Recurrent aphthous stomatitis, also known as recurrent aphthous ulcer, is a painful ulcerative disease of the oral mucosa of unclear etiology, but very common in the population. the rate of recurrence is variable, but most sufferers report at least one episode every 1-4 months.
Current management strategies include the use of various topical agents such as corticosteroids, antibiotics, analgesics, and herbal products that primarily aim to relieve pain and reduce the duration of ulcers, whereas there is an urgent need for alternative therapeutic agents that not only reduce symptoms but also prevent or reduce the frequency of future attacks.
Over the past two decades, the use of zinc supplementation in the management of various inflammatory diseases, including this one, has garnered much interest because it plays a crucial role in cell differentiation, growth and regeneration, and wound healing. Not only that, zinc comes into play in the regulation of the immune system by inhibiting T helper-17 cell activity, suppressing inflammatory cytokine production, decreasing neutrophil chemotaxis, and downregulating Toll-like-2 receptor expression in keratinocytes.
To date, overall, the results of the numerous studies already in the literature have shown positive effects of oral zinc supplementation on signs and symptoms in patients with this type of stomatitis with no or minimal side effects.
Most studies have, in addition, reported greater efficacy of zinc supplementation in reducing recurrence rates compared with controls. A very recent meta-analysis of 19 case-control studies found significantly lower serum zinc levels in patients with recurrent aphthous stomatitis compared with healthy controls, a finding that may explain and support the results shown with supplementation.
Other interesting aspects concern pain control and reduction of ulcer healing time, which can be attributed to the anti-inflammatory and immunomodulatory actions of zinc.
In fact, the role of zinc in tissue regeneration and acceleration of wound healing is well established in the literature.
Unfortunately, as in many other cases, also in this context there is too much heterogeneity in the method used, with variability in the formulation of zinc, in daily doses that ranged from 12 to 660 mg and in the duration of supplementation, but also by type of patients examined, severity of stomatitis and follow-up period.
Bibliogaphy
Zinc supplementation for prevention and management of recurrent aphthous stomatitis: a systematic review. Journal of trace elements in medicine and biology. Volume 68, December 2021.
Role of zinc in mucosal health and disease: a review of physiological, biochemical, and molecular processes. Cureus., 12 (May 5) (2020), p. e8197.
Clinical, immunological, anti-inflammatory and antioxidant roles of zinc. Experimental gerontology, 43 (May 5) (2008), pp. 370-377.
A double-blind trial of systemic zinc sulfate in recurrent aphthous stomatitis. Oral surgery, oral medicine, and oral pathology, 53 (May 5) (1982), pp. 469-472.
Trace elements zinc and copper in serum and recurrent oral ulcer. Journal of Clinical Stomatology, 01 (1987), pp. 20-22.
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