Therapeutic Strategies and Emerging Drug Delivery Systems for Oral Aphthous Ulcers

Authors

  • Ram Babu Sharma Professor & Principal, Himalayan Institute of Pharmacy, Kala-Amb, Sirmour, Himachal Pradesh
  • Abhishek Dadwal M. Pharm Scholar, Himalayan Institute of Pharmacy, Kala-Amb, Sirmour, Himachal Pradesh
  • Anjali Dixit Associate Professor, Himalayan Institute of Pharmacy, Kala-Amb, Sirmour, Himachal Pradesh

Abstract

Aphthous ulcers, also known as canker sores, are painful mucosal lesions that occur on oral structures, including the cheeks, gums, lips, and tongue. Although their precise etiology remains unclear, contributing factors include nutritional deficiencies (vitamins B12, folate, C), stress, trauma, infections (viral, bacterial, fungal), chemical irritants like sodium lauryl sulfate, and heavy metal exposure. These ulcers significantly impair quality of life by causing pain during eating, brushing, and speaking. Treatment aims to manage pain, promote healing, and reduce the frequency of recurrence. Topical corticosteroids remain the mainstay of therapy, offering rapid resolution with minimal systemic effects. Adjunctive treatments include local analgesics, immunomodulators (e.g., thalidomide), NSAIDs (mesalazine), stem‑cell therapy, and various herbal remedies such as extracts from Psidium guajava, Curcuma longa, Glycyrrhiza glabra, and Punica granatum, which demonstrate anti-inflammatory, antimicrobial, and wound‑healing properties. Recent advances focus on novel mucoadhesive drug delivery systems—patches, gels, microneedles, nanosheets, hydrogels—to enhance drug residence time, bioavailability, and patient compliance. These innovative approaches target both symptomatic relief and accelerated healing, while minimizing systemic exposure and improving therapeutic outcomes. Moving forward, integrating molecular insights into disease mechanisms (microRNA dysregulation in OPMDs, microbial dysbiosis) with tailored delivery platforms may pave the way for precision interventions targeting recurrent aphthous ulcers.

Keywords: Aphthous ulcers, nutritional deficiencies, stress, trauma, infections

Keywords:

Aphthous ulcers, nutritional deficiencies, stress, trauma, infections

DOI

https://doi.org/10.22270/jddt.v15i9.7350

Author Biographies

Ram Babu Sharma , Professor & Principal, Himalayan Institute of Pharmacy, Kala-Amb, Sirmour, Himachal Pradesh

Professor & Principal, Himalayan Institute of Pharmacy, Kala-Amb, Sirmour, Himachal Pradesh

Abhishek Dadwal , M. Pharm Scholar, Himalayan Institute of Pharmacy, Kala-Amb, Sirmour, Himachal Pradesh

M. Pharm Scholar, Himalayan Institute of Pharmacy, Kala-Amb, Sirmour, Himachal Pradesh

Anjali Dixit , Associate Professor, Himalayan Institute of Pharmacy, Kala-Amb, Sirmour, Himachal Pradesh

Associate Professor, Himalayan Institute of Pharmacy, Kala-Amb, Sirmour, Himachal Pradesh

References

1. Yogarajah S, Setterfield J. Mouth ulcers and diseases of the oral cavity. Medicine. 2021;49(7):407-413. https://doi.org/10.1016/j.mpmed.2021.04.003

2. Burley V, Biyani D, Umekar M, Naidu N. Medicinal plants for treatment of ulcer: A review. Journal of Medicinal Plants Studies. 2021;9(4):51-59. https://doi.org/10.22271/plants.2021.v9.i4a.1312

3. Öner Ü, Özdemir Ş, Öner F, Akdeniz N. Do Heavy Metals Accumulated in Saliva Involve in the Etiopathogenesis of Recurrent Aphthous Stomatitis? Biological Trace Element Research. 2020;198(1):46-50. https://doi.org/10.1007/s12011-020-02058-2 PMid:32030633

4. Pan Z, Zhang X, Xie W, Cui J, Wang Y, Zhang B, et al. Revisited and innovative perspectives of oral ulcer: From biological specificity to local treatment. Frontiers in Bioengineering and Biotechnology. 2024;12:1335377. https://doi.org/10.3389/fbioe.2024.1335377 PMid:38456005 PMCid:PMC10917957

5. Nishad SR, Narwade SS, Naik PR, Patil VP. Nature's Shield for Oral Ulcer Management: A Comprehensive Review. Research Journal of Pharmacognosy and Phytochemistry. 2025;17(1):49-55. https://doi.org/10.52711/0975-4385.2025.00009

6. Suharyani I, Fouad Abdelwahab Mohammed A, Muchtaridi M, Wathoni N, Abdassah M. Evolution of Drug Delivery Systems for Recurrent Aphthous Stomatitis. Drug Design, Development and Therapy. 2021;15:4071-4089. https://doi.org/10.2147/DDDT.S328371 PMid:34616142 PMCid:PMC8489189

7. Yadav RK. A review on mouth ulcer and its various treatment. Journal of Pharmaceutical Sciences and Research. 2021;10:28-40.

8. Tan Y, Wang Z, Xu M, Li B, Huang Z, Qin S, Nice EC, Tang J, Huang C. Oral squamous cell carcinomas: state of the field and emerging directions. International Journal of Oral Science. 2023;15. https://doi.org/10.1038/s41368-023-00249-w PMid:37736748 PMCid:PMC10517027

9. Maheswari TN Uma, Venugopal A, Sureshbabu N Malli, Ramani P. Salivary micro RNA as a potential biomarker in oral potentially malignant disorders: A systematic review. Tzu-Chi Medical Journal. 2018;30:55-60. https://doi.org/10.4103/tcmj.tcmj_114_17 PMid:29875583 PMCid:PMC5968743

10. Abati S, Bramati C, Bondi S, Lissoni A, Trimarchi M. Oral Cancer and Precancer: A Narrative Review on the Relevance of Early Diagnosis. International Journal of Environmental Research and Public Health. 2020;17. https://doi.org/10.3390/ijerph17249160 PMid:33302498 PMCid:PMC7764090

11. Choudhari S, Chaudhary M, Gadbail A, Sharma A, Tekade S. Oxidative and antioxidative mechanisms in oral cancer and precancer: a review. Oral Oncology. 2014;50(1):10-8. https://doi.org/10.1016/j.oraloncology.2013.09.011 PMid:24126222

12. Pan Z, Zhang X, Xie W, Cui J, Wang Y, Zhang B, et al. Revisited and innovative perspectives of oral ulcer: from biological specificity to local treatment. Frontiers in Bioengineering and Biotechnology. 2024;12:1335377. https://doi.org/10.3389/fbioe.2024.1335377 PMid:38456005 PMCid:PMC10917957

13. Maver T, Kurečič M, Smrke DM, Stana Kleinschek K, Maver U. Plant-Derived Medicines with Potential Use in Wound Treatment. Herbal Medicine. 2018; https://doi.org/10.5772/intechopen.72813

14. Thube SA, Patil MJ. Evaluation of Wound Healing Potential of Some Indian Herbal Extracts and its Formulation in Acne Vulgaris. Pharmacognosy Journal. 2014;6(5). https://doi.org/10.5530/pj.2014.5.8

15. Bandana K, Kumar S, Sagar MK, Tyagi H. Formulation and evaluation of herbal gel of guava leaves and liquorice roots extract for using mouth ulcer. Journal of Critical Reviews. 2020;7(18):3097-110.

16. Thete M, Shimpi P. Review on Role of Herbs in Management of Oral diseases. Asian Journal of Pharmaceutical Research. 2020;10(4). https://doi.org/10.5958/2231-5691.2020.00055.6

17. Sing R, Bansal S, Kumar Mishra M. Formulation and evaluation of herbal oral gel containing extracts of powdered Psidium guajava linn leaves with Curcuma longa linn rhizomes to treat mouth ulcer. International Journal of Drug Development and Research. 2020;12(2):1-7.

18. Jadhav TS. Formulation and evaluation pharmaceutical aqueous gel of powdered guava, aloe vera and acacia leaves for treatment of mouth ulcer. International Journal of Science and Research. 2018;8(5):1693-1697.

19. Jain NK, Roy R, Pathan HK, Sharma A, Ghosh S, Kumar S. Formulation and evaluation of polyherbal aqueous gel from Psidium guajava, Piper betel and Glycyrrhiza glabra extract for mouth ulcer treatment. Research Journal of Pharmacognosy and Phytochemistry. 2020;12(3):145-148. https://doi.org/10.5958/0975-4385.2020.00024.2

20. Mittal S, Nautiyal U. A review: herbal remedies used for the treatment of mouth ulcer. International Journal of Health and Clinical Research. 2019;2(1):17-23.

21. Pan Z, Zhang X, Xie W, Cui J, Wang Y, Zhang B, Du L, Zhai W, Sun H, Li Y, Li D. Revisited and innovative perspectives of oral ulcer: from biological specificity to local treatment. Frontiers in Bioengineering and Biotechnology. 2024;12:1335377. https://doi.org/10.3389/fbioe.2024.1335377 PMid:38456005 PMCid:PMC10917957

22. Yashaschandra P, Madhavi BL. Current Treatments and Strategies for Management of Oral Ulcers: A Review. 2025;16(90)

Published

2025-09-15
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How to Cite

1.
Sharma RB, Dadwal A, Dixit A. Therapeutic Strategies and Emerging Drug Delivery Systems for Oral Aphthous Ulcers. J. Drug Delivery Ther. [Internet]. 2025 Sep. 15 [cited 2026 Jan. 12];15(9):134-9. Available from: https://www.jddtonline.info/index.php/jddt/article/view/7350

How to Cite

1.
Sharma RB, Dadwal A, Dixit A. Therapeutic Strategies and Emerging Drug Delivery Systems for Oral Aphthous Ulcers. J. Drug Delivery Ther. [Internet]. 2025 Sep. 15 [cited 2026 Jan. 12];15(9):134-9. Available from: https://www.jddtonline.info/index.php/jddt/article/view/7350