Biologics in oral medicine: ulcerative disorders

Abstract

Inflammatory ulcerative diseases of the oral mucosa are wide ranging but include especially aphthous and aphthous-like ulceration, vesiculobullous disorders and erosive lichen planus (LP). While most patients with these conditions respond to conventional topical and/or systemic immunosuppressive agents, treatment-resistant cases remain challenging. In these, the use of biologics such as tumour necrosis factor alpha (TNF-α) inhibitors or rituximab may be of benefit. This article reviews the use of biologics in ulcerative oral conditions, highlighting potential benefits, adverse effects and principles of use and future developments. TNF-α inhibitors such as infliximab can be effective in inducing resolution in oral aphthous and aphthous-like ulcers and may be an appropriate therapy in those patients in which disease is severe and refractory to, or patients are intolerant of, traditional immunomodulatory regimens. There would also seem support and rationale for use of biologics (mainly rituximab) in pemphigus but not in oral LP or other oral ulcerative conditions.

Reccurent aphthous stomatitis

“…Na opisani način lokalni tkivni odgovor uzrokuje disrupciju tkiva koja se klinički vidi kao aftozna lezija. Ulogu TNF-α u patogenezi RAS-a potvrđuju i istraživanja u kojima je primjena imunomodulatornih lijekova (poput talidomida, pentoksifilina i antagonista TNF-α), zbog njihovog inhibitornog učinka na sintezu i djelovanje TNF-α, bila vrlo djelotvorna u liječenju RAS-a [36][37][38][39] .…”

A viscous lidocaine mouthwash is no better than placebo for improving oral intake in children with painful mouth ulcers

“…Other treatments, which solely treat the symptoms of painful mouth ulcers, are essentially anaesthetics (eg, lidocaine, benzocaine and diphenhydramine) or coating agents (such as sucralfate, Maalox, milk of magnesia and Kaopectate) 2 3…”

Bolitho not Bolam

“…Dr Aslam refers in his letter to the Bolam test 1 which would allow any practitioner to be defended by opposing expert opinion in the event of any accusation of negligence regarding lower wisdom tooth removal.…”