Sir, I wish to comment on Professor K. Mahalinga Bhat's letter on the action of cumin seeds which are a non-harmful remedy in the treatment of mouth ulcers: Fruit for ulcers (BDJ 2006; 201: 323). The points stated by the author are very true. I was suffering from recurrent aphthous ulcers for a long time and noticed that soaking these cumin seeds in warm water and later chewing them had a soothing effect, provided symptomatic relief and brought about quicker healing. I agree with the author that studies need to be conducted regarding the exact mode of action of these fruit grains.

I also wish to suggest a few treatment modalities which are used here in the Indian subcontinent that have proven to be effective in the treatment of RAU.

The use of herbs may be helpful; among these, liquorice that has had the glycyrrhizic acid removed and is called deglycyrrhizinated liquorice (DGL). This increases blood pressure and water retention in some people and may shorten the healing time. Aloe has also been shown to hasten the healing time and the antiviral and immunity-enhancing drug Echinacea has been shown to provide relief. Camomile tincture is known to have a soothing effect on mouth ulcers, and there are certain astringent herbs which contain tannin and bind up inflammation, including agrimony, cranesbill, periwinkle and witch hazel.

An incision biopsy performed on a large ulcer is also said to hasten healing; the mode of action is unknown!

The sodium lauryl sulphate present in toothpaste which acts as a detergent impedes healing of mouth ulcers as it has a denaturing effect on the oral mucin layer with exposure of the underlying epithelium and results in an increased incidence of RAU. Hence toothpastes containing SLS should be used with caution while RAU is being symptomatically treated. The use of herbal toothpastes which do not have an aggravating effect is recommended. The other treatment modalities of RAU, like those stated above, should also be studied rather than being limited to the conventional method of treatment with its many side effects.