Comprehensive management of major aphthous ulcer

Recurrent aphthous ulcers are the most prevalent oral mucosal disease, but the subset major aphthous ulcer is a less frequent type. These ulcers are refractory, may persist for several weeks to months, and interfere with the normal state of health. The aetiology is multifactorial and so is the treatment. We present a case of an adolescent male patient reported with multiple oral ulcers. He developed three ulcers simultaneously and suffered for 10 months despite using topical medications prescribed by different dental practitioners. We executed a multidisciplinary treatment approach that resulted in a long-term disease-free state. The treatment methods followed in our case could be a successful model to implement by medical practitioners and oral physicians when the situation demands.

Low Level Laser Therapy (LLLT) in the Effective Management of Recurrent Aphthous Ulcers (RAU): Clinical Case Reporting 3 Patients: A Case Series

Low-Level Laser therapy (LLLT) was employed for the treatment of three patients diagnosed with recurrent aphthous ulcers (RAU’s). The patients presented with recurrent aphthous ulcers in the region of floor of the mouth and buccal mucosa. The three patients with RAU’s were provided with a wavelength of946nm starting the use at 320µm fibre optic at a distance of 1-3 mm, peak power of 2W, frequency 10 Hz with no tissue contact in circular motion from outside to inside for 2 cycles with 100% duty for 30s for 3 consecutive days. The LLLT made possible an effective improvement in the reduction of pain and size associated with ulcers. It proved to be a safe and cost effective therapy in the management of recurrent aphthous ulcers.

Comparative assessment of low-level laser therapy (LLLT) vs. topical application of amlexanox + lidocaine to treat recurrent aphthous ulcers (RAUs): A randomized controlled trial

Background. The present study aimed to assess and compare the pain perception and ulcer sizes before and after applying low-level laser therapy (LLLT) and Amlexanox + lidocaine. Methods. Twenty-six patients referring to the out-patient department of the institution and diagnosed with recurrent aphthous ulcers (RAU) were assigned to two groups to receive either LLLT or Amlexanox + lidocaine. In group 1, the patients were provided with amlexanox + lidocaine to apply topically four times daily. In group 2, the patients underwent LLLT with no tissue contact in inward circular motions for two cycles for 30 seconds. This study was registered in "the Clinical Trials Registry- India" (CTRI), with the registration number CTRI/2019/09/028222. The data were analyzed with SPSS 16. Results. The intergroup comparison was performed using Mann-Whitney U test, and intragroup comparisons were made using Wilcoxon’s signed-rank test. The level of significance was set at P<0.05. The results showed that pain perception and ulcer size were significantly lower in group 2 subjects than group 1 subjects (P<0.05). Conclusion. LLLT was more effective than amlexanox + lidocaine in the management of RAU. It is a cost-effective therapy for treating RAU.

Comparison of Virgin Coconut Oil with 5% Amlexanox in Management of Minor Recurrent Aphthous Ulcers - A Randomized Control Trial

Objective: Recurrent Aphthous Ulcer (RAU) is a common (75-80%) painful inflammatory ulcerative disorder of the non-keratinized oral mucosa. Wide range of antiseptics, anti-inflammatory, antibiotics and corticosteroids are available for treatment. Amlexanox is a topical anti-inflammatory and anti-allergic drug used to treat RAS. Recently, there has been increase in interest in use of essential oil and herbal medicine in managing RAU, one such natural product is virgin coconut oil. This study is aimed to determine the efficacy of VCO in management of signs and symptoms of minor recurrent aphthous ulcers. Methodology: 40 patients were included for the study who were randomly divided into two groups. 20 patients in Group A (VCO) and 20 patients in Group B (5%Amlexanox). Primary outcome measured were reduction in ulcer size (in mm) and pain (VAS 1-10). Results: There is high statistical significant difference within the groups in ulcer healing and pain reduction (p=0.00) on 3rd and 5th day. In group A significant reduction in pain was present on the 5th day (p=0.02) and no significant reduction in ulcer size (p=0.083). No adverse effects were reported in either group. Conclusion: VCO could be used as an effective and safe drug in managing the signs and symptoms of RAS. It is edible oil with no known adverse effects and could be a safe therapeutic alternative in children and pregnant women.

Management of recurrent aphthous ulcer using corticosteroids, local anesthetics and nutritional supplements

Recurrent Aphthous ulcers are the most common oral lesions among dental patients. The ulcers, which usually occur on the nonkeratinized oral mucosa, can cause considerable pain and may interfere with eating, speaking, and swallowing. Therefore, it is of interest to report data on the management of recurrent aphthous ulcer using corticosteroids, local anesthetics and nutritional supplements. Case sheets of 76 patients who underwent treatment for recurrent aphthous ulcer between June 2019 and March 2020 at the Saveetha Dental College, India were used in this analysis. Data was analyzed using Chi square test at a P value < 0.05 that is statistically significant. Results show that topical anaesthetics in population (49%) were more effective that corticosteroids. Thus, topical anaesthetics are recommended for recurrent aphthous ulcer.

Bechet’s Disease and its association with Herpes Simplex Virus : Case Report of a rare Multisystem disorder with review of the literature

In the year 1937, A Turkish dermatologist Prof Hulusi Bechet described a syndrome based upon three cases. His first reported case in the year 1924 was a female who presented with recurrent aphthous ulcers of the oral cavity, genital ulcers, erythema nodosum and visual impairment which later lead to blindness. The second patient presented in 1930 with oro-genital ulcerations and scleral injection in the eyes. The third case was reported in the year 1936, a male which similar complaints, scrotal ulcers, loss of vision, scleral injection, fever and myalgia. Professor Hulusi Bechet grouped these clinical findings into a syndrome known as Bechet’s syndrome. Bechet's disease may present in several ways, and many patients' oral ulcers are the presenting complaints. Oral ulcers are usually underdiagnosed and often ignored by the patients. Later on, genital ulcers and complications such as Uveitis appear, which cause the patients to seek medical help. This is a rare disorder, but it must be considered as the complications may lead to a permanent impairment of vision.In many cases and studies, Bechet's disease is associated with the Herpes simplex virus. The evidence that we report is also found to have positive antibodies for Herpes simplex virus. Herpes Simplex Virus is a DNA Virus and is a causative agent in various ocular diseases such as conjunctivitis, corneal ulceration, stromal keratitis, scleritis iridocyclitis, Uveitis. On an average HSV Uveitis occurs at the age of 46 years. Herpetic corneal ulceration is a cause of blindness in these patients. Bechet's disease is also associated with Uveitis and has a dreaded complication of blindness. The patient that we report had both oral ulceration, genital ulceration, Uveitis and was found to have HSV antibodies. Management and treatment must reduce relapses.