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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 31  |  Issue : 4  |  Page : 298-302

Efficacy of alum in recurrent aphthous stomatitis


Department of Oral Medicine and Radiology, Pandit Deendayal Upadhyay Dental College, Solapur, Maharashtra, India

Date of Submission25-Jun-2019
Date of Acceptance09-Sep-2019
Date of Web Publication03-Mar-2020

Correspondence Address:
Dr. Vasundhara Bandagi
Pandit Deendayal Upadhyay Dental College, 19/1 Kegaon, Solapur - 413 255, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_123_19

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   Abstract 


Aphthous ulcers are the most common lesions encountered in the oral cavity. The mild recurrent apthous stomatitis (RAS), is an extremely painful condition. Various treatment modalities are tried for RAS. Alum is also tried and found to be successful. Alum is used in traditional medicine for the treatment of oral ulcers without significant side effect. Aim: To assess the efficacy of alum for the treatment of recurrent aphthous stomatitis. Settings and Design: Longitudinal study was carried out in the Department of Oral Medicine and Radiology under institution setting. Methods and Materials: This study was conducted on 50 patients with RAS, aged between 15 and 40 years. The diagnosis of RAS was made based on its clinical appearance and the history provided by the patient. Application of alum on aphthous ulcers was done. Statistical Analysis Used: The data obtained was tabulated and subjected to statistical analysis. Results: In 50 patients reporting to the Department of Oral Medicine with RAS, 70% were female and 30% were male. Majority of cases found in the range of 21–30 years. The majority of patients gave VAS 0 on the second day of application. The rest of the patients gave a VAS 0 on the third day of application. Complete healing of the ulcer was seen in 85% of the patients on third day and the rest of the patients showed healing on fourth day. Conclusions: The results showed that alum significantly reduces the severity of pain and duration of healing without any side effects.

Keywords: Alum, recurrent aphthous ulcer, types of recurrent aphthous ulcers


How to cite this article:
Bandagi V, Onkar S, Birangane R, Kulkarni A, Chaudhari R, Parkarwar P. Efficacy of alum in recurrent aphthous stomatitis. J Indian Acad Oral Med Radiol 2019;31:298-302

How to cite this URL:
Bandagi V, Onkar S, Birangane R, Kulkarni A, Chaudhari R, Parkarwar P. Efficacy of alum in recurrent aphthous stomatitis. J Indian Acad Oral Med Radiol [serial online] 2019 [cited 2020 May 26];31:298-302. Available from: http://www.jiaomr.in/text.asp?2019/31/4/298/279845




   Introduction Top


Recurrent apthous stomatitis (RAS) is a common disorder characterized by recurring ulcers confined to the oral mucosa in patients with no other signs of systemic disease. It is an acute painful condition.[1] It generally affects 20% general population. RAS is confined to nonkeratinized oral mucosa.

Alum (KAI (SO4).12 H2O) is translucent and odorless crystals with astringent and hemostatic properties.[2] Nowadays corticosteroids are widely used to control aphthous lesions; however, even their topical application may be associated with some side effects. To decrease the use of steroids, the current study is aimed to assess the efficacy of alum on RAS.


   Aim and Objective Top


To assess the efficacy of alum for the treatment of recurrent aphthous stomatitis.


   Subjects and Methods Top


We diagnosed aphthous ulcers as minor aphthous ulcers according to Burket 12th edition, that is, RAS are confined to the oral mucosa and begin with prodromal burning or the sensation of a small bump in the mucosa from 2 to 48 h before an ulcer appears. During this initial period, a localized area of erythema develops. Within hours, a small white papule forms, ulcerates, and gradually enlarges over the next 48–72 h. The individual lesions are round, symmetric, and shallow (similar to viral ulcers), without any tissue tags. RAS, the lesions reach a size of 0.3–1.0 cm and begin healing within a few days.

This longitudinal study was conducted on 50 patients with recurrent minor aphthous ulcers, aged between 15 and 40 years who reported to the Department of Oral Medicine and Radiology with the chief complaint of oral ulcers. The diagnosis of RAS was made based on its clinical appearance and the history provided by the patient.

  • Inclusion criteria:


    1. Patients with recurrent minor aphthous ulcers single or multiple with size less than 1 cm in diameter, age in the range of 15–40 years.
    2. The duration of ulcers should not be more than 7–10 days.


  • Exclusion criteria: pregnancy and nursing, patients with fungal or viral infections, patient who are under treatment with any medication and those taking nonsteroidal anti-inflammatory drugs, and patients with fixed orthodontic appliances or retainers or sharp cusp of tooth which was in close contact with aphthous ulcer.
  • Written informed consent was taken from the patient prior to the procedure.


Application of alum on recurrent aphthous stomatitis in the form of:

  1. Powder form [Figure 1]: two times for 5 days for 30 s. Informed patients hold the powder on the ulcer with the help of cotton swab for 30 s. Over a period of 30 s, patients were instructed to wash the mouth with water.
  2. Solution form [Figure 2]: two times for 5 days, 500 mg of powder dissolved in 2 ml of drinking water and applied for 30 s. Over a period of 30 s, patients were instructed to wash the mouth with water. (used in case of multiple minor aphthous ulcers)


Patients who met the inclusion criteria were divided into 2 groups of 25 each.
Figure 1: Alum in powder form

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Figure 2: Alum in liquid form

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  • One group was advised to apply alum powder directly onto the ulcer [Figure 3] and [Figure 4], using a cotton bud/swab.
  • The other group was advised to dissolve the alum powder in drinking water. Use of alum in solution form where powder application is not possible for example in case of multiple aphthous ulcer [Figure 5].


Patient response to treatment was determined by:
Figure 3: Minor aphthous ulcer present on lower labial mucosa

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Figure 4: Application of alum on day 1

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Figure 5: Multiple minor aphthous ulcer present on right buccal mucosa

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  1. Clinical evaluation of the lesion [Figure 6], [Figure 7], [Figure 8] and subjective treatment response (VAS),
  2. Duration of lesion healing.
Figure 6: Application of alum on ulcer on day 2 shows reduction in size and surrounding erythema of ulcer

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Figure 7: Day 3 shows complete healing of ulcer

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Figure 8: Day 3 shows complete healing of multiple minor ulcers

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   Results Top


In 50 patients reporting to the Department of Oral Medicine with recurrent minor aphthous ulcers, 70% were female and 30% were male [Graph 1]. Age of the patients ranged between 15 and 40 years. The majority of cases found in the range of 21–30 years [Graph 2]. In our study, the most common location of apthous ulcers was on buccal mucosa (30%) followed by labial mucosa (20%). Other areas such as retropharyngeal area, floor of mouth, and tongue (15%) found involved in similar frequency and other area such as palate least commonly involved (5%) as shown in [Graph 3]. Visual analogue scale (VAS) was taken by the patient before the application of alum and from the day of application of alum till complete resolution pain. Burning sensation was increased at the time of application for 5–10 s after that severity of pain was greatly reduced. The majority of patients gave VAS 0 on the second day of application. The rest of the patients gave a VAS 0 on the third day of application [Graph 4]. The disappearance of the lesion [Figure 5], [Figure 6], [Figure 8] was seen in 85% of the patients on third day and the rest of the patients showed healing on fourth day [Graph 5]. Satisfactory healing was seen in both the groups, healing time being almost the same.




   Discussion Top


The incidence rate of RAS is higher in students, higher socioeconomic classes, female, and age in the range of 10 to 40 years.[3],[4],[5] Etiology of RAS[6],[7] is incompletely understood but appears to involve immune system dysfunction. Few theories suggesting an association between RAS and a number of microbial agents such as oral Streptococci, Helicobacter pylori, VZV, CMV, and human herpesvirus (HHV)-6 and HHV-7, and genetic factors, hematologic or immunologic abnormalities, and local factors such as trauma and smoking. Research has suggested a relationship between RAS and lymphocytotoxicity, antibody-dependent cell-mediated cytotoxicity, defects in lymphocyte cell subpopulations, and an alteration in the CD4 to CD8 lymphocyte ratio.

Based on its clinical presentation RAS is classified into:

  1. Minor aphthous ulcers (80%), less than 1 cm in diameter. Minor ulcers heal within 7–14 days without scarring,
  2. Major aphthous ulcers which are more than 1.0 cm, lasting weeks, heal often with scarring,
  3. Herpetiform aphthous ulcers, less than 1.0 cm in diameter, more than 10 in numbers, dispersed widely over mucosa.


There is no definite treatment for RAS and supportive treatment is performed aiming to control pain and accelerate healing.[5] In mild cases, a protective emollient such as Orabase often relieves pain and facilitates healing. Other treatment modalities include anesthetic agent such as benzocaine or lidocaine, topical steroid preparation, tetracycline or doxycycline either as a topical or mouthrinse, and intralesional steroid injections along with nutritional supplement.[8]

Herbal medications such as alum have been tried in the form of an adhesive patch and have given better results. It enhances wound healing by decreasing the inflammation in the mucosal membrane [Figure 9]. Along with this property, it also causes tissue contraction.[9],[10] Alum is active against oral bacteria especially Streptococcus. The available data indicate that most of aphthous ulcers have female predilection and common in 21–30 years of age group. For the management of RAS, supportive care is taken to reduce the severity of pain and maintain function during the attack. Rafieian used 7% of alum in the form of an adhesive patch to treat RAS and found that alum is safe to use in treating RAS without any side effects.[11] Altaei et al. used 1%, 3%, 5%, and 7% suspensions of alum to treat RAS and found alum significantly effective in reducing the severity of pain and even size of ulcer compared to the control group.[11] These results support our findings that such as a reduction in the severity of pain was on the first day of application and healing of the ulcers on the third day or maximum on the fourth day.
Figure 9: Mode of Action of Alum

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Alum accelerates wound healing by decreasing mucosal membrane inflammation. Alum prevents bacterial growth and extension of lesions by reducing pH which helps the immune system to eliminate fatty acids produced by bacteria.[11] The risk of aluminium toxicity is associated with the use of alum. Till now, there was no sign of oral mucosal injury, not even any side effects reported. The study conducted by Altaei et al. found that tongue was the most common site for ulcers in female which is contrast to our finding. Buccal and labial mucosa are the often involved site for RAS. Along with RAS, alum is effective in reducing gingivitis. High concentrations (5%–25%) of alum have been used traditionally gingival retraction agents to reduce inflammation and bleeding following oral surgery. Putt et al. conducted a study on the evaluation of an alum-containing mouthrinse in children for plaque and gingivitis inhibition during 4 weeks of supervised use and found that alum significantly reduced existing dental plaque in children who followed normal oral hygiene habits including tooth brushing for a period of 4 weeks.[9] And no adverse effect found on the use of alum in patients even after 4 weeks. Even in the current study, no side effect was observed due to the application of alum and it was conveniently used by patients at home.


   Conclusions Top


The results showed that alum significantly reduces the severity of pain and duration of healing without any side effects.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ship JA, Chavez EM, Doerr PA, Henson BS, Sarmadi M. Recurrent aphthous stomatitis. Quintessence Int 2000;31:95-112.  Back to cited text no. 1
    
2.
Gennaro AR. Remington's Pharmaceutical Science. 17th ed. Easton: Pennsylvania: Mack Publishing Co; 1985. p. 777.  Back to cited text no. 2
    
3.
Belenguer-Guallar I, Jiménez-Soriano Y, Claramunt Lozano A. Treatment of recurrent aphthous stomatitis. A literature review. J Clin Exp Dent 2014;6:168-74.  Back to cited text no. 3
    
4.
Donatsky O. Epidemiologic study on recurrent aphthous ulceration among 512 Danish dental students. Community Dent Oral Epidemiol 1973;1:37-40.  Back to cited text no. 4
    
5.
Rodu B, Mattingly G. Oral mucosal ulcers: Diagnosis and management. J AM Dent Assoc 1992;123:83-6.  Back to cited text no. 5
    
6.
Alidaee MR, Taheri A, Mansoori P, Ghodsi SZ. Silver nitrate cautery in aphthous stomatitis: A randomized controlled trial. Br J Dermatol 2005;153:521-5.  Back to cited text no. 6
    
7.
Lalla RV, Choquette LE, Feinn R, Zawistowski H, Latortue MC, Kelly ET, Multivitamin therapy for recurrent aphthous stomatitis: A randomized, double-masked, placebo-controlled trial. J Am Dent Assoc 2012;143:370-6.  Back to cited text no. 7
    
8.
Greenberg M, Glick M, Ship J. Burket's Oral Medicine. 11th ed. Hamilton, Ontario: BC Decker Inc; 2008. p. 5760.  Back to cited text no. 8
    
9.
Putt MS, Kleber CJ, Smith CE. Evaluation of an alumcontaining mouthrinse in children for plaque and gingivitis inhibition during 4 weeks of supervised use. Pediatr Dent 1996;18:139-44.  Back to cited text no. 9
    
10.
Gennaro AR. Remington: The Science and Practice of Pharmacy. 19th ed. Easton and Pennsylvania: Mack Publishing Co; 1995. p. 871.  Back to cited text no. 10
    
11.
Nasrin R, Hamidreza A, Aliakbar M, Mina J Efficacy of alum for treatment of recurrent aphthous stomatitis. Caspian J Intern Med 2016;7:201-5.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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