Effectiveness of acemannan in the treatment of oral aphthous ulceration

Acemannan (β-(1,4)-acetylated polymannose) increased oral epithelium and fibroblast proliferation. Animal experiments confirmed that acemannan accelerated oral wound healing. Objectives: To measure effectiveness of acemannan for oral aphthous ulceration treatment. Methods: 0.5% acemannan in Carbopol^® 934P NF (Noveon^TM, USA) was applied to the lower lip oral mucosa of 150 healthy participants three times/day for seven days. Oral examination and blood tests to measure liver and kidney function were performed before and after seven days of application to assess side effects of acemannan when used on oral mucosa. Then, 150 subjects with recurrent aphthous ulceration randomly received one of three treatments: 0.1% triamcinolone acetonide (HOE Pharmaceuticals, Malaysia), 0.5% acemannan in Carbopol^® 934P NF and pure Carbopol^® 934P NF. Medications were applied to the ulcers three times/day for seven days. Measurements of ulcer size and satisfaction ratings were performed at follow-up (days three, five and seven). Pain ratings were recorded daily. The study was conducted with informed consent using protocols approved by the Chulalongkorn University Faculty of Dentistry's Committee on Investigations Involving Human Subjects. Acemannan used in the study was extracted from aloe vera and passed cellular and animal safety screening and skin patch testing. Results: The results revealed that no subjects had any allergic reactions or side effects to acemannan. No significant difference was found in the blood values before and after seven days of acemannan application. The effectiveness of acemannan in reducing ulcer size and pain is superior to that of control but inferior to 0.1% triamcinolone acetonide. Patients were satisfied most with 0.1% triamcinolone acetonide, followed by acemannan and pure Carbopol^® 934P NF. Conclusions: Acemannan can be used for the treatment of oral aphthous ulceration in patients who wish to avoid steroid medications, although the effectiveness is inferior to 0.1% triamcinolone acetonide.