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PubMed2002

[Recurrent aphthous stomatitis: treatment with colchicine. An open trial of 54 cases].

INTRODUCTION: Colchicine is a treatment used for aphthous stomatitis but its efficacy has never been proved. We report the results of an open trial of 54 patients treated with colchicine for aphthous stomatitis. The aim of our study was to assess the long and short term efficacy and tolerance of this molecule in this disease. PATIENTS AND METHODS: The case reports of 64 patients presenting with severe, recurrent aphthous stomatitis treated with colchicine between 1986 and 2000 were analyzed retrospectively. Only immunocompetent patients exhibiting idiopathic aphthous stomatitis or Behçet's disease were included. Ten patients were excluded: 4 cases of Behçet's disease treated with colchicine and systemic corticosteroids, 4 cases of aphthous stomatitis secondary to a hematological cause and 2 patients who were lost to follow-up after 3 month's treatment. Colchicine was prescribed at a dose of 1 to 1.5 mg/d for at least 3 months. All the patients were assessed after 3 month's treatment and all were contacted by phone in May 2000. Our end-point criteria were: the frequency and duration of the episodes, intensity of pain and impact on the quality of life of the patients. RESULTS: Fifty-four patients were included: 39 women (mean age=44 +/- 16.8) and 15 men (mean age=49 +/- 13.5). The disease had progressed for a mean of 11.6 +/- 13.5 years. After 3 month's treatment, 12 patients (22 p. 100) no longer had aphta and were in complete remission, 22 patients (41 p. 100) were significantly improved, since the frequency and duration of the lesions had decreased by at least 50 p. 100 and the latter were no longer painful. Treatment failed or tolerance was poor in 20 patients (37 p. 100). Patients were monitored and assessed for a mean of 4.7 years (range: 6 months to 13 years). Six patients were lost to follow-up. Three patients (6 p. 100) were considered as cured, since they were still in complete remission after suspension of colchicine respectively 6, 24 and 72 months later. Fifteen patients (31 p. 100) had still improved. Among the latter, 10 continued colchicine for a mean of 27 months, and 5 patients stopped treatment, which they considered tedious, after a mean of 16 months. These 15 patients noted a significant reduction in the frequency and duration of the lesions. Moreover, the subjective end-point criteria had improved significantly for them not to wish to change treatment. Thirty patients (63 p. 100) were not improved by the treatment. Some benign adverse events were noted in 10 patients (18.5 p. 100) and led to suspension of treatment in 4 cases. DISCUSSION: This study, which is the first in size (n=54) and duration of follow-up (4.7 years), showed that colchicine is an efficient preventive treatment of severe aphthous stomatitis for 63 p. 100 of patients after 3 month's treatment and that this improvement was lasting in 37 p. 100 of them. Colchicine should therefore be proposed in first intention in severe recurrent aphthous stomatitis, since it is effective, well tolerated and easy to use.

Adult↗
PubMed1977

Recurrent aphthous stomatitis: clinical characteristics and evidence for an immunopathogenesis.

Recurrent aphthous stomatitis is one of the most common diseases affecting the oral mucosa, and one of its variants is the most painful affliction of the oral mucosa. The lesions of recurrent aphthous stomatitis can be manifested as part of a broad spectrum of clinical disease ranging from the common minor aphthous ulcers to Behçet's syndrome. Differential diagnosis, although not often difficult, must include many conditions capable of producing erosive and ulcerative oral mucosal lesions. The salient features of recurrent aphthous stomatitis suggest that it is a heterogeneous entity. Recent immunologic investigations have focused attention on a possible immunopathogenesis and the evidence for this is reviewed.

Behcet Syndrome↗
PubMed2002

Serum iron, ferritin, folic acid, and vitamin B12 levels in recurrent aphthous stomatitis.

BACKGROUND: The exact aetiology of recurrent aphthous stomatitis (RAS) is still unknown, but different predisposing factors, including iron, vitamin B12 and folic acid deficiencies, have been proposed. MATERIAL AND METHODS: Serum iron, ferritin, folic acid and vitamin B12 levels were investigated in 35 patients with RAS and in 26 healthy controls. RESULTS: Vitamin B12 levels were found significantly lower in subjects with RAS than in controls. No significant differences were found in other parameters. CONCLUSION: We concluded that vitamin B 12 deficiency may be an aetiological factor in recurrent aphthous stomatitis.

Adolescent↗
PubMed1992

The association of menstrual cycle, pregnancy, and menopause with recurrent oral aphthous stomatitis: a review and critique.

OBJECTIVE: To examine critically the postulated associations between recurrent aphthous stomatitis and the menstrual cycle, pregnancy, and menopause, and to determine why such associations had been accepted previously in the absence of convincing evidence. DATA SOURCES: We used MEDLINE data base searches in 1988 and 1991 to identify all articles since 1966 referring to estrogen, progesterone, menstruation, menstrual cycle, menopause, or pregnancy, and to aphthous stomatitis. Similar searches were carried out in the Index to Dental Literature for the period 1942-1991, and in MEDLINE on CD-ROM in 1991. Articles uncovered were examined for further appropriate references in the 50-year period 1942-1991. We excluded letters, abstracts, and articles in journals that are not peer-reviewed. METHODS OF STUDY SELECTION: We discovered one retrospective study on aphthous ulceration and ovarian hormones, eight prospective studies, three uncontrolled trials on the use of hormones in aphthous stomatitis, one controlled trial, and four review papers. DATA EXTRACTION AND SYNTHESIS: Each paper was carefully read, in translation where necessary, and opinions and findings were critically examined for source, authenticity, and statistical analysis. Each paper was also examined critically in terms of its review and acceptance of previous papers. The papers were too diverse in nature to permit a structured criticism. CONCLUSIONS: No associations have been established between aphthous stomatitis and the premenstrual period, pregnancy, or menopause. No properly designed study has shown a therapeutic effect of ovarian hormones on aphthous stomatitis. Reasons for this lack and the need for large-scale studies are identified.

Female↗
PubMed2005

A prospective randomized controlled trial to determine if cryotherapy can reduce the pain of patients with minor form of recurrent aphthous stomatitis.

BACKGROUND: Tissue cooling has long been used in the management of both acute and chronic pain. OBJECTIVE: To determine whether the application of cryotherapy can reduce the pain of patients with minor form of recurrent aphthous stomatitis. STUDY DESIGN: Twenty adult patients who had 2 discrete aphthous stomatitides in the labial mucosa at the same time were included in this prospective, randomized, and placebo-controlled study. One of the 2 aphthous stomatitides was treated with cryotherapy, the other serving as a control. The pain of aphthous stomatitis was scored by the patient on a 6-point scale (from 0 to 5). The size of the aphthous stomatitis was also measured. RESULTS: At any interval, no statistical difference was found between the cryotherapy-treated aphthous stomatitis and the control in the change in the value of pain severity, nor was any statistical difference found in the change in the size of the aphthous stomatitis. However, a trend toward less pain in the aphthous stomatitis receiving cryotherapy was noted. CONCLUSION: These results suggest that application of cryotherapy on minor form of recurrent oral aphthous stomatitis has no beneficial analgesic effect compared to placebo.

Adolescent↗
PubMed1987

Clinical evaluation of benzydamine, chlorhexidine, and placebo mouthwashes in the management of recurrent aphthous stomatitis.

Eighteen patients with minor recurrent aphthous stomatitis were given alcoholic benzydamine hydrochloride, aqueous chlorhexidine, or a benzydamine-free placebo mouthwash in random order. Each patient used each preparation for a 3-month period. Ulcer diaries were marked at the same time each week during the 9-month test period. Records were made of the number, size, sites, and pain severity of any ulcers present. Statistical analysis of the results showed no significant differences between any of the treatments tested. Stinging of the oral mucosa was the only consistent side effects noted by nine patients using benzydamine, nine patients using placebo, and three patients using chlorhexidine. Eight patients stated a personal preference for benzydamine because of the transient local anesthetic effect of benzydamine, which gave pain relief.

Benzydamine↗
PubMed2004

Erythrocyte superoxide dismutase, catalase activities and plasma nitrite and nitrate levels in patients with Behçet disease and recurrent aphthous stomatitis.

Behçet disease (BD) and recurrent aphthous stomatitis (RAS) are two distinct diseases of unknown aetiology which are both characterized by oral aphthae. The aim of this study was to determine the possible association of both diseases with antioxidant status and nitric oxide levels. Twenty-six patients (17 female, nine male) with RAS, 28 patients (17 female, 11 male) with BD and 31 (22 female, nine male) healthy control subjects were included in the study. Blood samples were studied for erythrocyte superoxide dismutase (SOD) and catalase (CAT) activities and plasma nitric oxide (NO) levels. Erythrocyte SOD activity in BD patients was significantly higher than in RAS patients and controls. Although SOD activity in RAS patients was higher than in controls, the difference was not statistically significant. No significant differences in CAT activities or NO levels were found between the three groups. In conclusion, changes in SOD activity may be important in the inflammatory reactions observed in BD and RAS, but NO does not seem to play a primary role in the aetiopathogenesis.

Adult↗