Life Science Journal 2012;9(3) http://www.lifesciencesite.com 2398 Therapeutic Efficacy of Herbal formulations for Recurrent Aphthous Ulcer. Correlation with Salivary Epidermal Growth Factor Maha Galal 1 ; Sherine Adel Nasry 2 ; Dina M. Mostafa 3 and Nagwa M. Ammar 4 1 College of Oral & Dental Surgery, Misr University for Science & Technology (MUST), Cairo, Egypt, 2 Surgery and Oral Medicine Department, National Research Center, Cairo, Egypt 3 Pharmaceutical Technology Department, Pharmaceutical and Drug Industries Division, National Research Center, Cairo, Egypt 4 Department of Pharmacognosy, Pharmaceutical and Drug Industries Division, National Research Center, Cairo, Egypt nasrysherine@yahoo.com Abstract: Background: Recurrent aphthous ulceration (RAU) is one of the most common oral mucosal lesions seen in primary care. Epidermal growth factor(EGF) in saliva is cytoprotective against injuries and plays a role in maintaining the mucosal integrity and promoting wound healing. This study compared the efficacy of three herbal components in the management of RAU and correlated this effect with salivary epidermal growth factor levels. Methods: Forty patients with minor aphthae were selected and randomly divided into four groups. The first three groups received topical preparations of Acacia nilotica (A), Glycyrrhiz glabra orLicorice (L) and a mixture of Acacia nilotica and Licorice (A&L).The fourth group (negative control) used a placebo. Ulcer size, pain score and salivary EGF level were recorded on treatment days 0, 2 and 5. Results: At day zero, there was no statistically significant difference between the four groups regarding pain score, ulcer size and salivary EGF level. At days 2 and 5, there was no significant difference between Group A and control groups; both showed the highest mean pain scores(P ≤ 0.05). Group (A & L) showed the lowest mean pain score and ulcer size, followed by group L. At the same observational period, both of (A & L) and (L) groups showed the highest mean EGF values. This was followed by Group (A). Control group showed the lowest mean EGF value..Conclusion: Treatment of minor aphthae using a mixture of Licorice and Acacia nilotica extracts revealed improved pain reduction and healing potential than each substance alone. These results correlated positively with salivary EGF levels measured during the same observational periods. [Maha Galal; Sherine Adel Nasry; Dina M. Mostafa and Nagwa M. Ammar. Therapeutic Efficacy of Herbal formulations for Recurrent Aphthous Ulcer. Correlation with Salivary Epidermal Growth Factor. Life Sci J 2012;9(3):2398-2406] (ISSN:1097-8135). http://www.lifesciencesite.com . 345 Key words: Medicinal plants; Acacia nilotica; Licorice; Aphthous ulceration; Epidermal growth factor. 1. Introduction Recurrent aphthous ulceration (RAU) is the most common oral disease affecting 5-25% of the general population worldwide and is amongst the most prevalent and complicated disorders of the oral cavity (1). Several initiating factors have been implicated in the pathogenesis of RAU (2), however their role as the main etiological factors in the pathogenesis remains to be elucidated. Furthermore, with the dramatic worldwide increase in patients with immuno- suppression caused by medical treatments, systemic diseases, or both, the prevalence of RAU may be increasing (3). The treatment of RAU still remains nonspecific and is based primarily on empirical data. The goals of therapy include the management of pain and functional impairment by suppressing inflammatory responses, as well as reducing the frequency of recurrences or avoiding the onset of new aphthae (4). Antibacterial, anti-inflammatory and anti- histaminic agents, analgesics, local anesthetics, and glucocorticoids have been used topically to manage RAU. Most of these therapies are associated with side effects or unwanted reactions (5). Epidermal growth factor (EGF), also known as epithelial growth factor is the founding member of the EGF family of proteins. It is an amino acid peptide that is present in a variety of biologic fluids including saliva, and is also present in the mucosa lining the whole human digestive tract (6). EGF stimulates the division and proliferation of cells of various tissues including the oral epithelial cells (7). It plays an important physiological role in the maintenance of esophageal and gastric tissue integrity by aiding in the healing of oral and gastroesophageal ulcers, inhibition of gastric acid secretion, stimulation of DNA synthesis as well as protection of the mucosa from injurious factors (8). Preliminary studies assessing the role of EGF on mucosal healing have been conducted. Low salivary EGF levels have been observed in patients with various forms of oral mucosal disease (9),