Department of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Department of Periodontics, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Radiation Oncologist, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Department of Oral Medicine, Islamic Azad University Dental Branch, Tehran, Iran.
Background and Objective: Several studies have shown the wound healing effect of topical phenytoin, which is applied by its effect on connective tissue intracellular matrix. However, there are still some controversies about its effect on various kinds of wounds, especially in the experimental models. This study is aimed at evaluating the effect of mucoadhesive paste compared to phenytoin mucoadhesive paste on wound healing after oral biopsy. Material and Methods: In this double blind randomized clinical trial, 20 patients who were eligible for oral biopsy were allocated into the case and control groups. After the biopsy, patients having ulcers ranging between one and two centimeters were treated by simple or 1% phenytoin mucoadhesive paste. All patients were instructed to apply their paste at least three times a day for five days after the biopsy. Patients in both groups were evaluated every other day for size of the ulcer, degree of pain and diameter of the inflammatory halo. Statistical analysis was done using SPSS software and Mann-Whitney test. Results: After the second and third appointments, it was observed that the rate of wound healing and decrease in the size of the ulcers were significantly quicker in the treatment group (p = 0.001 and p = 0.003 respectively) and the patients in the phenytoin group reported less pain. Diameter of the inflammatory halo was not significantly different between two groups. Conclusion: Applying 1% phenytoin mucoadhesive paste on biopsy ulcers resulted in accelerated wound healing and decrease in pain, but had no effect on the diameter of the inflammatory halo.
Baharvand, M. , Lafzi, A. , R-Mafi, A. , Taheri, J. , Mortazavi, H. and Alirezaei, S. (2014) Formulation of a new phenytoin-containing mucoadhesive and evaluation of its healing effects on oral biopsy ulcers. Open Journal of Stomatology, 4, 5-9. doi: 10.4236/ojst.2014.41002.
[1] Jarrahi, M. and Vafaei, A. (2004) Topical phenytoin cream on linear incisional wound healing in albino rats. DARU, 2, 223-227. [2] Meena, K., Mohan, A.V., Sharath, B., Somayaji, S.N. and Bairy, K.L. (2011) Effect of topical phenytoin on burn wound healing in rats. Indian Journal of Experimental Biology, 49, 56-59. [3] DaCosta, M.L., Regan, M.C., al Sader, M., Leader, M. and Bouchier-Hayes, D. (1998) Diphenylhydantoin sodium promotes early and marked angiogenesis and results in increased collagen deposition and tensile strength in healing wounds. Surgery, 123,287-293.
http://dx.doi.org/10.1016/S0039-6060(98)70181-3 [4] Rhodes, R.S., Heyneman, C.A., Culbertson, V.L., Wilson, S.E. and Phatak, H.M. (2001) Topical phenytoin treatment of stage II decubitus ulcers in the elderly. Annals of Pharmacotherapy, 35, 675-681.
http://dx.doi.org/10.1345/aph.10267 [5] Chan, F.C., Kennedy, C., Hanson, R.P., O’Sullivan, B., Kelly, J. and Bouchier-Hayes, D. (2007) Topical diphenylhydantoin sodium can improve healing in a diabetic incisional animal wound model. Journal of Wound Care, 16, 359-363. [6] Malhotra, Y.K. and Amin, S.S. (1991) Role of topical phenytoin in trophic ulcers of leprosy in India. International Journal of Leprosy and Other Mycobacterial Diseases, 59, 337-338. [7] Yadav, J.K., Singhvi, A.M., Kumar, N. and Garg, S. (1993) Topical phenytoin in the treatment of split-thickness skin autograft donor sites: a comparative study with polyurethane membrane drape and conventional dressing. Burns, 19, 306-310.
http://dx.doi.org/10.1016/0305-4179(93)90118-R [8] Fonseka, H.F., Ekanayake, S.M. and Dissanayake, M. (2010) Two percent topical phenytoin sodium solution in treating pyoderma gangrenosum: A cohort study. International Wound Journal, 7, 519-523.
http://dx.doi.org/10.1111/j.1742-481X.2010.00725.x [9] Ashima Bhatia, M.D. and Surya Prakash, D.V.D. (2009) Topical phenytoin for wound healing. Dermatology Online Journal, 10, 5. [10] Modaghegh, S., Salehian, B., Tavassoli, M., Djamshidi, A. and Rezai, A.S. (1989) Use of phenytoin in healing of war and non-war wounds. A pilot study of 25 cases. International Journal of Dermatology, 28, 347-350.
http://dx.doi.org/10.1111/j.1365-4362.1989.tb01363.x [11] Kadkhodazadeh, M., Khodadoustan, A., Seif, N.S. and Amid, R. (2012) Short term effect of 1% topical phenytoin suspension on the pain and wound dimensions of donor site after free gingival graft. Journal of Dental School, 29, 366-371. [12] Hasamnis, A., Mohanty, B. and Muralikrishna, P.S. (2010) Evaluation of wound healing effect of topical phenytoin on excisional wound in albino rats. Journal of Young Pharmacy, 2, 59-62.
http://dx.doi.org/10.4103/0975-1483.62215 [13] Baharvand, M., Sarrafi, M., Alavi, K., Jalali, M.E. (2010) Efficacy of topical phenytoin on chemotherapy-induced oral mucositis; a pilot study. Daru, 18, 46-50. [14] Hamian, M., Baharvand, M., Mousavizadeh, M., Mortazavi, A. and Ameri, A. (2011) Effect of topical phenytoin on chemo radiotherapy-induced mucositis. Tehran, Shahid Beheshti University of Medical Sciences, 37 p. Dissertation. [15] Trevor, A.J., Katzung, B.G., Masters, S.B. and Knuidering-Hall, M. (2013) Antiseizure drugs. In: Trevor, A.J., Katzung, B.G., Masters, S.B. and Knuidering-Hall, M., Eds., Katsung & Trevors’ Pharmacology, 10th Edition, McGraw Hill, 217-225. [16] Nash, A.S., Thompson, H. and Bogan, J.A. (1977) Phenytoin toxicity: A fetal case in a dog with hepatitis and joundice. Veterinary Record, 100, 280-281.
http://dx.doi.org/10.1136/vr.100.14.280 [17] Papich, M.G. (2009) Anticonvulsant drugs. In: Riviere, J.E. and Papich, M.G., Eds., Veterinary pharmacology and therapeutics. 9th Edition, Wiley Blackwell, Iowa, 493-509. [18] El-Zayat, S.G. (1989) Preliminary experience with topical phenytoin in wound healing in war zone. Military Medicine, 28, 347-350. [19] Moy, L.S., Tan, E.M.L., Holness, R. and Uitto, J. (1985) Phenytoin modulates connective tissue metabolism and cell proliferation in human skin fibroblast cultures. Archives of Dermatology, 121, 79-83.
http://dx.doi.org/10.1001/archderm.1985.01660010083024 [20] Williams, V.S.L., Morlock, R.J. and Feltner, D. (2010) Psychometric evaluation of a visual analog scale for the assessment of anxiety. Health Quality of Life Outcomes, 8, 57. http://dx.doi.org/10.1186/1477-7525-8-57