재발하는 구내염 치료의 음식 및 비타미네 치료법

[문형철]

beyond reason

가장 흔한 구내염은 아프타성 구내염

아프타성 : 궤양이라는 뜻의 그리스어

헤르페스 심플렉스 바이러스 등 바이러스가 염증, 궤양을 일으키는 아프타성 구내염으로 분류됨

정확한 진단은 바이러스 배양검사를 해야 ....

원인은 세균·바이러스·진균(眞菌) 등의 감염에 의한 것이 많고, 대체로 구강이 불결한 경우에 나타난다. 또 의치(義齒) 등에 의한 기계적 자극, 열탕(熱湯)에 의한 온열적 자극, 약품에 의한 화학적 자극 외에 전신질환을 비롯하여 영양불량·임신, 그 밖에 저항력이 감퇴하였을 때에도 발생한다. 증세는 구강점막의 발적(發赤)·종창·작열감(灼熱感)·구취·물집·궤양 등이 생기고 동통(疼痛)이 심하다. 중증이면 발열하고 저작(咀嚼)·연하(嚥下)·발음 장애를 일으키며, 유아는 영양장애가 있기 쉽고 국소(局所) 림프절도 부어오른다.

• 재발성 아프타성 구내궤양(canker sore): 입 안에 궤양이 생기는 구내염으로, 정확한 원인은 알 수 없지만 면역체계의 이상이나 세균, 바이러스 감염에 의한 것으로 알려져 있다. 뜨거운 음식, 뺨과 혀의 상처 등이 원인이 되기도 하고, 피로와 스트레스, 알레르기 등에 의해 증세가 악화될 수 있다.

• 헤르페스성 구내염(cold sore): 헤르페스 바이러스에 의해 입 주변 얼굴에 발생하며 수포가 생기고 통증이 심하다. 성인이 되기 전에 잘 나타나며, 전염성이 있는 질환이다.

• 편평태선(leukoplakia): 세포의 과다 성장으로 인해 뺨, 잇몸, 혀에 두꺼운 하얀 조각(patch)이 생기는 구내염이며, 흡연자에게서 흔히 나타난다. 잘 맞지 않는 틀니를 사용하거나 뺨을 씹는 습관이 있는 경우에도 생길 수 있다. 종양으로 발전할 수도 있다.

• 칸디다증(candidiasis): 곰팡이 감염으로 인해 생긴다. 틀니를 사용하거나 소모성 질환 또는 면역질환을 앓고 있는 경우 잘 발생하는데, 특히 어린아이에게서 흔히 발병한다. 구강 건조증이 있는 사람이나 항생제 복용 후에 일어나기도 한다.

이 외에도 감염 경로를 기준으로 분류할 수 있는데, 세균 감염, 진균 감염(곰팡이균), 바이러스 감염 등의 감염성 구강점막 질환과 재발성 아프타성 구내궤양, 유천포창, 천포창 등의 면역성 구강점막 질환, 그리고 혀 표면의 갈라짐, 양성 이동성 설염, 위축성 설염 등의 혀 점막의 질환으로 나누어 볼 수 있다.

1) 아프타성궤양(Aphthous ulcer, canker sore)

아프타성궤양의 발병 원인은 정확하게 알려져 있지 않지만, 신체 외상이나 스트레스, 수면 부족, 갑작스러운 체중 감소, 음식 알레르기, 면역 체계에 대한 반응^[4], 감귤류(오렌지, 레몬 등)와 비타민 _B12와 철분, 엽산의 결핍^[5]이 아프타성궤양 발병의 요인이 될 수 있다. 혈관확장제(협심증 치료제)인 니코란딜과 기타 여러 형태의 화학요법 역시 아프타성궤양의 발병과 연결 지을 수 있다.^[6] 최근에 한 연구 결과에 따르면 우유 알레르기와 아프타성궤양이 깊은 상관관계가 있다고 한다.^[7] 아프타성궤양은 베체트병의 주요 증상이기는 하지만,^[8] 크론병 환자에게서도 일반적으로 관찰되는 증상이기도 하다.^[9] 구강 외상이 가장 일반적인 요인이다.^[10][11][12] 

이빨이나 칫솔질로 인한 찰과상 또는 토스트나 과자 같이 딱딱하거나 질긴 음식 섭취, 치아 손실 이후 내지는 치아 교정기가 혀와 잇몸과 마찰해 손상을 입히면서 아프타성궤양이 발병할 수도 있다. 또한 화학적 자극제나 열상 등 다른 요인들로 인해서도 아프타성궤양이 발병할 수 있다. 로릴 황산 나트륨(SLS)이 들어 있지 않은 치약을 사용하는 것이 아프타성 궤양의 빈도를 낮출 수 있다.^{[13][14][15][16]} 한 연구 결과에 따르면 치약에 포함된 로릴황산나트륨 성분과 아프타성궤양 간에는 연관성이 없는 것으로 밝혀졌다.^[17] 셀리악병은 아프타성궤양의 발병 원인 가운데 하나로 제시되었으며,^[18][19] 일부 환자들은 음식에서 글루텐을 제거함으로써 치료 효과를 보았다.^[18]

라우릴 황산나트륨이 없는 치약

https://kr.iherb.com/pr/Now-Foods-Solutions-XyliWhite-Toothpaste-Gel-Platinum-Mint-6-4-oz-181-g/11465

https://kr.iherb.com/pr/Now-Foods-Solutions-XyliWhite-Toothpaste-Gel-Neem-Tea-Tree-6-4-oz-181-g/58911

https://kr.iherb.com/pr/Now-Foods-Solutions-XyliWhite-Toothpaste-Gel-Coconut-Oil-Mint-Flavor-6-4-oz-181-g/78246

아래 상반된 주장을 펴는 두 리뷰논문 impact pactor는 차례대로 1.36 . 1.04

Effect of sodium lauryl sulfate on recurrent aphthous stomatitis. A systematic review.pdf

Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: A systematic review

Abstract

The present systematic review sought to eval‎uate the effects of Sodium Lauryl Sulfate (SLS)‐free compared to SLS‐containing dentifrices on (Recurrent) aphthous stomatitis (RAS) in patients with this condition. Cochrane, Medline (PubMed) and Embase databases, and some trial registries were searched through December 2017. There was no language, nor publication year restrictions. We included double‐blinded randomized controlled trials that compared the effects of dentifrices with and without SLS on RAS in humans. Data extraction was compliant with PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. PROSPERO 2018:CRD42018086001. Four trials were included in this review (all crossover studies; n = 124 participants) and two contributed to the main meta‐analysis based on the random‐effect model. SLS‐free dentifrice, when compared to SLS‐containing statistically significantly, reduced the number of ulcers, duration of ulcer, number of episodes, and ulcer pain. Sensitivity analysis of the four studies as parallel‐group trials shows a consistent direction of effect in favor of SLS‐free dentifrice usage. In conclusion, the qualitative and quantitative synthesis of the eligible trials for this review showed that use of SLS‐free consistently reduced all four parameters of ulcers measured. The available evidence suggests that patients with RAS may benefit from using SLS‐free dentifrices for their daily oral care. However, future well‐designed trials are still required to strengthen the current body of evidence.

반대 리뷰논문

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651417/

Human and Environmental Toxicity of Sodium Lauryl Sulfate (SLS): Evidence for Safe Use in Household Cleaning Products

Cara AM Bondi, Julia L Marks, [...], and Kay E Gebhardt

Additional article information

Abstract

Environmental chemical exposure is a major concern for consumers of packaged goods. The complexity of chemical nomenclature and wide availability of scientific research provide detailed information but lends itself to misinterpretation by the lay person. For the surfactant sodium lauryl sulfate (SLS), this has resulted in a misunderstanding of the environmental health impact of the chemical and statements in the media that are not scientifically supported. This review demonstrates how scientific works can be misinterpreted and used in a manner that was not intended by the authors, while simultaneously providing insight into the true environmental health impact of SLS. SLS is an anionic surfactant commonly used in consumer household cleaning products. For decades, this chemical has been developing a negative reputation with consumers because of inaccurate interpretations of the scientific literature and confusion between SLS and chemicals with similar names. Here, we review the human and environmental toxicity profiles of SLS and demonstrate that it is safe for use in consumer household cleaning products.

Keywords: surfactant, media claims, product formulation, ingredient safety review

• Letter
• Published: 20 December 2019

Oral health

Sodium lauryl sulphate

• T. J. Paul, 
• T. Taylor & 
• A. Babu R. S. 

British Dental Journal volume 227, page1012(2019)Cite this article

• 951 Accesses

• 1 Citations

• Metricsdetails

Sir, sodium lauryl sulphate (SLS) is a synthetic product that is broadly utilised in toothpaste. Recently, a systematic review reported on SLS based dentifrices and their influence on recurrent aphthous stomatitis. The results also mentioned that SLS-free dentifrices showed significant reduction on number, duration, episodes and pain among recurrent aphthous ulceration (Sutton's disease) patients.1 In addition, SLS has been linked with other adverse effects likely to compromise oral health such as local irritation of mucosa leading to desquamation.2 Due to desquamation the integrity of the oral mucosa is compromised, thus initiating aphthous stomatitis. Globally, aphthous stomatitis is reported as being among the most common oral mucosal pathologies.

There is a need for the search of natural and innovative substances that can fill the role provided by SLS in toothpastes, with less or no potential for harm. Plant-derived saponin may prove beneficial as it is likely to be relatively harmless when taken orally, and toxicity is minimised during ingestion by low absorption and hydrolysis.3,4 While the foaming properties of saponin might be inferior to SLS, it may still produce a substantial effect that is visible and favourable to consumers. Limitations on plant sources may also be adjusted by seeking yield from frequently discarded plant material; and a potential reserve of such material is the Jamaican ackee (Blighia sapida).

Being a natural source, it is biodegradable and less likely to bioaccumulate and cause toxicity and disease. Currently, there are no studies that show the occurrence of recurrent aphthous ulcers from the use of ackee-derived saponin. Confirmation of the benefits of ackee-derived toothpaste could boost its production and contribute to a better use of the enormous quantity of seeds and pods that are often discarded annually in Jamaica. Given the popularity and acceptance of ackee in Jamaica, toothpaste derived with ingredients from the ackee plant is likely to find high acceptability. This innovation would also expand the economic impact of ackee farming for the country and the wider world.

References

1. 1.

   Alli B Y, Erinoso O A, Olawuyi A B. Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: A systematic review. J Oral Pathol Med 2019; 48: 358-364.

2. 2.

   Siegel I A, Gordon H P. Surfactant-induced alterations of permeability of rabbit oral mucosa in vitro. Exp Mol Pathol 1986; 44: 132-137.

3. 3.

   Deore S L, Khadabadi S S, Chittam K P et al. Properties and pharmacological applications of saponins. Pharmacologyonline 2009; 2: 61-84. Available at: http://pharmacologyonline.silae.it/files/newsletter/2009/vol2/8.Deore.pdf (accessed November 2019).

4. 4.

   Dewick P. Medicinal natural products: a biosynthetic approach. 2nd ed. West Sussex, England: John Wiley & Sons, 2002.

1차 근육검사 ; 라우릴 황산타트륨이 들어있는 치약은 인체건강에 문제가 있다 yes

                                                         아프타성 구내염에 원인이된다 yes

아프타성 구내염과 비타민 b12 부족관련 논문

Case Reports

 

Neth J Med

. 1998 Oct;53(4):172-5.

 doi: 10.1016/s0300-2977(98)00096-5.

Aphthous ulcers and vitamin B12 deficiency

B L Weusten 1, A van de Wiel

Affiliations expand

• PMID: 9825643
 
• DOI: 10.1016/s0300-2977(98)00096-5

Abstract

Aphthous ulcers of the oral cavity are frequently encountered in general practice. Although the exact pathophysiology remains obscure, many factors can contribute to the pathogenesis of these lesions, such as immunological factors, local trauma, smoking, stress, hormonal state, family history, food hypersensitivity, and infection. We describe three patients in whom a clear relationship appeared to exist between recurrent aphthous ulcers and a deficiency of vitamin B12. It is concluded that in all patients with recurrent aphthous ulceration, deficiency of vitamin B12 should be considered.

What is the role of oral vitamin B-12 in the treatment of recurrent aphthous stomatitis (RAS)?

Updated: May 11, 2020 

• Author: Jaisri R Thoppay, DDS, MBA, MS; Chief Editor: Arlen D Meyers, MD, MBA  more...

• References

Oral vitamin B-12 may significantly reduce or eliminate RAS recurrences. For example, a randomized, double-blind, placebo-controlled study by Volkov et al found that in patients taking 1000 μg of sublingual vitamin B-12 daily for 6 months, there was a significant decrease in the number of ulcers and level of pain, as well as in the duration of outbreaks, at 5 and 6 months no matter what the patients' initial B-12 blood levels had been. Moreover, during the sixth month of treatment, 74.1% of the patients taking B-12 achieved "no aphthous ulcers status," compared with 32.0% of patients in the control group. ^[17]

^{비타민 b1, 2, 6 부족과 아프타성 구내염}

J Oral Pathol Med

. 1991 Sep;20(8):389-91.

 doi: 10.1111/j.1600-0714.1991.tb00950.x.

Recurrent aphthous ulceration: vitamin B1, B2 and B6 status and response to replacement therapy

A Nolan 1, W B McIntosh, B F Allam, P J Lamey

Affiliations expand

• PMID: 1941656
 
• DOI: 10.1111/j.1600-0714.1991.tb00950.x

Abstract

An eval‎uation of the thiamine, riboflavin and pyridoxine (vitamin B1, B2 and B6) status of 60 patients with recurrent mouth ulcers was performed. Seventeen patients (28.2%) were found to be deficient in one or more of these vitamins. Replacement therapy of these vitamins was given to a study group of deficient patients and a non-deficient group for one month. At the end of therapy and after a follow-up period of 3 months, only those patients who had a B complex deficiency had a significant sustained clinical improvement in their mouth ulcers. Vitamin B1, B2 and B6 deficiencies should, therefore, be considered as another possible precipitating factor in recurrent aphthous ulceration.

아연부족과 아프타성 구내염

비타민 c부족과 아프타성 구내염

Management of Aphthous Ulcers

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DAVID R. MCBRIDE, M.D., Lynn Community Health Center, Lynn, Massachusetts

Am Fam Physician. 2000 Jul 1;62(1):149-154.

  See related patient information handout on aphthous ulcers, written by the author of this article.

Aphthous ulcers are a common and painful problem. Benign aphthae tend to be small (less than 1 cm in diameter) and shallow. Aphthous ulcers that occur in conjunction with symptoms of uveitis, genital ulcerations, conjunctivitis, arthritis, fever or adenopathy should prompt a search for a serious etiology. The lack of clarity regarding the etiology of aphthous ulcers has resulted in treatments that are largely empiric. These treatments include antibiotics, antiinflammatories, immune modulators, anesthetics and alternative (herbal) remedies.

Aphthous ulcers can be classified into three different types: minor, major and herpetiform.1,2 Minor aphthae are generally located on labial or buccal mucosa, the soft palate and the floor of the mouth. They can be singular or multiple, and tend to be small (less than 1 cm in diameter) and shallow3 (Figure 1). Major aphthae are larger and involve deeper ulceration. Major aphthae may also be more likely to scar with healing2 (Figure 2). Herpetiform aphthae frequently are more numerous and vesicular in morphology. Patients with benign aphthous ulcers should have no other findings such as fever, adenopathy, gastrointestinal symptoms or other skin or mucous-membrane symptoms.

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FIGURE 1.

Minor aphthous ulcer.

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FIGURE 2.

Major aphthous ulcer.

Pathophysiology

The pathophysiology of aphthous ulcers is poorly understood. Histologically, aphthae contain a mononuclear infiltrate with a fibrin coating.3 Patients with recurrent aphthae may have alteration of local cell–mediated immunity. Systemic T- and B-cell responses have also been reported as altered in patients with recurrent aphthae.2

Etiology

Aphthae more commonly affect young adults, and a familial tendency may exist.3 Paradoxically, smoking offers a somewhat protective effect against recurrent aphthae.2 Other etiologic factors such as stress, physical or chemical trauma, food sensitivity and infection have been proposed. Infectious agents such as Helicobacter pylori and herpes simplex virus have been investigated but have not been consistently found in aphthous ulcers.4 The lack of clarity regarding etiology has resulted in treatments that are largely empiric and aimed at symptom reduction.

Differential Diagnosis

Several conditions should be considered in the differential diagnosis when eval‎uating patients with recurrent aphthae. A primary consideration is that benign aphthae tend to be smaller and are more often self-limited when compared to more serious conditions. Major aphthae can be associated with human immunodeficiency virus (HIV) infection; clinicians should consider HIV testing when aphthae are large and slow to heal. Table 1 outlines the differential diagnosis of aphthous ulcers, with distinguishing features.

View/Print Table

TABLE 1

Differential Diagnosis of Aphthous Ulcers

DIAGNOSIS		POTENTIAL DIFFERENTIATING FEATURES
Infection
Viral
	Herpesvirus	Vesicular lesions, Tzank stain positive for inclusion-bearing giant cells
	Cytomegalovirus	Immunocompromised patient, biopsy positive for multinucleated giant cells
	Varicella	Characteristic skin lesions
	Coxsackievirus	Hand/foot/buttock lesions, typically in children
Treponemal
	Syphilis	Risk factors, other skin lesions, RPR/FTA test is positive
Fungal
	Cryptosporidium, mucormycosis, histoplasma	Immunocompromised patient, chronicity, biopsy and culture positive
Autoimmune
Behçet's syndrome		Genital ulceration, uveitis, retinitis
Reiter's syndrome		Uveitis, conjunctivitis, HLA B27 arthritis
Inflammatory bowel disease		Recurrent bloody or mucous diarrhea, other GI ulcerations
Lupus erythematosus		Malar rash, ANA-positive
Bullous pemphigoid		Diffuse skin involvement
Pemphigus vulgaris		Diffuse skin involvement
Hematologic
Cyclic neutropenia		Periodic fever, neutropenia
Neoplasm
Squamous cell carcinoma		Chronicity, head/neck adenopathy, biopsy positive

---

RPR/FTA = rapid plasma reagin/fluorescein treponema antibody test; GI = gastrointestinal; ANA = antinuclear antibody.

Infection-causing ulceration in the mouth should be considered when eval‎uating patients with oral symptoms. A common infection, particularly in patients with HIV infection and aphthae, is herpes5 (Figure 3). When Tzank staining is available, a sample from a herpetic lesion will reveal inclusion-bearing giant cells. Other viral, bacterial, treponemal and fungal agents have the potential to cause mouth ulcers. Biopsy alone or in conjunction with a culture of lesions or blood testing may aid in distinguishing the causative agent.

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FIGURE 3.

Herpes stomatitis, found primarily on the alveolar mucosa. Tzank stain of a lesion scraping revealed inclusion-bearing giant cells.

AUTOIMMUNE DISEASES

Several autoimmune diseases may mimic benign aphthous ulcers. Behçet's syndrome is an autoimmune vasculitis that causes recurrent oral and genital ulcerations, uveitis and retinitis. Severe aphthae and Behçet's syndrome may be two points on a disease continuum. Non-oral symptoms of Behçet's syndrome may be present in 43 to 100 percent of patients with recurrent aphthous ulcers, depending on severity.6 Reiter's syndrome is associated with oral ulcers, uveitis, conjunctivitis and HLA B27-positive arthritis following nongonococcal urethritis or bacillary dysentery.3 Patients with inflammatory bowel disease, in particular Crohn's disease, may present with associated mouth ulcerations. Lupus erythematosus, bullous pemphigoid and pemphigus vulgaris are other diseases that may involve ulceration of the mouth. In all of these conditions, the associated symptoms should be elicited to make a differentiation from benign recurrent aphthae.

HEMATOLOGIC/ONCOLOGIC DISEASES

Hematologic etiologies should be considered when eval‎uating recurrent or slow-healing mouth ulcers. Cyclic neutropenia is associated with mouth ulcers during neutropenic periods.2 Fever may also be a presenting symptom during these periods. Consideration may be given to blood count measurement if fever and mouth ulcers regularly occur together. Finally, a neoplasm such as squamous cell carcinoma must be ruled out when eval‎uating patients with persistent, nonhealing mouth ulceration. Office punch biopsy or surgical biopsy may help make this distinction. Eval‎uation of the head and neck for adenopathy is particularly important in this situation.

Treatment

Treatment for oral aphthae can be divided into five categories: antibiotic, anti-inflammatory, immune modulatory, symptomatic and alternative (Table 2). The lack of predictability of the efficacy of a particular treatment mirrors the mystery surrounding the etiology of the condition.

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TABLE 2

Common Treatments for Aphthous Ulcers

AGENT	DOSAGE	EVIDENCE FOR USE
Tetracycline capsule, 250 mg	1 capsule dissolved in 180 mL of water; rinse with this suspension four times daily for 4 to 5 days	Randomized, controlled studies1 support use
Tetracycline syrup, 250 mg per 5 mL	5 mL “swish and spit” four times daily for 4 to 5 days	As above
Minocycline tablet, 100 mg	1 tablet dissolved in 180 mL of water; rinse with this suspension twice daily for 4 to 5 days	As above
Triamcinolone 0.1% in Orabase (Kenalog in Orabase)	Apply to dried ulcer two to four times daily until healed	Randomized, controlled studies1 show decreased pain
Dexamethasone elixir, 0.5 mg per 5 mL	Swish and spit with 5 mL every 12 hours	As above
Thalidomide	200 mg, one to two times daily for 3 to 8 weeks Warning: contraindicated in pregnancy	Studies in HIV-infected patients only7
Amlexanox 5% paste	Apply to dried ulcer two to four times daily	Randomized, controlled studies9,10 show decreased symptoms and faster healing
Viscous lidocaine, 2%	Apply to ulcer as needed	For brief local pain relief only
Zinc lozenges	Suck one lozenge four to six times daily	No studies
Vitamin C, 500 mg	One tablet, four times daily	No studies
Vitamin B complex	One tablet, four times daily	No studies
l-Lysine, 500 mg	One tablet, one to three times daily	Studies in herpes only

ANTIBIOTIC THERAPY

Topical and systemic antibiotic treatments are empiric and are used because of a belief that some as-yet-undiscovered infectious agent is causing the aphthous ulcer. Tetracycline and minocycline are the agents most commonly used. A 250-mg antibiotic capsule of tetracycline can be dissolved in 180 mL water and used as a “swish and swallow” or “swish and spit” treatment four times per day for several days in adult patients. Reduction of pain and duration of ulcerations may result. Tetracycline suspension, 250 mg per 5 mL, can also be used in a similar fashion, with 5 mL swished four times per day. (In children and in women who may be pregnant, tetracycline should be avoided because of its tendency to discolor teeth.) Minocycline can also be used this way, with a 100-mg tablet dissolved in 180 mL water and swished twice per day.1 The same precautions for children and women apply. In addition, minocycline use can cause fetal harm. Therefore, women who are pregnant or who become pregnant while taking the antibiotic should be informed of the potential for harm to the fetus.

ANTI-INFLAMMATORY AGENTS

Local anti-inflammatory agents may be the most helpful way to speed healing and relieve symptoms in the management of recurrent minor aphthous ulcers. Triamcinolone 0.1 percent (Kenalog in Orabase) can be applied to ulcers two to four times a day.1 This preparation also provides a protective local coating for the ulcer. Early initiation of this treatment may result in a more rapid response. The paste can be applied until the ulcer is healed. For more extensive oral ulceration, dexamethasone elixir, 0.5 mg per 5 mL, may be used as a rinse and expectorated.1 Patients should be warned of the potential for secondary fungal infection when using a steroid rinse. Systemic steroids are generally not recommended in the management of aphthous ulcers, although they may be helpful in the management of conditions that mimic aphthous ulcers.

IMMUNE MODULATORS

Immune modulators used for the management of aphthous ulcers have been investigated most thoroughly in patients infected with HIV. Aphthous ulcers in HIV-infected patients may have extremely protracted healing times, up to months. Thalidomide (Thalomid) is the agent most frequently used for management of aphthous ulcers that cause severe pain with eating. Thalidomide in a dosage of 200 mg once to twice daily for three to eight weeks yields a faster healing rate than placebo.7,8 Thalidomide is contraindicated in non-HIV–infected patients because of its potential for significant side effects and teratogenicity.

Amlexanox 5 percent paste (Aphthasol) has been examined in several studies of the treatment of aphthous ulcers. The paste was applied to ulcers two to four times a day.9 Healing time was improved with this agent. In one large study, 21 percent of patients achieved complete healing at three days compared with 8 percent of untreated patients.10

OTHER AGENTS

Other strategies exist for local and systemic symptom relief in patients with aphthous ulcers. Pain relief may be achieved with 2 percent viscous lidocaine applied with a cotton swab several times daily, as needed.1,11 Over-the-counter benzocaine preparations (e.g., Anbesol and Oragel) may also be used. Over-the-counter agents such as Orabase or Zilactin-B coat aphthous ulcers and provide local protection.11 Brief anesthesia may be obtained with the application of a silver nitrate stick, although the application itself is quite painful. Silver nitrate may cause more local necrosis and, ultimately, delayed healing. Finally, the combination of over-the-counter magnesium hydroxide antacid and diphenhydramine hydrochloride (5 mg per mL), mixed half and half, will bring about some symptom relief.1 A 5-mL dose of the mixture can be swished and swallowed four to six times a day. Systemic nonsteroidal anti-inflammatory agents or acetaminophen may provide some analgesia when ulcers are very painful.

ALTERNATIVE AGENTS

Sucking on zinc gluconate lozenges is anecdotally reported to provide local relief and speeding of healing time for aphthous ulcers. Vitamin C, vitamin B complex and lysine may speed healing when taken orally at the onset of lesions. Sage and chamomile mouthwash, created by infusing equal amounts of the two herbs in water, may be helpful when used four to six times a day. Echinacea is reported to speed healing, perhaps through its immune modulatory effect. Carrot, celery and cantaloupe juices also have been reported as helpful complementary agents.12 None of these agents has been studied in randomized controlled trials.

Final Comment

Aphthous ulcers are a poorly understood clinical entity that cause significant pain in otherwise healthy patients. Several agents are helpful in the management of aphthous ulcers, including antibiotics, antiinflammatories, immune modulators, anesthetics and alternative products. When ulcers are slow to heal or if associated systemic symptoms are present (e.g., uveitis, arthritis, fever, adenopathy), other, more serious conditions should be ruled out.

The Author

DAVID R. MCBRIDE, M.D., is the medical director of the Lynn Community Health Center in Lynn, Mass. He is also a clinical instructor in the departments of family medicine at Boston University School of Medicine and Tufts University School of Medicine. Dr. McBride received his medical degree from the University of Pittsburgh (Pa.) School of Medicine and completed a residency in family practice at York (Pa.) Hospital.

Address correspondence to David R. McBride, M.D., Lynn Community Health Center, 269 Union St., Lynn, MA 01901. Reprints are not available from the author.

REFERENCES

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1. Burgess JA, Johnson BD, Sommers E. Pharmacological management of recurrent oral mucosal ulceration. Drugs. 1990;39(1):54–65....

Richard W. Sloan, M.D., R.Ph., coordinator of this series, is chairman and residency program director of the Department of Family Medicine at York (Pa.) Hospital and clinical associate professor in family and community medicine at the Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pa.

오메가 3 지방산의 아프타성 구내염 치료효과 논문

ORAL MEDICINE| VOLUME 117, ISSUE 2, P191-196, FEBRUARY 01, 2014

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Efficacy of omega-3 in treatment of recurrent aphthous stomatitis and improvement of quality of life: a randomized, double-blind, placebo-controlled study

• Amr M. El khouli, BDS, MS, PhD 
• Enas Ahmed El-Gendy, BDS, MS, PhD

Published:November 25, 2013DOI:https://doi.org/10.1016/j.oooo.2013.09.003

Objective

This study assessed the effects of systemic omega-3 on the treatment of recurrent aphthous stomatitis and on the improvement of quality of life.

Study Design

Fifty participants were randomly assigned to receive either omega-3 (1 g, 3 times daily) or placebo for 6 months. Assessment of outcome measures including monthly number of new ulcers, average duration of ulcer episodes, and pain level of ulcers was carried out at baseline and monthly for 6 months. Analysis of potential impact on quality of life using the Oral Health Impact Profile 14 was carried out at baseline and 6 months.

Results

Daily omega-3 treatment achieved a significant reduction in number of ulcers, duration of ulcers, and level of pain by 3 months that persisted for 6 months. Mean score on Oral Health Impact Profile 14 also significantly improved by 6 months.

Conclusions

A daily omega-3 regimen shows promise as therapy for treatment and management of patients with recurrent aphthous stomatitis.

비타민 d와 아프타성 구내염 치료 논문

- 너무 많음..  클리클릭

[문형철]

http://www.doiserbia.nb.rs/img/doi/0042-8450/2020%20OnLine-First/0042-84501900037S.pdf - 헤르페스 심플렉스 바이러스 치료 논문

[문형철]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681845/ 칸디다 곰팡이 균에 의한 구내염은 너무 어려운 듯