Effect of 0.5% Chitosan mouthwash on recurrent aphthous stomatitis

A randomized double-blind crossover clinical trial

Authors

  • Mina Motallebnejad DDS of Oral and Maxillofacial Medicine, Professor, Faculty of Dentistry, Oral Health Research Center, Babol University of Medical Sciences, Babol, Iran

Keywords:

Recurrent aphthous stomatitis, Chitosan, Triamcinolone, Mouthwash

Abstract

Background: Recurrent aphthous stomatitis (RAS) is one of the most common painful oral lesions of which there is no certain treatment. Objective: The aim of this study was to determine the effect of Chitosan mouthwash 0.5% on RAS. Methods: This randomized double-blind crossover clinical trial was conducted at a dental school in Babol, Iran, from 2015 to 2016. Twenty patients with a history of minor aphthous stomatitis were entered into this study. All patients were initially monitored in the first episode without treatment, and then were randomly treated in three other episodes with Chitosan, Triamcinolone or Biogel mouthwashes. The ulcer size and pain intensity by using visual analogous score (VAS) were recorded in each episode. Data were analyzed by ANOVA and Tukey test. We used SPSS version 20 to analyze data. Results: The mean ulcer size on the fifth day (p=0.026, p=0.042, respectively) and VAS on the third and fifth days (p=0.011, p=0.013, respectively) were significantly less in Triamcinolone and Chitosan groups than Biogel and the no treatment episode. There were no significant differences between Chitosan and Triamcinolone groups in the average ulcer size and pain intensity in all the examination days.  Conclusions: Chitosan mouthwash is effective on pain relief and reducing ulcer size of minor aphthous stomatitis and this effect is almost the same as Triamcinolone mouthwash. Clinical trial registration: The study was registered and approved by Iranian Registry of Clinical Trials (http://www.irct.ir) with IRCT ID: IRCT2015030718753N2. Funding: The study was funded by Deputy of Research and Technology of Babol University of Medical Sciences (ref. no.: 9133625)

References

Jurge S, Kuffer R, Scully C, Porter SR. Mucosal disease series. Number VI. Recurrent aphthous stomatitis.

Oral diseases. 2006; 12(1): 1-21. doi: 10.1111/j.1601-0825.2005.01143.x. PMID: 16390463.

Gallo Cde B, Mimura MA, Sugaya NN. Psychological stress and recurrent aphthous stomatitis. Clinics

(Sao Paulo). 2009; 64(7): 645-8. doi: 10.1590/S1807-59322009000700007. PMID: 19606240, PMCID:

PMC2710437.

Preeti L, Magesh K, Rajkumar K, Karthik R. Recurrent aphthous stomatitis. Journal of oral and

maxillofacial pathology: JOMFP. 2011; 15(3): 252-6. doi: 10.4103/0973-029X.86669.

Belenguer-Guallar I, Jimenez-Soriano Y, Claramunt-Lozano A. Treatment of recurrent aphthous stomatitis.

A literature review. J Clin Exp Dent. 2014; 6(2): e168-74. doi: 10.4317/jced.51401. PMID: 24790718,

PMCID: PMC4002348.

Ji QX, Zhong de Y, Lu R, Zhang WQ, Deng J, Chen XG. In vitro evaluation of the biomedical properties

of chitosan and quaternized chitosan for dental applications. Carbohydrate research. 2009; 344(11): 1297- 302. doi: 10.1016/j.carres.2009.05.014. PMID: 19535044.

Costa EM, Silva S, Madureira AR, Cardelle-Cobas A, Tavaria FK, Pintado MM. A comprehensive study

into the impact of a chitosan mouthwash upon oral microorganism's biofilm formation in vitro.

Carbohydrate polymers. 2014; 101: 1081-6. doi: 10.1016/j.carbpol.2013.09.041. PMID: 24299877.

Rinaudo M. Chitin and chitosan: Properties and applications. Progress in Polymer Science. 2006; 31(7):

-32. doi: 10.1016/j.progpolymsci.2006.06.001.

Okamoto Y, Kawakami K, Miyatake K, Morimoto M, Shigemasa Y, Minami S. Analgesic effects of chitin

and chitosan. Carbohydrate polymers. 2002; 49(3): 249-52. doi: 10.1016/S0144-8617(01)00316-2.

Maria M, Carvalho SG, Stamford TCM, Santos EP, Tenório P, Sampaio F. chitosan as an oral antimicribial

agent. Mendez-Vilas A, editor. badajoz: Formatex Research Center; 2011.

Huang S, Han B, Shao K, Yu M, Liu W. Analgesis and wound healing effect of chitosan and

carboxymethyl chitosan on scaled rats. Journal of Ocean University of china. 2014; 13(5): 837-41. doi:

1007/s11802-014-2285-2.

Ueno H, Mori T, Fujinaga T. Topical formulations and wound healing applications of chitosan. Advanced

Drug Delivery Reviews. 2001; 52(2): 105-15. doi: 10.1016/S0169-409X(01)00189-2. PMID: 11718934.

Kilic C, Gulec Peker EG, Acarturk F, Kilicaslan SM, Coskun Cevher S. Investigation of the effects of local

glutathione and chitosan administration on incisional oral mucosal wound healing in rabbits. Colloids Surf

B Biointerfaces. 2013; 112: 499-507. doi: 10.1016/j.colsurfb.2013.08.050. PMID: 24119774.

Zhou Y, Chen Q, Meng W, Jiang L, Wang Z, Liu J, et al. Evaluation of penicillin G potassium troches in

the treatment of minor recurrent aphthous ulceration in a Chinese cohort: a randomized, double-blinded,

placebo and no-treatment-controlled, multicenter clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol

Endod. 2010; 109(4): 561-6. doi: 10.1016/j.tripleo.2009.11.006. PMID: 20188604.

Jiang XW, Zhang Y, Song GD, Li FF, Peng HY, Yang SK, et al. Clinical evaluation of allicin oral adhesive

tablets in the treatment of recurrent aphthous ulceration. Oral Surg Oral Med Oral Pathol Oral Radiol

Endod. 2012; 113(4): 500-4. doi: 10.1016/j.oooo.2011.09.007. PMID: 22668427.

Tarakji B, Gazal G, Al-Maweri SA, Azzeghaiby SN, Alaizari N. Guideline for the diagnosis and treatment

of recurrent aphthous stomatitis for dental practitioners. Journal of international oral health: JIOH. 2015;

(5): 74-80. PMID: 26028911, PMCID: PMC4441245.

Bae K, Jun EJ, Lee SM, Paik DI, Kim JB. Effect of water-soluble reduced chitosan on Streptococcus

mutans, plaque regrowth and biofilm vitality. Clinical oral investigations. 2006; 10(2): 102-7. doi:

1007/s00784-006-0038-3. PMID: 16572330.

Costa EM, Silva S, Costa MR, Pereira M, Campos DA, Odila J, et al. Chitosan mouthwash: toxicity and in

vivo validation. Carbohydr Polym. 2014; 111: 385-92. doi: 10.1016/j.carbpol.2014.04.046. PMID:

Hamishehkar H, Nokhodchi A, Ghanbarzadeh S, Kouhsoltani M. Triamcinolone Acetonide

Oromucoadhesive Paste for Treatment of Aphthous Stomatitis. Advanced pharmaceutical bulletin. 2015;

(2): 277-82. doi: 10.15171/apb.2015.038. PMID: 26236668, PMCID: PMC4517075.

Published

2021-12-24

Issue

Section

Articles