Sahba & Alipour Effects of Chamomill Mouthrinse on Recurrent Aphthous Stomatitis Original Article Evaluation of the Effects of Chamomill Mouthrinse on Recurrent Aphthous Stomatitis S. Sahba 1~, Sh. Mohammadalipour 2 1Associate Professor, Department of Oral Medicine, Faculty of Dentistry, Shaheed Beheshti University of Medical Sciences, Tehran, Iran 2Dentist, Private practice Abstract: Statement of Problem: Recurrent aphthous stomatitis (RAS) is one of the most common diseases affecting the oral mucosa. Many topical and systemic medications used to treat RAS have adverse local and systemic effects. Chamomill (kamillosan) has been shown to be an effective drug, without any noticeable side effects. Purpose: The aim of present study was to assess the efficacy of a chamomill mouthrinse on RAS in comparison with a placebo mouthrinse. Materials and Methods: The study was designed as a double blind randomized placebo controlled clinical trial with participation of 50 patients diagnosed with RAS. They were randomly divided into two groups: 26 patients forming the test group, received chamomill mouthrinse and 24 patients constituting the control group received a placebo rinse. All subjects were instructed to use the solutions three times a day until complete resolution of the lesions. Treatment outcome was assessed on days 3 and 5 and at the exact healing time. The ability of the solution to control the pain and burning sensation and the diameter of the ulcers was evaluated. Statistical analysis was performed using the χ2 and unpaired t test for comparison between the two groups. Results: The chamomill group showed a significant reduction in the time required for ~ controlling the pain and burning sensation (P<0.01). Ulcer diameter and healing time Corresponding author: S. Sahba, Department of Oral were also decreased (P<0.01). Medicine, Saheed Beheshti Conclusion: Chamomill mouthrinse was effective in the treatment of RAS without University of medical sciences, producing adverse effect. Tehran, Iran [email protected] Key Words: Aphthous stomatitis; Herbal medicines; Matricaria Chamomilla Received: 2 April 2005 Accepted: 2 November 2005 Journal of Dentistry, Tehran University of Medical Sciences, Tehran, Iran (2005; Vol: 2, No.4) INTRODUCTION thalidomide, but each of these medications Recurrent aphthous stomatitis (RAS) is a have the potential to cause side effects [5,6]. common and painful disorder that may affect Tooth discoloration is a common complaint of 20% of the populationArchive [1,2]. This lesion causes ofpatients SIDwho use chlorhexidine [7,8]. difficulty in eating, speaking and swallowing Candidiasis is an adverse effect of tetracycline and therefore may negatively affects the and nausea has been reported in most trials of patient’s quality of life [3,4]. levamisole [9]. Thalidomide is a toxic and In order to reduce the pain and severity of teratogenic agent [10]. RAS, a number of medications have been used Recently Chamomill (kamillosan) has been such as local or systemic steroids, tetracycline shown to be effective in reducing the pain and mouthrinse, chlorhexidine gel or mouthwash, discomfort of mucositis without any noticeable systemic levamisole, cholchicine and even side effect, Therefore this herbal extract was 2005; Vol. 2, No. 4 147 www.SID.ir Journal of Dentistry, Tehran University of Medical Sciences Sahba & Alipour employed in the present study [11]. informed consent. The exclusion criteria were Chamomill liquidum has been extracted from as follows: the flower of the Matricaria Chamomilla plant • More than three days elapsing from the and is widely used in folk medicine for its initiation of RAS carminative, antibacterial, spasmolytic and • Use of any kind of medication before anti-inflammatory characteristics. The local participating in the study application of this herbal solution is • Patients suffering from Behcet syndrome or recommended for relieving inflammatory any other immunologic disease conditions and promoting epithelization Considering these criteria, 50 patients (27 [12,13]. females and 23 males) with a mean age of 25 The use of chamomilla for treatment of years, ranging from 10 to 54 years were digestion disorders goes back to the 1st entered the study. century AD. Hahnemann published the effects The subjects were assigned randomly to either of this herbal drug on pain relief in his materia group A (test-group) or group B (control- medica pura [14]. group). At the initial appointment, an The anti-inflammatory and epithelization information form was completed for each effects of chamomilla have been investigated patient. The intensity of pain and burning by treating artificially-induced skin injuries in sensation was measured by using a visual 5 healthy patients [15]. analogue scale graded from 0 to 10, where 0 is Carl and Emrich showed that Kamillosan no burning and 10, the worst burning (chamomilla liquidum) is effective in reducing imaginable. the intensity of mucositis in people who were The diameters of the lesions were measured by under radiation and chemotherapy. No adverse a periodontal probe (Williams' probe). The test reactions at therapeutic doses have been group received Chamomill mouthrinse and the reported [11]. control group received placebo. A research conducted by Talaeipour et al at the The test and placebo solutions were placed in Imam Khomeini Hospital, Department of identically appearing containers and the Radiotherapy, Tehran, Iran, proved chamomill investigator(s) was blind to the contents of the mouthrinse to be effective in the reduction of containers. The patients were instructed to use pain and discomfort in patients with radiation 30 drops of the solution in approximately mucositis [12]. 100ml of water and rinse for 1-2 minutes, The purpose of this study was to evaluate the three times a day until complete resolution of effectiveness of Chamomill mouthrinse against the ulcers. The patients were instructed to RAS in comparison with a placebo avoid eating or drinking at least 30 minutes mouthrinse. after rinsing. Every patient kept a diary to record the pain MATERIALS ANDArchive METHODS andof burning SID sensation on 2 separate visual Fifty patients participated in this randomized scales every day until the elimination of the double-blind placebo-controlled clinical trial. symptoms. All subjects were selected from patients In order to evaluate the progress of treatment, diagnosed with RAS, attending the follow-up examinations took place on days 3 Department of Oral Medicine, School of and 5. The intensity of the pain and burning Dentistry, Shaheed Beheshti University of sensation, the amount of epithelization Medical Sciences. (healing progress) and reduction in the All patients were required to fill and sign an diameter of the ulcers were assessed. The 148 2005; Vol. 2, No. 4 www.SID.ir Sahba & Alipour Effects of Chamomill Mouthrinse on Recurrent Aphthous Stomatitis 6 patients were examined again after complete 5.4 5.3 5.1 resolution of the ulcer. During examination, 5 4.2 the oral mucosa was observed for local 4 adverse reactions and the patients were 4 questioned if they had experienced any side 3 effects such as irritation or burning sensation 2.1 2 in the mouth. The collected data were analyzed by χ2 (Chi- 1 Lesion diameter (mm) diameter Lesion Square) and unpaired t-test. 0 Day 0Day 3Day 5 RESULTS Camomill Placibo A total of 50 RAS patients fulfilled the Fig.1: Mean ulcer Diameter in chamomill and Placebo selection criteria and were included in the groups in 0, 3 and 5 days. statistical analysis. The subjects were randomly assigned to two groups with 26 None of our patients experienced any side patients (14 females and 12 males) in the test effects from the treatment. group and 24 (13 females and 11 males) patients in the control group. The mean age of DISCUSSION the patients in the test and control groups was Aphthous ulcers are among the most common 24.9 and 25.1, respectively. oral lesions in the general population, with a The two groups were similar in age and gender frequency of up to 25% and three-month with no significant differences between them recurrence rates as high as 50%. In spite of the (P>0.05). After using the mouthrinses the high prevalence of RAS, the exact cause of following results were obtained: this problem is unknown; therefore, treatment The intensity of the pain and burning sensation has been mainly directed toward the was significantly lower in the test group as symptomatic management of the lesion. compared to the control group (p<0.01) (Table Different protocols have been used for the I). treatment of RAS which usually create adverse Regarding the diameter of the lesions, the two effects [9,16]. groups did not show a statistically significant In order to minimize drug reactions, it is difference on day 3 (p>0.05), but the diameter crucial to use medications with fewer side of the lesions decreased significantly on day 5, effects. In recent years, herbal medicines in the Chamomill group (p<0.01) (Fig.1). without noticeable adverse side effects have Duration of the lesions and the time required been considered in medicine and dentistry. for healing were decreased significantly in test Carl et al demonstrated accelerated resolution group compared to control group (p<0.01). of mucositis and considerable epithelialization after rinsing with Kamillosan (chamomilla Table I: Intensity Archiveof pain in chamomill and placebo of SID liquidum) [11]. Considering these facts, the groups based on Visual Analogue Scaling. present study was designed to evaluate the Group Days Min. Max. Mean SD efficacy of Chamomill as a mouthrinse in 3 3 8 5.04 1.25 controlling RAS. Chamomill 5 0 6 2.19 1.170 The results of the present study indicate that chamomill mouthrinse reduces the time 3 4 9 6.37 1.31 Placebo required for controlling the pain and burning 5 0 8 3.83 1.171 sensation and also decreases healing time and 2005; Vol. 2, No. 4 149 www.SID.ir Journal of Dentistry, Tehran University of Medical Sciences Sahba & Alipour accelerates epithelization P<0.01 (Table I).