Clinical Efficacy of Topical Kenacort and Aloe Vera Gel in Minor Aphthous Stomatitis: A Comparative Study

ABSTRACT

Aim:

The aim of the study is to compare the clinical efficacy of both the topical agents—aloe vera gel and Kenacort oral paste (0.1% triamcinolone acetonide) in patients with minor aphthous stomatitis.

Materials and Methods:

60 patients were recruited for the study and were randomly divided into two groups—Group A (aloe vera gel group) and Group B (Kenacort oral paste group). The baseline parameters were taken and recorded on the day of the first visit which included ulcer size, pain, and burning sensation. Evaluation of reduction in ulcer size, pain, and burning sensation were made on day 3 and day 7.

Results:

The results of the present study revealed that both the study groups showed no significant difference in the size of ulcer at day 1, day 3, and day 7 when compared using independent t-test as P > 0.05 at all study intervals. Therefore, both the agents were found to be equally effective against reducing the size of ulcer, pain, and burning sensation.

Conclusion:

The present study findings demonstrate that topical application of the aloe vera gel was able to decrease the ulcer size, intensity of pain, and burning sensation, thereby accelerating the healing without any side effects. Thus, topical aloe vera could be safe and a better alternative to topical steroid for RAS.

INTRODUCTION

The word “aphthous” is a translation of the Greek verb “aphthi,” which means “to light on fire” or “to inflame.” The most prevalent oral cavity condition affecting the general population is aphthous ulcers.[1] An inflammation called minor aphthous stomatitis frequently affects otherwise healthy people. The buccal mucosa, the oral floor, and the labial mucosa are all affected, and there may be one, several, or recurrent ulcers present.[2] In the general population, the prevalence ranges from 2% to 66%.[2,3] Aphthous stomatitis has three clinical subtypes: minor, major, and herpetiform. Among all of these, mild aphthous ulceration is the most common form.[4,5]

Aphthous stomatitis’ etiology is unknown. A family history, nutritional inadequacies, food sensitivities, immunological variables, menstrual cycle changes, tobacco cessation, psychological stress, or trauma to the mouth mucosa are a few examples of etiological factors.[5] A definite diagnosis for minor aphthous stomatitis cannot be made in a laboratory setting. Topical anesthetics, antimicrobials, topical corticosteroids, immunomodulatory drugs, and laser therapy are among the therapeutic options.[6,7]

The use of natural treatments for the prevention and treatment of oral mucosal problems has grown recently. Aloe vera is an important component of the traditional medical system known as Ayurveda. Because of its numerous pharmacological and biological qualities, the succulent aloe vera leaves and the gel that may be derived from them have been utilized as herbal medicines for a variety of illnesses.[2] There are numerous research showing the individual effectiveness of steroids and aloe vera gel in treating oral mucosal diseases. Few research, meanwhile, have examined the effectiveness of Ayurveda and allopathy in treating aphthous ulcers. Consequently, the aim of this study is to investigate the efficacy of aloe vera gel and Kenacort oral paste in those with minor aphthous stomatitis.

MATERIALS AND METHODS

1. SOURCE OF DATA - The study involved 60 individuals who visited the Oral Medicine and Radiology Department at the Vyas Dental College and Hospital in Jodhpur, Rajasthan. Patients gave an informed consent and were clinically diagnosed with minor aphthous stomatitis with a history of duration of ulcers for less than 48 hours. The study excluded patients who had any systemic disorders, women who were pregnant, and had major and herpetiform ulcers. The institutional ethics board granted the clearance for conduct with approval number VDCH/IEC/02/2019.

Medications used

1. Aloe vera gel—by Mandhaniya Herbal products.

2. Kenacort oral paste by Abbott Healthcare Pvt Ltd.—0.1% triamcinolone acetonide.

Study procedure

The sample was divided into two distinct groups which are as follows:

Group A: comprised 30 patients having a clinical diagnosis of minor aphthous stomatitis. The patients were given instructions to immediately apply aloe vera gel to the ulcers thrice a day for a week. Patients were instructed to wait 30 minutes before eating or drinking after the application. On the initial visit, baseline measurements of the ulcer size, pain (measured as a VAS score), and burning sensation were taken. Assessments of reduction in pain, ulcer size, and burning sensation were made on days 3 and 7.

Group B: comprised 30 patients having a clinical diagnosis of minor aphthous stomatitis. The patients were instructed to topically apply Kenacort paste to the ulcer three times each day for a week. Patients were instructed to wait 30 minutes before eating or drinking after the application. On the initial visit, baseline measurements of the ulcer size, pain (measured as a VAS score), and burning sensation were taken. Assessments of reduction in pain, ulcer size, and burning sensation were made on days 3 and 7.

The size of the ulcer was assessed using a calibrated William’s periodontal probe with millimeter marks.

RESULTS AND STATISTICAL ANALYSIS

The data were analyzed using IBM Inc.’s Statistical Package for Social Sciences (SPSS) version 21 software. Each variable’s descriptive data was supplied. Descriptive statistics like mean and standard deviation were calculated for continuous variables.

The Shapiro–Wilk test was used to determine whether the data were normal. Bivariate analyses were carried out using an independent “t”-test because the data was discovered to be regularly distributed.

The results of present study concluded that there was no significant difference seen in the reduction of ulcer size, VAS score for pain, and burning sensation on inter-group comparison, at different follow-up intervals when compared using independent t-test as P > 0.05 at all study intervals as shown in Figure 1. Hence, both aloe vera gel and Kenacort oral paste (0.1% triamcinolone acetonide) were found to be equally effective against reducing the size of ulcer, pain, and burning reported in minor aphthous stomatitis patients.

Figure 1.

Comparison of ulcer sizes and VAS score for pain and burning sensation among the study groups at different time intervals

DISCUSSION

The most prevalent oral illness, minor aphthous stomatitis, lacks a definite pathogenesis. Most of the 8–10 treatments are diverse. It may be difficult to conduct clinical trials for new medicines. These days, aloe vera is getting a lot of attention.[8,9,10,11,12] Despite its widespread use, aloe vera gel has not yet been thoroughly studied by science. Since there have only been a few allergic reactions reported, it is considered safe.[11,13] According to Figure 1, there were no discernible differences between the two test agents’ efficacy in this study in terms of reducing ulcer size, discomfort, or burning sensation. The effectiveness of aloe vera gel in the treatment of aphthous ulceration was evaluated by Giroh VR et al. and Bhalang K et al., in contrast. They asserted that research shown that Kenacort was more effective in healing than aloe vera gel.[8,14] Patients with recurrent aphthous stomatitis, possibly malignant diseases, and oral cancer showed greater levels of IgA and IgM compared to healthy controls.[15,16,17] The Thompson paper from 1991 stated that topical aloe vera gel encouraged fibroblast activation and collagen synthesis.[17]

There are always limitations to study. This study’s shortcoming is the way ulcers were measured. Monitoring lowered depth and inflammation levels is crucial because ulcer size reduction and pain relief are not the only signs of better wound healing. Future research must therefore develop criteria for assessing and standardising these elements.

CONCLUSION

The findings of the present study demonstrated that using aloe vera gel topically decreased ulcer size and pain severity without having any adverse side effects. Aloe vera gel may therefore be a safer and better option than topical steroids for the treatment of aphthous stomatitis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.