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Thirty-five patients suffering from minor recurrent aphthous ulceration (RAU) entered a single-phase double-blind clinical trial of treatment with topical prostaglandin E2 (PGE2). The PGE2 was applied as a gel at a dose of 0.3 mg twice daily for 10 days. The vehicle alone acted as control. Patients were examined on days 1, 3, 5, 7 and 10 and also maintained daily diary cards. Of the 33 patients (94%) who completed the study, 18 had been allocated the active PGE2 and 15 the placebo. The two volunteers who failed to complete were excluded on technical grounds related to the strict study design and did not withdraw on the basis of adverse reactions to the trial preparation. Patients using the active PGE2 gel experienced significantly fewer new lesions than those on placebo (P < 0.05) over the 10-day trial period. There were no significant differences between the PGE2 and placebo gels in terms of speed of healing or pain relief of established aphthous ulcers. Prostaglandin E2 may, therefore, have useful prophylactic activity in RAU.

A number of compounds have been used in the management of recurrent oral ulceration, including antimicrobials. This was a double-blind placebo-controlled cross-over study to assess the value of a 0.1% hexetidine mouthwash in the management of minor aphthous ulceration and as an adjunct to oral hygiene. Forty patients with a catalogued history of ulceration took part. Patients were randomly allocated to active/placebo or vice versa order of mouthwashes, which were used as 15 ml volumes three times a day. Treatment periods were 6 weeks with a 3 week washout. During each period patients kept daily records of the number, site, and duration of ulcers, together with pain scores. Plaque and gingivitis were scored at baseline and end of treatment periods. Thirty-eight patients completed the study, with no significant treatment differences between active and placebo rinses on any ulcer parameter. Additionally, the hexetidine rinse provided no significant benefit to oral hygiene or gingival health. However, there was a significant period effect, with considerable ulcer improvements during the second period, irrespective of treatment. In conclusion, the hexetidine rinse appeared to offer no benefits to these patients, but professional supervision of ulcer treatment does appear to result in a worthwhile placebo effect.

This study compared viral culture with routine cytology and immunofluorescent staining of oral epithelial cell smears for the diagnosis of orofacial infections due to herpes simplex virus (HSV) or herpes zoster (HZ). Twenty-one patients were studied. Viral culture gave the greatest number of positive results, with an assumed sensitivity and specificity of 100%, but the test took at least 24 hours. For haematoxylin and eosin cytology, the corresponding figures for sensitivity and specificity were 54% and 100%, respectively. Direct staining of epithelial smears with FITC-conjugated monoclonal antibodies to HSV type 1, HSV type 2 and HZ had a sensitivity of 82% and specificity of 71%. Smears prepared from oral washings, and stained with the same fluorescent antibodies, yielded a sensitivity of 83% and specificity of 86%. To allow rapid diagnosis, oral epithelial smears for immunofluorescent examination should also be prepared, since in more than 80% of cases such smears will confirm an herpetic infection in less than one hour.