International Medical Journal Vol. 21, No. 3, pp.

319 - 320 , June 2014 319

SHORT COMMUNICATIONS

Comparison of the Effectiveness between Virgin Coconut Oil

(VCO) and Triamcinolone for Treatment of Minor
Recurrent Aphthous Stomatitis (RAS)

Daddy Suradi Halim, Nurul Asma Abdullah, Mohammad Khursheed Alam,

Siti Nuraini Bt Samsee, Tan Suk May

ABSTRACT
Background: There are many medications and traditional remedies in treating mouth ulcers. This study aimed to compare
the effectiveness between virgin coconut oil (VCO) and triamcinolone in treating RAS in oral cavity.
Methods: The effectiveness of healing ulcer was measured using two parameters, ulcer size and pain score. Twenty patients
(n = 20) with RAS were volunteered to join the study. Subjects are the staffs and students of Hospital Universiti Sains Malaysia
(HUSM), Kelantan as well as patients who attend HUSM dental clinic without systemic disease. Subjects were divided into two
groups. One group received VCO and the other group received triamcinolone acetonide (0.1%) for RAS treatment. The subjects
were required to apply the medication twice per day. Ulcer size and pain were measured on treatment days 1 and 5. Data were
analyzed using t test.
Results: No significant differences were found between the two studied groups. Even though the difference in ulcer size is not
significant, the mean comparison revealed that virgin coconut oil is better in reducing the size of the ulcer and relieving pain
compare to triamcinolone.
Conclusion: Treatments applied had similar effectiveness as they both relieved pain and reduced the size of ulcer. As an
alternative, the VCO can be used for treating RAS.

KEY WORDS
virgin coconut oil, triamcinolone, minor recurrent aphthous stomatitis, minor recurrent aphthous ulcer

INTRODUCTION
Recurrent aphthous stomatitis (RAS; aphthae; canker sores) is typi-
fied by a common oral mucosal disorder that is characterized by multi-
ple, recurrent, small, round, or ovoid ulcers with circumscribed margins,
erythematous haloes, and yellow or grey floors that present first in
childhood or adolescence (Scully et al. 2008). The factors that predis-
pose to RAS, such as behavioral factor in smoking and stress, trauma,
food and nutrients deficiency, systemic disease (e.g: anemia, Behcet's
disease, Chron's disease), and medication (e.g. NSAIDs, -blockers,
Nicorandil, Alendronate) (Chattopadhyay and Shetty, 2011).
There is no curative treatment for RAS. There have been few ran-
dom control trials (RCTs) of treatment for RAS. But, treatment options
for now are no treatment, palliative approach (e.g.: Topical agents:
home remedies, over-the-counter medications, prescribed analgesics,
cauterizing agents), anti-inflammatory and antimicrobial agents, immu-
nomodulation (e.g.: Topical such as corticosteroid creams, ointments,
gels, rinses;"intralesional" (perilesional) corticosteroid injections, and
systemic such as corticosteroids, nonsteroidal immunosuppressive
agents, antiinflammatory agents), or combined therapy, for examples,
Attempts have been made by few investigators to determine the phenolic
content in VCO. The results revealed that VCO contained higher total
phenolic content compared to refined coconut oil (Dia et al. 2005).
Recently, considerable interests in the possible impact of consuming
certain foods to fight against several diseases have appeared. Study sug-
gests that the consumption of foods containing dietary phenolics may
significantly contribute to human health (Naczk and Shahidi, 2004).
However, to date, no study is reporting the effect of VCO on RAS
despite its numerous properties and medical benefits. Therefore, the
purpose of this study is to evaluate the effectiveness of VCO in treating
patient with RAS in oral cavity and compare with the common medica-
tion used for this ulcer, which is the triamcinolone.
MATERIALS AND METHODS
This study is a single blinded randomized clinical trial. Twenty sub-
jects with RAS in the oral cavity were examined. There were several
inclusion and exclusion criteria:
Inclusion criteria:

topical combines with systemic agents or systemic agents in combina-

- Age 18 years old and above
tion (Eisenberg, 2003), honey, salicylate gel (Halim et al. 2012).
- Have ulcer size < 10 mm, not more than 3 days
Consumption of VCO extracted from fresh coconut meat, with its
- Not taking antibiotic 3 months prior to the study
high content of biologically active components is superior in antioxidant
- Are not on analgesic or antiseptic
Exclusion criteria:
property than coconut oil extracted by dry process (Nevin et al. 2006).
The term VCO refers to an oil that are obtained from fresh, mature kernel - Patient with systemic disease (diabetes) and immunodeficiency
of the coconut by mechanical or natural means, with or without the use of state
heat and without undergoing chemical refining (Villarino et al. 2007). - Smoker

Received on December 15, 2012 and accepted on May 25, 2013

School of Dental Sciences, Health Campus, Universiti Sains Malaysia
16150, Kubang Kerian, Kelantan, Malaysia
Correspondence to: Daddy Suradi Halim
(e-mail: daddy@kb.usm.my)

C 2014 Japan Health Sciences University

& Japan International Cultural Exchange Foundation
320
Table 1. The group received VCO
Subjects Pain score Ulcer size (mm2)
Day 1 Day 5 Day 1 Day 5
1 5 0 4.15 0.00
2 5 0 15.90 2.54
3 2 0 13.85 0.28
4 8 0 13.20 0.00
5 2 0 9.62 0.00
6 1 0 1.33 0.64
7 5 2 13.20 3.80
8 5 0 2.83 1.33
9 6 1 22.05 13.85
10 2 0 2.27 0.00
Mean 4.1 0.3 9.8384 2.24
Std. 2.234 0.675 6.95737 4.27
Deviation
Table 3. Comparison of ulcer size difference and
pain score difference between virgin coco-
nut oil and triamcinolone.
Group 1: the group received VCO and Group 2: the
other group received triamcinolone acetonide (0.1%).
Variable Ulcer size Pain score
Group 1 Group 2 Group 1 Group 2
Mean 79.5625 69.1936 3.8 2.3
SD 24.36903 26.33475 2.150 1.418
P-value 0.373 0.082
- Under systemic or topical corticosteroid therapy
- Pregnant women or lactating mothers
Ethical approval was obtained from the Research and Ethics
Comittee, Universiti Sains Malaysia on June 2012.
The 20 subjects were divided equally into two groups and had been
given different medication for the RAS. Subjects for group 1 were been
given VCO, while the group 2 received the triamcinolone. The tools
used in this research were the pain score and the size of the ulcer. The
Visual Analogue Score (VAS) was been used to assess the pain score
and the ulcer size was been measured by sliding caliper. Both ulcer size
and pain score were being taken on the day 1. The subjects were been
instructed to apply the medicament for five minutes, twice a day for five
consecutive days. On the day 5, the ulcer size and the pain score had
been assessed again. The collected data were analyzed by SPSS version
20.0.0. The data were analyzed using independent t test to compare the
mean between two groups. P < 0.05 indicate significant differences
between two groups.
RESULTS
Pain score and ulcer size difference between day 1 and day 5 (Table
1 and 2) were analyzed using independent t test. Based on the result in
table, both variables have P > 0.05 indicate there are no significant dif-
ference between virgin coconut oil and triamcinolone for treatment of
RAS (Table 3).
Even though the difference is not significant, the VCO has greater
value of mean for ulcer size, indicate that VCO is better in reducing the
size of the ulcer compare to triamcinolone. As well as, for pain score,
VCO found to be better medicament for relieving the pain of the ulcer
compared to triamcinolone.
DISCUSSION
In this study, results speculate, VCO can be an alternative medica-
ment for the treatment of RAS. It revealed that the VCO helps in reduc-
ing the ulcer size and pain of the ulcer. Other studies suggest that VCO
healed wound much faster. Three identified mechanism behind these
effects are its ability to accelerate re-epitheliazation, improved antioxi-
dant enzymes activities and stimulate higher collagen cross-linking
within the tissue being repaired (Nevin and Rajamohan, 2010). An ani-
mal study, in acute inflammatory models VCO shows moderate anti-in-
The author has requested enhancement of the downloaded file. All in-text references underlined in blue are linked to publications on ResearchGate.
Halim D. S. et al.
Table 2. The group received Triamcinolone
acetonate (0.1%)
Subjects Pain score Ulcer size (mm2)
Day 1 Day 5 Day 1 Day 5
11 5 1 12.56 3.46
12 3 2 1.54 1.13
13 2 0 1.54 0.63
14 6 3 20.42 4.90
15 2 2 10.75 0.50
16 5 1 7.34 3.52
17 3 1 0.95 0.64
18 2 1 2.27 0.50
19 4 0 2.01 0.00
20 2 0 2.27 0.00
Mean 3.4 1.1 6.1638 1.52
Std. 1.506 0.994 6.53237 1.75
Deviation
flammatory effects on ethyl-phenylpropiolate induced ear edema in rats,
and carregeenin and arachidonic-acid induced paw edema. VCO exhib-
ited an inhibitory effect on chronic inflammation by reducing transuda-
tive weight, granuloma formation, and serum alkaline phosphatase
activity. VCO also showed moderate analgesic effects on acetic acid-in-
duced writhing response. All of these suggest that VCO has anti-inflam-
matory and analgesics properties (Intahphuak et. al, 2007).
Another study showed that since its first appearance, VCO has
gained wide attraction among the public and scientific community as
functional food oil. From the health point of view, VCO is beneficial in
clinical trials such as having more antioxidant potential compared to
refine coconut oil. A number of studies confirmed the higher content of
phenolic contents, which correlated with higher antioxidant activity in
VCO, compared with refined coconut oil. Investigators in developing
methods for detection of adulteration in VCO also addressed attention.
The overall knowledge improvement allowed the identification of suit-
able new techniques to better differentiate VCO from other vegetable
oils, especially from refined coconut oil. Further studies are necessary
to establish effective purity criteria for VCO (Marina et. al, 2009).
CONCLUSION
VCO helps in reducing the ulcer size and pain of the ulcer.VCO can
be an alternative medicament for the treatment of RAS.
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