Evolution of Drug Delivery Systems for Recurrent Aphthous Stomatitis

Abstract

Recurrent aphthous stomatitis (RAS) is a disease marked by painful oral lesions on the buccal and labial mucosa or tongue. Drug delivery systems (DDS) for RAS include topical forms that manage wound healing, cover the ulcer, and relieve the associated pain. DDS targeting the oral mucosa face a major challenge, especially the short residence times in the mouth due to the effect of “saliva wash-out”, which continually removes the drug. The objective of this review is to study the development of preparation forms and delivery systems of various types and preparations that have been used for RAS management from 1965 until February 2020. There are 20 types of DDS for RAS which were discussed in 62 articles. The preparations were classified into 4 preparation forms: liquid, semi-solid, solid, and miscellaneous. In addition, the ultimate DDS for RAS preparations is the semi-solid forms (41.94%), which include 5 types of DDS are gel, paste, patch, cream, and ointment. This preparation was developed into new preparation form (11.29%), such as adhesive alginates, dentifrice, OraDisc, membranes, bioresorbable plates, pellicles, and gelosomes. Generally, the mucosal drug delivery system is the method of choice in RAS treatment because the ulcer is commonly located in the oral mucosa. In conclusion, these preparations are designed to improve drug delivery and drug activity for the treatment of RAS ulcers. Moreover, almost all of these DDS are topical preparations that use various types of mucoadhesive polymers to increase both residence time in the oral mucosa and pain relief in RAS treatment.

A Fresh Look at Mouthwashes—What Is Inside and What Is It For?

“… (1) Surfactant (may act as a solubiliser, emulsifier, emulsion stabiliser, detergent, wetting agent, foaming agent/defoamer and may possess antimicrobial features) [ 75 ]; (2) mucoadhesive film former (filmogenic agents) (it is suggested that they may act as a moisturiser, as dressing for wounds, to prevent dental plaque and stain formation, to prevent demineralisation, as a barrier to relieve pain in oral lesions such as aphthous ulcers, to improving the delivery and retention of actives) [ 27 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 ]; (3) remineralisation agent (to remineralise the demineralised tooth surface in dental caries or erosion as well as to prevent demineralisation, also in dentin hypersensitivity to obturate the dentinal tubules); (4) antimicrobial agent (an oral antiseptic, it may act as a preservative); (^) means it is discussed in the subsequent text. …”

The applications of polysaccharides in dentistry

“…Some studies have suggested that sodium alginate could treat recurrent aphthous ulcers. The compound can alleviate the pain and improve the persistence of a drug in the oral mucosa (Laffleur and Kuppers, 2019;Suharyani et al, 2021). In addition, alginate is mainly used for stomatology as an impression of oral materials (Cervino et al, 2018).…”

Lesões aftoides da cavidade oral: apresentação clínica, diagnóstico e tratamento

“…As lesões clássicas da EAR envolvem a mucosa oral não queratinizada, apresentando-se como úlceras rasas redondas ou ovais, dolorosas, claramente definidas, com um centro necrótico raso. O próximo passo é o estágio ulcerativo, no qual se desenvolve o edema, acompanhado pela presença de queratinócitos e vasculite superficial localizada, que gera inflamação na região, ulceração e infiltração de plasmócitos, linfócitos e neutrófilos (Gorsky et al, 2007;Suharyani et al, 2021). A resposta imune do hospedeiro leva as células T, macrófagos e mastócitos a liberarem o fator de necrose tumoral alfa (TNF-α), dando início ao processo de cicatrização (Cui et al, 2016).…”