الفهرس 
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Abstract
O
ne of the most common complaints of oral mucosa is oral ulceration. The term ulcer is used to describe damage to both the epithelium and lamina propria of oral mucous membrane. Several predisposing factors have been suggested and oral ulcers can be a feature of different systemic disorders. Oral ulcers are categorized by the nature, site, duration and frequency. Moreover, histopathological examination usually produces a definitive diagnosis for the condition.
The majority of cases of ulcers of the oral mucosa are due to physical trauma. However, chemical trauma must also be considered. Infection viral and/or bacterial, also could cause ulcerative lesions as in herpes simplex virus 1, recurrent herpes, herpes simplex virus 2, Epstein-Barr virus, cytomegalovirus, human herpesvirus 8 and human immunodeficiency virus. Bacterial infection as in acute necrotizing ulcerative gingivitis, treponema pallidum and mycobacterial infection also yeast and fungal infections as candidal infecion. Other causes of oral ulcers are idiopathic ulcers as aphthous stomatitis, systemic diseases as gluten-sensitive enteropathy, dermatitis herpetiformis and related disorders, Crohn’s disease and related disorders, Ulcerative colitis, Lichen planus and malignancy.
Tongue is a unique organ with two different surface lining for the ventral and dorsal surface. Lining mucosa also contains a lamina propria and submucosa. In the submucosa, muscle fibers are located under the surface of the tongue. The entire area exhibits dense, interlaced muscle and connective tissue fibers. Limits of the submucosa are not distinct because the submucosa continues with the deep muscles of the tongue along with connective tissue fibers. The dorsum or superior surface of the tongue (anterior two thirds) is covered with a specialized mucosa. This mucosa consists of four types of epithelial structures called papillae. Most of these papillae are filiform papillae, which are slender, threadlike keratinized extensions of the surface epithelial cells. Interspersed between the filiform papillae are the fungiform papillae, few in number but more numerous near the tip of the tongue. The fungiform papillae are mushroom shaped, with the cap usually larger than the stalk. Taste buds are occasionally found on the superior surface of the fungiform papillae The circumvallate papillae 10 to 14 in number and are located along the V-shaped sulcus between the body and base of the tongue. These papillae are level with the surface of the tongue and each has a surrounding groove. They are large-3 mm in diameter. Ducts of the underlying serous glands (von Ebner’s glands) are seen opening into the grooves surrounding these papillae. Taste buds line the walls of the papillae. The watery secretion of these glands washes out substances so that new tastes can be perceived. On the lateral posterior sides of the tongue are 4 to 11 vertical grooves or furrows containing taste buds. These furrows are termed foliate papillae. Like circumvallate papillae, they contain serous glands underlying the taste buds, which cleanse the trenches of the foliate papillae.
Taste buds are microscopically visible, barrel-shaped bodies found in the oral epithelium. These discrete sense organs contain the chemical sense of taste. They are generally associated with the papillae of the tongue the circumvallate, foliate, and fungiform although some are distributed in the soft palate, epiglottis, larynx, and pharynx. Oral mucosa is continuously subjected to physical or chemical injuries where it becomes a common site for the occurrence of ulcerated lesions. The repair of this type of injury occurs by secondary intention, and events occur in cascade, comprising the stages of inflammation, proliferation and remodeling, culminating with healing. However, this process becomes complex due to the specifics of the oral environment and high number of microorganisms. Studies describe that the oral cavity can harbor as many as 800 to 1000 different bacterial species. These microorganisms produce substances that may alter or interfere with healing, delaying the repair process.
Strategies for treating mouth ulcers are; reducing pain and inflammation, preventing secondary infection and reducing duration and repetition. Treatment modalities in combination with oral hygiene measures; local and oral steroids that have effect on T-lymphocytes and reduce inflammation, local antibiotics as chlorohexidine and benzidamine, solving vitamin and mineral deficiency, such as B12, iron, folic acid and avoidance of food allergens and oher treatments such as amelexanox, levamisol and talidomide are effective too.
Traditionally herbal agents used by herbalists and indigenous healers for preventing and treating ulcers. Herbal medicines with anti-ulcer activity include flavonoids, saponins, tannins, gums and mucilages. Among herbal drugs, liquorice, aloe gel and capsicum have been used extensively. Benefits of using herbal medicines are; long history of use and better patient tolerance and public acceptance. Moreover medical plants have a renewable source, so that we can have sustainable supplies of cheaper medicines for the worlds growing population, richagro-climatic, cultural and ethnic biodiversity of developing countries like India availability of medicinal plants is not a problem, the cultivation and processing of medicinal herbs are eco-friendly and prolong and apparently uneventful use of herbal medicines is safe and efficacious.
Nutmeg belongs to the Myristicaceae family. Its seeds are being used as spice. Its oil is being used in pharmaceutical industries. It has analgesic, anti-inflammatory, antithrombotic effects, anti-cancer activity and antimicrobial activity. In a study was carried to investigate the protective effect of Myristica fragrans in ethanol induced peptic ulcer, authors concluded that Myristica fragrans showed significant protective activity in induced ulcer. The extract of Myristica fragrans effect against ulcer could be assigned to the antioxidative and anti-inflammatory properties of flavonoids present in Myristica fragrans. Flavonoids show anti-ulcer and anti-inflammatory activities and most of them are strong antioxidants. Moreover, topical nutmeg extracts was used as a potential analgesic for diabetic neuropathic pain. It significantly reduced the worst and mean pain scores, and improved the quality of life. However, authors recommended further investigations on the efficacy of topical nutmeg extracts for the treatment of diabetic neuropathic pain. Propolis is a resin-like compound extracted from plants by bees. The chemical composition of propolis is formed from several compounds that represent alcohols, aldehydes, aliphatics acids and esters, amino acids, aromatic acids and esters, flavonoids, ketones and sugars. The caffeic acid phenethyl ester (CAPE) of propolis is able to increased the submucosal collagen content during wound healing.
Propolis has been used for treating different diseases and inflammatory conditions as both local and systemic applications. In nature, or when in room temperature, it is a sticky substance, but becomes hard and brittle at low temperature. Flavonoids are plant compounds which have antibacterial, antifungal, antiviral, antioxidant and anti-inflammatory proprieties. With the increased interest in herbal medicines, studies are being carried to investigate, promote and enhance the biological effects of the nutmeg essential oil as antimicrobial, antiseptic, antiparasitic, antiinflammatory and antioxidant agent versus effect of propolis in treatment of chemically induced ulcer. This would expose huge gaps in the scientific knowledge to be explored.
Aim of work:
The aim of the current study was to primarily evaluate the effect of propolis and nutmeg oil ingestion in the treatment of chemical induced ulcer of the tongue papillae both. Also, we aim at comparing the potential therapeutic effect of both remedies.
Materials and Methods:
Oral ulcers chemically induced by topical application of cotton swap soaked in a full strength formocresol and applied to the dorsal surface of the tongue (2mm from the tip). This assessed histologically by H&E for histological detection any structural changes in the epithelium, lamina propria and morphologically by SEM for detection of any possible changes in of the surface epithelium. Animal grouping: group 1: control group of 10 albino rats receiving no treatment. group 2: ulcer group of 14 albino rats with formocresol induced ulcer. group 3: propolis group of 14 albino rats with induced ulcers treated by propolis application after 3 days of ulcer induction. group 4: Nutmeg oil group of 14 albino rats with induced ulcers treated by nutmeg oil application after 3 days of ulcer induction. Each group further subdivided into 2 subgroups first euthenticated at 7 days and the second at 14 days.
Our most important results:
We found that propolis group of 14 albino rats with induced ulcers treated by propolis application after 3 days of ulcer induction. Subgroup 3A: At seven days post ulcer induction, the dorsal surface of the tongue of rats treated with propolis showed healed ulcer with apparently thin keratinized epithelial layer (fig.14). Higher magnification showed nearly flat rete pegs of the epithelium, few mitotic figures and apoptotic cells. Lamina propria showed some chronic inflammatory cells, fibroblasts, and dilated blood vessels (fig. 15). Subgroup 3B: At fourteen days post ulcer induction, the dorsal surface of the tongue of rats treated with propolis showed healing of ulcer and formation of tongue papillae filliform fungiform papillae the papilla is covered with ortho-keratinized stratified squamous epithelium overlying c.t core.
Nutmeg oil group of 14 albino rats with induced ulcers treated by nutmeg oil application after 3 days of ulcer induction. Subgroup 4A: At seven days post ulcer induction, the dorsal surface of the tongue of rats treated with nutmeg oil show delay of healing. Subgroup 4B: At fourteen days post ulcer induction, the dorsal surface of the tongue of rats treated with nutmeg oil show delay in the growth of epithelial tongue (ET), a large number of inflammatory cells in the connective tissue, and areas of necrosis.
Among Propolis group, after one week group revealed a greater mean of inflammatory cell count compared to the mean value of after two weeks group. Un-paired t-test revealed that the difference was extremely statistically significant (P> 0.001).
In nutmeg group, after one week group revealed a greater mean of inflammatory cell count compared to the mean value of after two weeks group. Un-paired t-test revealed that the difference was extremely statistically significant (P> 0.001).
A scanning electron micrograph of Propolis treated group showing signs of the beginning of healing ulcer and filiform papillae appeared conical in shape with pointed tips and rough surface.