysis. Sensitivity analysis and quality check of the included literature were conducted.
RESULTS
From the selection process, oral bacteria counts were measured by polymerase chain reaction (PCR) in 8 studies and next-generation sequencing in 4 studies. Healthy control, ulcerative phases of RAS (UC-RAS), non-ulcerative phases of RAS (Non-UC-RAS) groups included 442, 473, and 386 participants in a total of 12 studies. For PCR detection, mean differences (95 % confidence intervals) of Veillonella and Streptococcus counts between the healthy-control and RAS groups were -1.91 (-2.41 ∼ -1.41) and -1.34 (-1.85 ∼ -0.83)(P < 0.0001). The bacteria count results by "Next-generation" sequencing (NGS) and PCR methods were similar. Significantly lower Veillonella and Streptococcus counts were observed in the UC-RAS group than in the non-UC-RAS group (P < 0.0001). Veillonella and Streptococcus count differences between RAS and controls aged ≥30 years were greater than those aged <30 years. At the species level, the prevalence of RAS had a negative relation with Veillonella dispar count.
CONCLUSIONS
Counts of Veillonella and Streptococcus are strongly correlated with the recovery and progression of RAS, especially in middle-aged patients. Adjustment of oral microbiota should be considered in the treatment of RAS.
Topics: Humans; Middle Aged; Neisseria; Stomatitis, Aphthous; Streptococcus; Veillonella
PubMed: 34167010
DOI: 10.1016/j.archoralbio.2021.105198 -
Oral Diseases Sep 2020A few studies have associated vitamin D deficiency with the occurrence of recurrent aphthous stomatitis (RAS). Hence, the aim of the present systematic review and... (Review)
Review
OBJECTIVES
A few studies have associated vitamin D deficiency with the occurrence of recurrent aphthous stomatitis (RAS). Hence, the aim of the present systematic review and meta-analysis is to explore such a potential association.
METHODS
A comprehensive search of PubMed, Scopus, and Web of Science databases was conducted in June 2019. The inclusion criteria were (a) observational studies that assessed the relationship between vitamin D and RAS, and (b) the outcome measures reported quantitative vitamin D levels. Studies without control groups, case series, case reports, experimental studies, letter to editors, reviews, were excluded. The random effects model was conducted for meta-analyses using RevMan 5.3 software.
RESULTS
Five studies comprising 208 RAS patients and 241 healthy individuals were included. All studies except one reported significantly lower levels of vitamin D in RAS patients compared with the healthy individuals. The results of the pooled 5 studies revealed statistically significant lower levels of vitamin D in RAS patients (Mean Difference (MD) = -9.67 ng/ml, 95% CI = -15.68, -3.65; p ˂ .002).
CONCLUSION
The present meta-analysis suggests a significant association between low vitamin D levels and RAS. Further well-designed studies with adequate sample sizes are required to elucidate the role of vitamin D in pathogenesis of RAS.
PubMed: 31493304
DOI: 10.1111/odi.13189 -
Dentistry Journal Jan 2024The systematic review assessed the efficacy and safety of propolis for treating recurrent aphthous stomatitis (RAS). The review adopted the PICO framework to examine the... (Review)
Review
The systematic review assessed the efficacy and safety of propolis for treating recurrent aphthous stomatitis (RAS). The review adopted the PICO framework to examine the effects of topical and systemic propolis on RAS while also comparing it to established treatments, placebos, or no treatment. The main focus was on the healing time, pain levels, adverse effects, the likelihood of ulcer recurrence, and accompanying symptoms such as redness. The team included randomised controlled trials (RCTs) and quasi-randomised trials, excluding case reports and studies on oral ulcers other than RAS. In May 2022, the review team comprehensively searched nine databases and trial registries following the PRISMA guidelines. The protocol was registered in the PROSPERO database under the registration number CRD42022327123. Two review authors conducted a comprehensive and autonomous search for pertinent papers and extracted essential data. Where data permitted, the team utilised Review Manager 5 to conduct a random-effects meta-analysis, assessing the risk of bias and heterogeneity of the included studies. Where possible, the GRADE Pro programme was used to assess the certainty of the evidence for all the outcomes. This review included 10 RCTs, comprising 825 participants aged between 18 and 69 years. Seven studies evaluated the efficacy and safety of propolis when applied topically, all of which used different formulations, concentrations, and carriers. The remaining three studies assessed systemic administration in tablet form. The duration of investigations ranged from 5 days to 3 years. The review team classified two studies as having an overall 'high risk' of bias, while the remaining studies were categorised as having an overall 'uncertain risk'. The overall certainty of the evidence was 'very low'. The results indicate that topical and systemic propolis may decrease the duration of healing, alleviate pain, and reduce redness in patients with RAS compared to a placebo. However, the certainty of the evidence is very low. These may be due to the high risk of bias, substantial heterogeneity, and limited sample sizes in the included studies. For these reasons, the results of this review should be interpreted with caution. Nevertheless, the limited number of adverse effects observed suggests that propolis may have a favourable safety profile when used for a short period in treating RAS.
PubMed: 38248221
DOI: 10.3390/dj12010013