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The oral mucosa is thin, and even slight trauma leads to rupture of vesicles and
bullae forming eroded, red areas, then fibrin forms over the erosion and an ulcer
develops. Ulcers are well-circumscribed, sometimes depressed lesions with an
epithelial defect that is covered by a fibrin clot, resulting in a yellow white
appearance. A good example for this is an aphthous ulcer.
Recurrent aphthous ulcers are characterized by small, round or oval-shaped lesions
with yellow or gray floors that are surrounded by erythematous halo.
12
They generally
occur in the oral mucosa and rarely on the gingiva.RAS accounts for 25 percent of
recurrent ulcers in adults and 40 percent in children.
1
It is more common in female.
There are three clinical presentations of Recurrent aphthous ulcers Minor, Recurrent
aphthous ulcers major and herpetiform ulceration. It is well recognized that the
symptoms caused by recurrent or chronic oral mucosal lesions such as pain during
speaking, eating, and swallowing; discomfort; impairment in food and liquid intake;
and problems in interpersonal relationships and self-esteem can deeply affect the
oral health-related quality of life (OHRQoL) of patients.
10,11
Recurrent aphthous ulcers do not have a clear etiology and, in some cases, are of
difficult control and treatment, causing discomfort to the patients. The development
of recurrence can be related to hereditary, psychosomatic, infectious, hormonal
(periods, pregnancy or post-menopausal) factors, trauma, stress, food allergies,
nutritional deficiencies (iron, vitamin B12 and folic acid) and hematological
abnormalities. However, the absence of biochemical and histological specific
changes characterizes this condition and allow to make the diagnosis of recurrent
aphthous ulcers.
2,3
There are many attempts to find the ideal treatment for this condition, however,
some patients do not need treatment due to the mild nature of the disease whereas
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others, who experience multiple episodes for months and/or with severe symptoms
of pain and difficulty in eating, should be treated in a palliative way.
4,5
Topical agents are the first treatment of choice because they are safe and effective,
with few side effects and have a lower chance of drug interaction.
6,7
Several topical
medications with distinct mechanisms are effective in managing Recurrent aphthous
ulcers lesions. Topical treatment is aimed at prevention of super-infection, protection
of existing ulcers, analgesia, decreasing inflammation, and treating active ulcers.
18
The word ‘LASER’ is an acronym for ‘Light Amplification by Stimulated Emission of
Radiation’. Low-level laser therapy (LLLT) is also known as ‘soft laser therapy’ or
bio-stimulation. The biostimulating effect of lasers used in the low-energy range (in
the order of mw/sm) is manifested in acceleration of regeneration processes. Lasers
using red light induce powerful analgesic and anti-inflammatory effects. Healing of
the ulcerations is mainly achieved by stimulating epithelial growth and
angiogenesis.
8,9
The mechanism of pain relief as a result of laser therapy is a matter of intensive
biological research. One of the ways by which Low-level laser therapy can cause
symptomatic pain relief is by enhancing the level of adenosine triphosphate (ATP)
synthesis in the mitochondria of neurons.
13
The increased level of ATP will cause
hyperpolarization of the neurons and obstruction of pain stimuli.
13,14
As a result, there
will be marked decrease in the induction of pain stimuli. Due to the stimulation by
Low-level laser therapy, there is a complex mechanism by which the level of ATP
increases in mitochondria and the cytoplasm in neuronal cells. Certain
photoreceptors in the mitochondrial respiratory chain absorb infrared wave lengths
and get excited.
15
This mitochondrial activation causes oxidative phosphorylation and
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production of ATP. There is also an increase in the electrical potential of
mitochondrial membrane and induction of nucleic acid synthesis.
16
Another
mechanism that has been proposed to explain the phenomenon of pain relief as a
result of Low-level laser therapy is the modification in the nerve conduction by the
process of release of endorphins and enkephalins.
16, 17
It is also suggested that Low-
level laser therapy may reduce pain perception by lowering the level of prostaglandin
E2 and interleukin-1β.
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REFERENCES:
1. Wallace a, rogers hJ, hughes sC, et al. Management of recurrent aphthous stomatitis in
children. Oral Medicine. 2015;42(6):564572.
2. Safadi RA. Prevalence of recurrent aphthous ulceration in Jordanian dental Patients. BMC
Oral Health. 2009;9:31
3. Preeti L, Magesh K, Rajkumar K, Karthik R. Recurrent aphthous stomatitis. J Oral Maxillofac
Pathol. 2011;15:252-6
4. Hamedi S, Sadeghpour O, Shamsardekani MR, Amin G, Hajighasemali D, Feyzabadi Z. The
Most Common Herbs to Cure the Most Common Oral Disease: Stomatitis Recurrent
Aphthous Ulcer (RAU). Iran Red Crescent Med J. 2016;18:e21694.
5. Natah SS, Konttinen YT, Enattah NS, Ashammakhi N, Sharkey KA, Häyrinen- Immonen R..
Recurrent aphthous ulcers today: a review of the growing knowledge. Int J Oral Maxillofac
Surg. 2004;33:221-34.
6. Tarakji B, Gazal G, Al-Maweri SA, Azzeghaiby SN, Alaizari N. Guideline for the Diagnosis and
Treatment of Recurrent Aphthous Stomatitis for Dental Practitioners. J Int Oral Health.
2015;7:74-80.
7. Scully C, Porter S. Oral mucosal diseases: recurrent aphthous stomatitis. Br J Oral Maxillofac
Surg. 2008;46:198-206.
8. Mosvin CV, Buylin BA. Foundations of laser therapy.Moskow: Triada; 2006. Russian.
9. Ryazkova M, Kirova I. Physical therapygeneral and special part. Sofia: Medical Publishing
House ARSO; 2002.Bulgarian.
10. Llewellyn CD, Warnakulasuriya S. The impact of stomatological disease on oral health-
related quality of life. Eur J Oral Sci. 2003;111(4):297304.
11. Tabolli S, Bergamo F, Alessandroni L, Di Pietro C, Sampogna F,Abeni D. Quality of life and
psychological problems of patients with oral mucosal disease in dermatological practice.
Dermatology. 2009;218(4):314320.
12. Scully C, Felix DH. Oral medicine--update for the dental practitioner. Aphthous and other
common ulcers. Br Dent J. 2005;199(5):259-264. doi:10.1038/sj.bdj.4812649.
13. Hamblin Demidova, T.N MR. Mechanisms of low level light therapy. Proc SPIE.2006:614001.
14. Miloro M, Halkias LE, Mallery S, Travers S, Rashid RG. Low-level laser effect on neural
regeneration in Gore-Tex tubes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
2002;93(1):27-34.
15. Karu T. Photo biology of low-power laser effects. Heal Phys. 1989;56:691-704.
16. Aggarwal H, Singh MP, Nahar P, Mathur H, Gv S. Efficacy of low-level laser therapy in
treatment of recurrent aphthous ulcers - a sham controlled, split mouth follow up study. J
Clin Diagn Res. 2014;8(2):218-221.
17. Lins Dantas, E.M., Lucena, K.C., Catão, M.H., Granville-Garcia, A.F., Carvalho Neto, L.G RD.
Bio stimulation effects of low-power laser in the repair process. Ann Bras Dermatol.
2010;85:849-855.
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18. Edgar NR, Saleh D, Miller RA. Recurrent aphthous stomatitis: a review. The Journal of clinical
and aesthetic dermatology. 2017 Mar;10(3):26.

Unformatted Attachment Preview

The oral mucosa is thin, and even slight trauma leads to rupture of vesicles and bullae forming eroded, red areas, then fibrin forms over the erosion and an ulcer develops. Ulcers are well-circumscribed, sometimes depressed lesions with an epithelial defect that is covered by a fibrin clot, resulting in a yellow white appearance. A good example for this is an aphthous ulcer. Recurrent aphthous ulcers are characterized by small, round or oval-shaped lesions with yellow or gray floors that are surrounded by erythematous halo.12They generally occur in the oral mucosa and rarely on the gingiva.RAS accounts for 25 percent of recurrent ulcers in adults and 40 percent in children.1 It is more common in female. There are three clinical presentations of Recurrent aphthous ulcers Minor, Recurrent aphthous ulcers major and herpetiform ulceration. It is well recognized that the symptoms caused by recurrent or chronic oral mucosal lesions such as pain during speaking, eating, and swallowing; discomfort; impairment in food and liquid intake; and problems in interpersonal relationships and self-esteem can deeply affect the oral health-related quality of life (OHRQoL) of patients.10,11 Recurrent aphthous ulcers do not have a clear etiology and, in some cases, are of difficult control and treatment, causing discomfort to the patients. The development of recurrence can be related to hereditary, psychosomatic, infectious, hormonal (periods, pregnancy or post-menopausal) factors, trauma, stress, food allergies, nutritional deficiencies (iron, vitamin B12 and folic acid) and hematological abnormalities. However, the absence of biochemical and histological specific changes characterizes this condition and allow to make the diagnosis of recurrent aphthous ulcers.2,3 There are many attempts to find the ideal treatment for this condition, however, some patients do not need treatment due to the mild nature of the disease whereas others, who experience multiple episodes for months and/or with severe symptoms of pain and difficulty in eating, should be treated in a palliative way.4,5 Topical agents are the first treatment of choice because they are safe and effective, with few side effects and have a lower chance of drug interaction.6,7 Several topical medications with distinct mechanisms are effective in managing Recurrent aphthous ulcers lesions. Topical treatment is aimed at prevention of super-infection, protection of existing ulcers, analgesia, decreasing inflammation, and treating active ulcers. 18 The word ‘LASER’ is an acronym for ‘Light Amplification by Stimulated Emission of Radiation’. Low-level laser therapy (LLLT) is also known as ‘soft laser therapy’ or bio-stimulation. The biostimulating effect of lasers used in the low-energy range (in the order of mw/sm) is manifested in acceleration of regeneration processes. Lasers using red light induce powerful analgesic and anti-inflammatory effects. Healing of the ulcerations is mainly achieved by stimulating epithelial growth and angiogenesis.8,9 The mechanism of pain relief as a result of laser therapy is a matter of intensive biological research. One of the ways by which Low-level laser therapy can cause symptomatic pain relief is by enhancing the level of adenosine triphosphate (ATP) synthesis in the mitochondria of neurons.13The increased level of ATP will cause hyperpolarization of the neurons and obstruction of pain stimuli.13,14 As a result, there will be marked decrease in the induction of pain stimuli. Due to the stimulation by Low-level laser therapy, there is a complex mechanism by which the level of ATP increases in mitochondria and the cytoplasm in neuronal cells. Certain photoreceptors in the mitochondrial respiratory chain absorb infrared wave lengths and get excited.15 This mitochondrial activation causes oxidative phosphorylation and production of ATP. There is also an increase in the electrical potential of mitochondrial membrane and induction of nucleic acid synthesis.16 Another mechanism that has been proposed to explain the phenomenon of pain relief as a result of Low-level laser therapy is the modification in the nerve conduction by the process of release of endorphins and enkephalins.16, 17 It is also suggested that Lowlevel laser therapy may reduce pain perception by lowering the level of prostaglandin E2 and interleukin-1β. REFERENCES: 1. Wallace a, rogers hJ, hughes sC, et al. Management of recurrent aphthous stomatitis in children. Oral Medicine. 2015;42(6):564–572. 2. Safadi RA. Prevalence of recurrent aphthous ulceration in Jordanian dental Patients. BMC 3. 4. 5. 6. 7. Oral Health. 2009;9:31 Preeti L, Magesh K, Rajkumar K, Karthik R. Recurrent aphthous stomatitis. J Oral Maxillofac Pathol. 2011;15:252-6 Hamedi S, Sadeghpour O, Shamsardekani MR, Amin G, Hajighasemali D, Feyzabadi Z. The Most Common Herbs to Cure the Most Common Oral Disease: Stomatitis Recurrent Aphthous Ulcer (RAU). Iran Red Crescent Med J. 2016;18:e21694. Natah SS, Konttinen YT, Enattah NS, Ashammakhi N, Sharkey KA, Häyrinen- Immonen R.. Recurrent aphthous ulcers today: a review of the growing knowledge. Int J Oral Maxillofac Surg. 2004;33:221-34. Tarakji B, Gazal G, Al-Maweri SA, Azzeghaiby SN, Alaizari N. Guideline for the Diagnosis and Treatment of Recurrent Aphthous Stomatitis for Dental Practitioners. J Int Oral Health. 2015;7:74-80. Scully C, Porter S. Oral mucosal diseases: recurrent aphthous stomatitis. Br J Oral Maxillofac Surg. 2008;46:198-206. 8. Mosvin CV, Buylin BA. Foundations of laser therapy.Moskow: Triada; 2006. Russian. 9. Ryazkova M, Kirova I. Physical therapygeneral and special part. Sofia: Medical Publishing House ARSO; 2002.Bulgarian. 10. Llewellyn CD, Warnakulasuriya S. The impact of stomatological disease on oral healthrelated quality of life. Eur J Oral Sci. 2003;111(4):297–304. 11. Tabolli S, Bergamo F, Alessandroni L, Di Pietro C, Sampogna F,Abeni D. Quality of life and psychological problems of patients with oral mucosal disease in dermatological practice. Dermatology. 2009;218(4):314–320. 12. Scully C, Felix DH. Oral medicine--update for the dental practitioner. Aphthous and other common ulcers. Br Dent J. 2005;199(5):259-264. doi:10.1038/sj.bdj.4812649. 13. Hamblin Demidova, T.N MR. Mechanisms of low level light therapy. Proc SPIE.2006:614001. 14. Miloro M, Halkias LE, Mallery S, Travers S, Rashid RG. Low-level laser effect on neural regeneration in Gore-Tex tubes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;93(1):27-34. 15. Karu T. Photo biology of low-power laser effects. Heal Phys. 1989;56:691-704. 16. Aggarwal H, Singh MP, Nahar P, Mathur H, Gv S. Efficacy of low-level laser therapy in treatment of recurrent aphthous ulcers - a sham controlled, split mouth follow up study. J Clin Diagn Res. 2014;8(2):218-221. 17. Lins Dantas, E.M., Lucena, K.C., Catão, M.H., Granville-Garcia, A.F., Carvalho Neto, L.G RD. Bio stimulation effects of low-power laser in the repair process. Ann Bras Dermatol. 2010;85:849-855. 18. Edgar NR, Saleh D, Miller RA. Recurrent aphthous stomatitis: a review. The Journal of clinical and aesthetic dermatology. 2017 Mar;10(3):26. Name: Description: ...
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