Petcharat Kraivaphan

Efficacy of topical retinoic acid compared with topical fluocinolone acetonide in the treatment of oral lichen planus

The purpose of this study was to compare the efficacy of retinoic acid in an oral base 0.05% with fluocinolone acetonide in an oral base 0.1% in the treatment of atrophic and erosive oral lichen planus. Thirty-three patients with histologically proven oral lichen planus were asked to participate in the study. Lesions were scored ranging from 0 (no lesion) to 5 (large erosion) according to the severity. Patients were randomly assigned to receive either topical fluocinolone acetonide or topical retinoic acid. They were instructed to apply the medication on dried lesions four times a day. The lesions were evaluated after 2 and 4 weeks of treatment. The sign scores were analyzed by the Wilcoxon rank sum test. Eighteen patients receiving topical fluocinolone acetonide improved from the average score of 3.0 to 1.5 after 4 weeks of treatment, whereas 15 patients receiving topical retinoic acid showed little change (average score, 2.9 and 2.4, respectively). The changes were statistically significantly different between the two groups (p = 0.01). The results suggest that 0.1% fluocinolone acetonide reduced the severity of atrophic and erosive oral lichen planus better than 0.05% retinoic acid.

Efficacy of fluocinolone acetonide gel in the treatment of oral lichen planus.

OBJECTIVE The purpose of this study was to compare the efficacy of fluocinolone acetonide gel 0.1% in 2 base forms (numbers 1 and 2) with fluocinolone acetonide in an oral base 0.1%. STUDY DESIGN Forty-eight patients with histologically confirmed oral lichen planus were enrolled in the study. Lesions were scored ranging from 0 (no lesion) to 5 (large erosion) according to the severity. Patients were randomly given fluocinolone acetonide in an oral base, fluocinolone acetonide gel no. 1 or no. 2. They were asked to apply the medication on dried lesions 4 times a day. The lesions were evaluated after 2 and 4 weeks of treatment. The severity scores were analyzed by the Kruskal-Wallis k-sample test. RESULTS Patients who received fluocinolone acetonide in an oral base and those who received fluocinolone acetonide gel no. 1 and no. 2 improved from the average score of 3.0, 3.0, and 2.9 to 1.5, 1.5, and 1.6, respectively. There were no statistically significant differences in score changes noted in the 3 groups. The results indicate that fluocinolone acetonide gel no. 1 and no. 2 and fluocinolone acetonide in an oral base provide similar efficacy in the treatment of oral lichen planus. CONCLUSION Fluocinolone acetonide gel 0.1% is a safe and effective alternative therapy to fluocinolone acetonide in an oral base 0.1% in the treatment of oral lichen planus.

Oral lichen sclerosus et atrophicus ☆ ☆☆: A case report

Lichen sclerosus et atrophicus affecting only the oral mucosa is extremely rare. We report here a case of oral lichen sclerosus et atrophicus presenting as a white, flat lesion involving the right buccal and labial mucosa and vermillion border. The diagnosis was based on histopathologic features. Treatment with intralesional corticosteroid was successful in reducing the size of the lesion and the symptoms of the patient. A free gingival graft was also performed to restore the lost attached gingiva. No recurrence of the lesion was found after a 1-year follow-up period, and no skin or genital lesions developed during the 3 years of treatment.

Effect of the topical application of 50% lignocaine hydrochloride on the sensitivity of dentine in man

OBJECTIVE To determine the effect of topical applications of 50% (w/v) lignocaine HCl on the sensitivity of human dentine. DESIGN The experiments were carried out on 12 premolars scheduled for extraction as part of orthodontic treatment in nine subjects (ages: 16-29 years). Dentine was exposed by cutting a cavity at the tip of the buccal cusp of each tooth, and etched with 35% phosphoric acid. The sensitivity of the exposed dentine to probing and air-blast stimuli was assessed before and after applying either 50% (w/v) lignocaine HCl solution or distilled water to the exposed dentine for 10min. Changes in the sensitivity of the dentine were monitored for up to 160min. The subject indicated the intensity of any pain produced by marking a 100mm visual analogue scale (VAS). RESULTS Before treatment, both forms of stimulus evoked pain in all the teeth. The median VAS score with probing was 40mm and, with air-blast stimulation, 30mm. 50% lignocaine HCl produced a progressive fall in these scores and after 30min there was no response to either probing or air-blast stimulation. The responses started to return 30-160min after the lignocaine had been washed off. Water had no effect. CONCLUSIONS Lignocaine will diffuse into exposed dentine and block the pain evoked by probing and air-blast stimuli provided that a sufficiently steep diffusion gradient is created. A topical application of a 50% (w/v) solution of lignocaine HCl for 10min will anaesthetise dentine within 30min.

Effects of the iontophoresis of lignocaine with epinephrine into exposed dentine on the sensitivity of the dentine in man

OBJECTIVE To determine the effects of the iontophoretic application of lignocaine and epinephrine to exposed dentine on the sensitivity of the dentine in human subjects. DESIGN The experiments were carried out on 13 healthy premolars (13 subjects) that were scheduled for extraction. Dentine was exposed at the tip of the buccal cusp by cutting a cavity which was etched with 35% phosphoric acid. The sensitivity of the dentine was tested with probing and air blast stimuli. The subject indicated the intensity of any pain produced with a score of 0-100. In 7 teeth, the cavity was filled with a solution containing 20% (w/v) lignocaine HCl and 0.1% (w/v) epinephrine HCl, and an iontophoretic current of 120 μA was passed for 90s. The sensitivity of the dentine was tested before and immediately after the treatment and then at 10 min. intervals for 40 min. Pulpal blood flow was recorded at each stage. Control experiments were carried out on 6 teeth using a solution containing only the epinephrine. RESULTS The lignocaine plus epinephrine solution completely blocked the pain produced by both forms of stimulus immediately, and this continued for at least 40 min. It also produced an immediate fall in pulpal blood flow that also lasted for at least 40 min. The epinephrine solution had the same effect on pulpal blood flow but no effect on dentine sensitivity. CONCLUSIONS The topical application of 20% lignocaine and 0.1% epinephrine, with an iontophoretic current of 120μA for 90s, will anaesthetize exposed, normal, dentine.

The iontophoresis of lignocaine with epinephrine into carious dentine for pain control during cavity preparation in human molars.

OBJECTIVE To determine the effectiveness of the iontophoretic delivery of lignocaine with epinephrine through carious dentine for pain control during cavity preparation. DESIGN The experiments were carried out on 56 carious molars that required class I restorations in 42 subjects (aged 15-20 years). The overhanging enamel and soft caries were removed then the sensitivity of the exposed dentine was tested with drilling, probing and air blast stimuli. The subject indicated the intensity of any pain produced by marking a visual analogue scale (VAS). The cavity was then filled with 20% w/v lidocaine with 0.1% w/v epinephrine and a 200 μA iontophoretic current applied for 2 min after which the sensitivity of the dentine was re-tested. If the dentine was not anaesthetized, the treatment and testing were repeated up to 6 times. RESULTS The total duration (min) of iontophoresis required to anaesthetize the dentine was: 2 in 7 teeth, 4 in 17 teeth, 6 in 14 teeth, 8 in 4 teeth, and 10 in 7 teeth. The remaining 7 teeth were not anaesthetized even after 14 min of iontophoresis. CONCLUSIONS The iontophoretic delivery of lignocaine with epinephrine anaesthetized dentine for cavity preparation in 49 of 56 (87.5%) of carious molars.

Comparative clinical efficacy of three toothpastes in the control of supragingival calculus formation

Objectives: The purpose of this double-blind, parallel clinical study was to assess clinical efficacy in supragingival calculus formation reduction using Abhaibhubejhr Herbal Toothpaste compared to Colgate Total and Colgate Cavity Protection toothpastes. Materials and Methods: A total of 150 subjects participated in the pretest phase. All subjects were given oral soft/hard tissue evaluation, calculus examination using Volpe-Manhold calculus, and whole mouth oral prophylaxis. They received noncalculus control fluoride toothpaste and a soft-bristled toothbrush to brush for 1 min two times daily for 8 weeks. After which, subjects were given a test phase oral soft/hard tissue evaluation and calculus examination and were randomized into one of the three toothpaste groups. All subjects in the test phase received a whole mouth oral prophylaxis and were given their assigned toothpaste and a soft-bristled toothbrush to brush for 1 min two times a day for 12 weeks. Thereafter, subjects were assessed for their oral soft/hard tissue and calculus formation. Results: Mean Volpe-Manhold calculus index scores for the Cavity Protection, Abhaibhubejhr, and Total toothpaste groups were 0.78, 0.62, and 0.48, respectively, at the 12-week test phase evaluation. Abhaibhubejhr and Total toothpaste groups show 20.51% and 38.46% significantly less calculus formation than the Cavity Protection toothpaste group (P < 0.05). Total toothpaste group also show 22.58% significantly less calculus formation than the Abhaibhubejhr toothpaste group (P < 0.05). Conclusion: The use of Colgate Total toothpaste over a 12-week period was clinically more effective than either Abhaibhubejhr or Colgate Cavity Protection toothpastes in controlling supragingival calculus formation.