COMMENTARY

A Natural Remedy for Canker Sores?

Eric T. Stoopler, DMD

Disclosures

October 16, 2014

Efficacy of Honey in Comparison to Topical Corticosteroid for Treatment of Recurrent Minor Aphthous Ulceration: A Randomized, Blind, Controlled, Parallel, Double-Center Clinical Trial

El-Haddad SA, Asiri FY, Al-Qahtani HH, Al-Ghmlas AS
Quintessence Int. 2014;45:691-701

Study Summary

Aphthous ulcers (canker sores) are among the most common oral soft tissue diseases encountered in clinical dental practice. This condition affects approximately 20% of the general population and typically occurs in the adolescent years.[1] Most cases of recurrent aphthous ulcers (RAU) affect the buccal and labial mucosa and are typically well-circumscribed lesions with pseudomembranous coverings surrounded by erythema.[1,2] Most cases of RAU are considered to be of the minor variant, which is characterized by lesions smaller than 1 cm in diameter that heal in 10-14 days without scar formation.[1,2]

Although most individuals with RAU are not significantly affected by this condition, others are extremely symptomatic and have compromised oral function. The most common medications used to treat RAU are topical corticosteroids, which accelerate resolution of lesions and relieve associated symptoms but may cause side effects or induce hypersensitivity reactions.[1,2,3]

Natural substances (eg, honey) have been used as topical medicaments for centuries to treat a variety of human ailments with minimal side effects. El-Haddad and colleagues aimed to determine the efficacy and safety of topical honey compared with triamcinolone acetonide 0.1% (a common topical corticosteroid) and Orabase treatment in shortening the clinical course and recurrence of minor RAU.

The study was conducted in two centers from September 2012 to October 2013. A total of 94 patients diagnosed with RAU were enrolled in the study. The patients were prospectively randomly assigned to one of three groups, with all agents applied to lesions three times daily. The agents were commercial honey (34 patients with 67 RAU in group 1), triamcinolone acetonide 0.1% (30 patients with 57 RAU in group 2), and Orabase adhesive paste (30 patients with 56 RAU in group 3). Each patient underwent a baseline analysis before any treatment and a subsequent daily analysis through day 8 (end of the study period) by the same investigator, who was blinded to the study group. Patients self-scored pain levels.

The main study outcomes were change in ulcer size, pain level, and degree of erythema after topical application of agents. Ulcer size was assessed by measuring the maximum diameter of the ulcer(s) at each visit using a calibrated dental probe. Pain level was assessed using a pain diary that included a visual analog scale (0-10). The degree of erythema was assessed using a 4-point scale (0-3, noting increasing severity). A combination of statistical analyses, including Chi-square test and least significant difference test, was used to analyze the data obtained from the study.

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