Olibanum (Frankincense) Oral Disintegrating Tablets Reduces Ulcer Size and Pain Severity in Subjects with Oral Aphthous Lesions

by | Feb 1, 2023 | Boswellia, Botanicals, Oral Health

Written by Taylor Woosley, Staff Writer. 3-day treatment using olibanum ODTs containing 200mg boswellia significantly decreased ulcer size (p<0.001) and decreased pain score (p<0.001) compared to baseline. 

oral healthOral aphthosis is a painful inflammatory process of the oral mucosa and can appear alone or secondary to numerous distinct disease processes1. Recurrent aphthous stomatitis (RAS) is characterized by multiple, small, round mucosal ulcers with circumscribed margins, erythematous haloes, and yellow or gray floors that initially appear during childhood or adolescence2. Factors that modify the immunologic responses in RAS include genetic predisposition, viral and bacterial infections, nutrient deficiencies, hormonal imbalances, and stress3.

Several clinical studies have shown positive effects of natural herbs and extracts in reducing the pain and duration of mouth sores4. One such plant is Boswellia serrata, with frankincense and olibanum being derivates of the plant resin, whose bioactive compounds have a role in ulcer healing therapies5. It has been used for centuries as a remedy for the treatment of chronic diseases due to its potent anti-inflammatory properties6. Furthermore, boswellia contains acetyl-11-keto-β-boswellic acid (AKBA), which has an anti-bacterial effect on oral pathogens and prevents bacterial biofilm formation7.

Soltani et al. conducted a randomized, double-blind, placebo-controlled study to evaluate the effectiveness of olibanum orally disintegrating tablets (ODT) for the treatment of oral aphthous ulcers. Study inclusion consisted of being over 18 years of age, with 0 to 5 aphthous ulcers with no more than 48 h of the ulcer’s occurrence, who had not received any anti-inflammatory drugs or antibiotics within the past two weeks. Participants (n=50) were randomly assigned to either the frankincense (n=25) or placebo groups (n=25) and were instructed to use frankincense or placebo ODTs, respectively, four times daily for three days. The olibanum ODT given to the treatment group contained 200 mg of boswellia extract and had a simple shape and color to the placebo ODT. Pain severity and size of ulcer were recorded before the intervention (day 0) and at the beginning of the second and fourth days (end of treatment) for each patient. Pain severity was analyzed using visual analogue scale (VAS).

Chi-square and independent t-tests were used to compare sex distribution and mean age between the two groups, respectively. Wilcoxon signed-rank test was utilized because of non-normal distribution of results to compare the mean values at the different times with baseline in each group. Mann-Whitney U test was used to compare the values between the two groups at each time point. No statistically significant differences between the groups were noted regarding the baseline values. Significant findings of the study are as follows:

  • In the frankincense group, ulcer size decreased significantly in the second (p=0.002) and fourth (p<0.001) days of intervention compared to baseline (day 0), whereas in the placebo group, this parameter increased significantly in both times compared to the baseline.
  • In the frankincense group, pain score decreased significantly in the second and fourth days compared to the baseline (p<0.001), while no statistically significant difference was noted in the placebo group.
  • Kaplan-Meier survival test using log-rank test showed a statistically significant difference between the two groups in terms of complete healing, as five patients in the treatment group had complete healing compared to no case in the placebo group (p=0.020). Also, the test showed that there were statistically significant differences between the two groups regarding complete pain relief, with seven patients in the treatment group having complete pain relief on the second day of intervention and four patients at the end of the intervention, whereas no patient in the placebo group experienced complete pain relief (p<0.001).

Results of the study show that 3-day treatment of olibanum ODTs significantly improved pain scores and ulcer size in the treatment group, accelerating the healing time of RAS. Study limitations include the small sample size, short duration of the trial, and lack of histological assessment of the ulcers. Further research should continue to explore the efficacy of anti-inflammatory treatments for RAS.

Source: Soltani, Rasool, Zahra Saberi, Syed Mustafa Ghanadian, Azade Taheri, and Amir Entezarhojjat. “The effectiveness of olibanum orally disintegrating tablet in the treatment of oral aphthous ulcers: A randomized, double-blind, placebo-controlled clinical trial.” Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences 27 (2022).

© 2022 Journal of Research in Medical Sciences | Published by Wolters Kluwer – Medknow

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Posted February 1, 2023.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

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