The therapeutic effects of chamomilla tincture mouthwash on oral aphthae: A Randomized Clinical Trial

Introduction: Recurrent aphthous stomatitis (RAS) is a common clinical condition producing painful ulcerations in the oral cavity. However, there has been no optimal therapeutic approach. Topical and systemic steroids commonly prescribed for the condition have local and systemic side-effects. Recently, there is growing tendency toward herbal medication in the modern society. The objective of this study was to assess the efficacy of a chamomilla mouth rinse on reducing the signs and symptoms of aphthous lesions in comparison with a placebo mouth rinse. Material and Methods: A randomized, triple-blind, placebo-controlled trial was performed on 36 patients, from cases diagnosed with RAS, attending the Department of Oral Medicine, Mashhad University of Medical Sciences. They were randomly divided into two groups: the intervention group(A), receiving chamomilla mouth rinse, and the control group (B) receiving a placebo rinse. The ability of the solution to control the pain and burning sensation and the number and size of the ulcers were evaluated. Results: The number of ulcers in the 3rd visit (four days after treatment) showed a significant difference between the groups (P<0.001). The pain and burning sensation (VAS) was reduced significantly in the test group in the 2nd (p=0.001),3rd and 4th visit (P<0.001). Conclusions: Chamomilla mouth rinse was effective in the treatment of RAS, controlling the pain and burning sensation without producing any adverse side effects and can be advised as an alternative RAS treatment. Key words:Recurrent aphthous stomatitis, chamomilla mouth rinse, matricaria chamomilla, aphthous lesion treatment.


Introduction
Recurrent aphthous stomatitis [RAS] remains the most common ulcerative disease of the oral mucosa, in the form of painful round, shallow ulcers with well-defined erythematous margin and yellowish-gray pseudomembranous center (1). The etiology of RAS lesions is unknown, but several local, systemic, immunologic, gene-tic, allergic, nutritional, and microbial factors have been proposed as causative agents (2). The proper treatment of RAS depends on the frequency, size, and number of the ulcers, and remains mostly palliative (3). The best treatment is the one to control ulcers for the longest period with minimal adverse side effects. The treatment approach should be determined by e536 J Clin Exp Dent. 2014;6(5):e535-8.
The therapeutic effects of chamomilla tincture mouthwash on oral aphthae uptake, syndrome-related aphthous lesions, e.g. Behcet, Crohn, ulcerative colitis,…, patients whose lesions did not regress after one month according to the standards defined in the literature (6)

Results
Total number of 36 cases fulfilled the study period, 4 cases in the case and 10 cases in the control dropped out of the study. Comparison of mean age using Pearson Chi Square revealed that the sample was homogenous regarding age and there was no significant difference between the groups regarding age ( Table 1). The mean number of lesions at the beginning of the study was 2.95 in the case group and 2.67 in the control group, Pearson chi square test revealed no significant difference and the groups were homogenous (Table 2). Moreover, Pearson chi square test revealed no significant difference between the groups regarding sex, pain and burning sensation, and the site of the lesions.
disease severity [pain], the patient's medical history, the frequency of flare-ups, and the patient's ability to tolerate the medication (3). For common forms of RAS, standard topical treatment options that provide symptomatic relief include analgesics, anesthetics, antiseptics, anti-inflammatory agents, steroids, sucralfate, tetracycline suspension, and silver nitrate (4).
Complementary and alternative medicines are frequently used in chronic conditions (5). Chamomilla tincture is a herbal medicine which has many applications. The antiinflammatory, anti spasm, anti bacterial, antifungal, and analgesic effects of chamomilla tincture have been investigated on inflammatory dermal lesions (6). Chamomilla mouth rinse is prescribed for aphthous lesions, gingivitis, and laryngitis (7). Faster healing has been observed after administration of chamomilla. The effective ingredients in Chamomilla are essences [azolene, camozolene] and flavonoids. Camazolene has a dose-dependent antiinflamatory and anti spasm effects, it inhibits leukoterine B4 [LTB4] synthesis, and peroxidation of arachidonic acid in neutrophils. Azolene has analgesic and anti-inflammatory effects. Flavenoids are also known to have anti-inflammatory characteristics (6). There are few randomized clinical trials on the effect of chamomilla on aphthous lesions. The aim of this randomized clinical study was to investigate the therapeutic effects of chamomilla tincture mouthwash on oral aphthae.

Material and Methods
In

Discussion
The purpose of present study was to assess the efficacy of a chamomilla mouth rinse on reducing the pain, size   chamomilla as a medication to improve the quality of life of RAS patients. The analgesic quality was also reported by the patients in this study (6). Duart et al. evaluated the effect of Chamomilla recutita on the healing of ulcers in rats. Chamomilla stimulated re-epithelialization and the formation of collagen fibers after 10 days of treatment (8). Their result might cautiously explain accelerated healing of aphthous lesions in our study in the case group, in 100% of the cases after 4 visits. Although animal studies have shown accelerated healing after chamomilla administration (8,9), their results cannot be simply generalized to the human population.
Regarding the self-limiting nature of RAS lesions, even in the placebo group, the lesions finally regressed, but the point is that in the chamomilla group the healing process was accelerated, and from the second visit the symptoms were vanished, but the placebo group showed the normal healing process of a lesion. Chamomilla is an effective agent in RAS condition, and can be administered whenever appropriate. Future research should aim at clinical trials comparing chamomilla with corticosteroids.