Document Type : Original Article
Authors
- . Parichehr Ghalayani 1
- . Behzad Zolfaghary 2
- . Ali Reza Farhad 3
- . Atefeh Tavangar 1
- . Bahram Soleymani 4
1 Department of Oral Medicine and Torabinejad Dental Research Center, Isfahan University of Medical Science, Isfahan, Iran
2 Depatment of Pharmacognosy, Isfahan University of Medical Science, Isfahan, Iran
3 Department of Endodontics and Torabinejad Dental Research Center, Isfahan University of Medical Science, Isfahan, Iran
4 Department of Health, Islamic Azad University, Najafabad Branch, Isfahan, Iran
Abstract
Objective: Recurrent aphthous stomatitis (RAS) is a common, painful ulcerative disorder
of the oral cavity with unknown etiology. No documented cure exists and topical application
of medications aims to reduce pain associated with this condition. The aim of this study was
to evaluate the efficacy of Punica granatum (PG) extract on the clinical management of RAS.
Methods: A total of 40 patients with RAS participated in this randomized, double‑blind, and
placebo‑controlled study. During three episodes of RAS, the efficacy of topical PG gel (10%)
was evaluated. Patients were randomly assigned to use placebo gel or PG gel daily. The time
of pain elimination and the time of complete healing were recorded and the pain degree was
assessed and recorded by each patients in different time intervals including: Before using
the oral gel (day 0), and on days 1, 3, 5, 7 after using the product. Data were analyzed using
the repeated measures ANOVA, paired and independent t‑test.
Findings: Mean time of pain elimination showed a significant difference (P < 0.001) between
PG group (3.4 ± 1.09) and placebo group (5.9 ± 0.6). The mean duration of complete healing
also showed a significant difference (P < 0.001) between PG group (5.3 ± 0.81) and placebo
group (8.6 ± 0.99). The visual analog scale score in PG group was significantly less than the
placebo group in all time intervals (day 1 to day 7) (P < 0.001).
Conclusion: The findings of this study revealed that PG extract in the form of oral gel (10%)
may be beneficial in reducing RAS pain and has a positive effect in reducing the overall time
period of complete healing. It was concluded that PG is an effective herbal medicine for
the management of RAS.
Keywords
treatment. 11th ed, Hamilton: BC Decker; 2008. p. 63‑5.
2. Ship JA. Recurrent aphthous stomatitis. An update. Oral Surg
Oral Med Oral Pathol Oral Radial Endod 1996;81:141‑7.
3. Porter SR, Hegarty A, Kaliakatsou F, Hodgson TA,
Scully C. Recurrent aphthous stomatitis. Clin Dermatol
2000;18:569‑78.
4. Porter SR, Scully C, Pedersen A. Recurrent aphthous
stomatitis. Crit Rev Oral Biol Med 1998;9:306‑21.
5. Scully C, Gorsky M, Lozada‑Nur F. The diagnosis and
management of recurrent aphthous stomatitis: A consensus
approach. J Am Dent Assoc 2003;134:200‑7.
6. Barrons RW. Treatment strategies for recurrent oral aphthous
ulcers. Am J Health Syst Pharm 2001;58:41‑50.
7. MacPhail L. Topical and systemic therapy for recurrent
aphthous stomatitis. Semin Cutan Med Surg 1997;16:301‑7.
8. Saxen MA, Ambrosius WT, Rehemtula al‑KF, Russell AL,
Eckert GJ. Sustained relief of oral aphthous ulcer pain from
topical diclofenac in hyaluronan: Arandomized, double‑blind
clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 1997;84:356‑61.
9. Badiee B. The efficacy of myrtle in the management of aptholus
oral ulcers. [Thesis]. Qazvin: School of Dentistry, Qazvin
University of Medical Sciences; 1998.
10. Samet N, Laurent C, Susarla SM, Samet‑Rubinsteen N. The
effect of bee propolis on recurrent aphthous stomatitis: Apilot
study. Clin Oral Investig 2007;11:143‑7.
11. Mansoor P, Hadjiauhondi A, Ghavami R, Shafiee A. Clinical
evaluation of zataria multiflora essential oil mouthwash in
the management of recurrent aphthous stomatitis. DARU
2002;10:74‑7.
12. Jafari SH, Amanlou M, Borhan‑Mojabi K, Farsam H.
Comparative study of zataria multiflora and Anthemis nobelis
extracts with myrthus communis preparation in the treatment
of recurrent aphthous stomatitis. DARU 2003;11:23‑7.
13. Motallebnejad M, Moghadamnia A, Talei M. The efficacy of
Hypericum perforatum extracts on recurrent aphthous ulcers.
J Med Sci 2006;8:39‑43.
14. Amanlou M, Babaee N, Saheb‑Jamee M, Salehinia A,
Farsam H, Tohidast Z. Efficacy of Satureja khuzistanica extract
ant its essential oil preparations in the management of
recurrent aphthous stomatitis. DARU 2007;15:231‑5.
15. Lansky EP, Newman RA. Punica granatum (pomegranate) and
its potential for prevention and treatment of inflammation and
cancer. J Ethnopharmacol 2007;109:177‑206.
16. Wang R, Wei Wang, Wang L, Liu R, Yi Ding, Du L.
Constituents of the flowers of Punica granatum. Fitoterapia
2006;77:534‑7.
17. Jung KH, Kim MJ, Ha E, Uhm YK, Kim HK, Chung JH, et al.
Suppressive effect of Punica granatum on the production of
tumor necrosis factor(Tnf) in BV2 microglial cells. Biol Pharm
Bull 2006;29:1258‑61.
18. Sudheesh S, Vijayalakshmi NR. Flavonoids from Punica
granatum – Potential antiperoxidative agents. Fitoterapia
2005;76:181‑6.
19. Ricci D, Giamperi L, Bucchini A, Fraternale D. Antioxidant
activity of Punica granatum fruits. Fitoterapia 2006;77:310‑2.
20. Murthy KN, Reddy VK, Veigas JM, Murthy UD. Study on
wound healing activity of Punica granatum peel. J Med Food
2004;7:256‑9.
21. Noda Y, Kaneyuki T, Mori A, Packer L. Antioxidant activities
of pomegranate fruit extract and its anthocyanidins:
Delphinidin, cyanidin, and pelargonidin. J Agric Food Chem
2002;50:166‑71.
22. Braga LC, Shupp JW, Cummings C, Jett M, Takahashi JA,
Carmo LS, et al. Pomegranate extract inhibits
staphylococcus aureus growth and subsequent enterotoxin
production. J Ethnopharmacol 2005;96:335‑9.
23. Beil W, Birkholz C, Sewing KF. Effects of flavonoids on parietal
cell acid secretion, gastric mucosal prostaglandin production
and Helicobacter pylori growth. Arzneimittelforschung
1995;45:697‑700.
24. Li Y, Ooi LS, Wang H, But PP, Ooi VE. Antiviral activities
of medicinal herbs traditionally used in southern mainland
China. Phytother Res 2004;18:718‑22.
25. Nair R, Chanda S. Anti candidial activity of Punica granatum
exhibited in different solvents. Pharm Biol 2005;43:21‑5.
26. Sastravaha G, Yotnuengnit P, Booncong P, Sangtherapitikul P.
Adjunctive periodontal treatment with Centella asiatica and Punica granatum extracts. A preliminary study. J Int Acad
Periodontol 2003;5:106‑15.
27. Middleton E Jr, Kandaswami C, Theoharides TC. The effects
of plant flavonoids on mammalian cells: Implications for
inflammation, heart disease, and cancer. Pharmacol Rev
2000;52:673‑751.
28. Razi M. Al‑hawi fi al‑tibb. Translated by Afsharipour S. Tehran:
Academy of Medical Science of Islamic Republic of Iran; 2004.
p. 300‑3.
29. Ghasemi N. Iranian herbal pharmacopeia.Tehran: Ministry of
Health and Medical education; 2002. p. 99‑107.
30. Singleton VL, Orthofer R, Lumuela‑Raventos RM. Analysis of
total phenols and other oxidation substrates and antioxidants
by means of folin‑ciocaltu reagent. Methods Enzymol
1999;299:152‑78.